Unlocking the Potential of Ketamine Therapy with Dr. Jeffrey Becker

by Daniel Schmachtenberger , February 1, 2018

Unlocking the Potential of Ketamine Therapy with Dr. Jeffrey Becker

Dr. Jeffrey Becker joins Daniel on Collective Insights to discuss the use of ketamine as part of the growing movement of integrative medicine. Dr. Becker talks about some of the latest research and clinical evidence done regarding ketamine therapy and relates some of the case studies he’s seen at his own clinic involving patients who have benefited from the treatment. He goes into detail on how ketamine is used to treat depression, getting to the heart of the causes people encounter and deconstructing perceptions patients have about the world and their role within it.

Dr. Becker also discusses what makes for a good practitioner of psychotherapy and the importance of having a guide with experience and maturity. He also talks about the full arsenal of tools medical professionals should use when treating medical conditions and stresses the need for all these tools to work in tandem to help a person. He gives examples of how he uses these tools in his own practice. Dr. Becker gives his valuable perspective as he explores the intersection of physiology, psychiatry, and psycho-spiritual understanding.

In This Episode We Discussed:

The latest research on ketamine therapy
What patients experience during ketamine therapy
The physiological benefits of ketamine
Effective ketamine treatments
The Importance of educating oneself before seeking help
Tools used in integrative medicine
Transforming medicine to treat more complex conditions

Show Notes:

0:00 Intro
2:48 How Dr. Becker uses ketamine therapy and the changes he sees in his patients
10:15 Why it’s important to embrace the psychological elements of ketamine therapy
13:16 Case study of a woman who was not just depressed but in despair
19:07 The duality found within each person
22:35 The physiologic mechanisms involved in ketamine therapy
26:15 The first person ketamine experience
29:50 The deep relationship between practitioner and patient
42:12 Good books to start with in this area
45:50 Transformation through fragmentation
48:35 Physiological benefits of ketamine therapy
53:14 The different tools integrative medicine uses
1:01:43 The methodology for integrating tools for patient treatment
1:08:56 Frustrations with methods of modern medicine
1:12:17 Good resources for finding integrative practitioners
1:16:12 The future of integrative medicine

Bio:

Jeffrey Becker, MD trained at UCLA/NPI in both Medicine and Psychiatry with a focus on Neuropsychiatry and Functional Medicine. He is board-certified by the American Board of Psychiatry and Neurology as well as the American Board for Integrative and Holistic Medicine. He maintains clinical offices in Santa Barbara and Westwood and is affiliated with UCLA/NPI as Volunteer Clinical Faculty. The practice is non-insurance based, though patients are provided with receipts for reimbursement.

Dr. Becker is known for his focus on whole health integration, combining conventional medicine with research-supported nutrients and complementary treatment. Treatment is frequently designed to support the HPA-Axis, raise cellular energy stores, restore healthy digestion and flora, and support the body’s endogenous antioxidant system. The goal of Functional Medicine is to understand and treat maladaptive interactions across multiple physiologic systems simultaneously. Treatment should be designed to help restore natural physiology and correct congenital metabolic deficits or weakness. At all times when possible treatment and medications are designed to treat first principles and health leverage points with lowest-risk medications and natural treatment options.

Mentioned in This Episode:

Full Transcript:

Daniel: Welcome everyone, back to the Neurohacker Collective podcast, Collective Insights. My name is Daniel. We are here with Dr. Jeffrey Becker today. Jeffrey is a medical doctor psychiatrist who has been focused in integrative and functional psychiatry for longer than most people in the field, which [00:01:00] means that he uses psychiatric medicines as one part of an integrative process where they are the best tools, typically with deeper insights as to the underlying mechanisms that are involved based on deeper testing rather than just kind of, "Here are some protocols for the day." But that is one of many processes along with looking at people's nutrition, their genetics, their microbiome, their overall health, [00:01:30] deeper functional testing, and then also integrating that with psychological practice. Jeffrey's a pioneer in the field of integrative psychiatry, which is right at the center of the space that we care about at Neurohacker Collective. And so, Jeffrey, it's an honor to have you here today, and thank you for coming.

Jeffrey Becker: Thank you, man. Thank you for inviting me. It's been fun working with you so I'm looking forward to it.

Daniel: The place I would like to dive in [00:02:00] is ketamine therapy. You've been doing ketamine assisted psychotherapy for 13 years, I think, which is longer than almost anyone I know who's been working in the field. We can get into other areas of psychotherapeutics and functional psychiatry as it comes up, but this is such a possibly powerful tool for so many people, and has [00:02:30] just kind of come into more popular understanding very recently. I'd love to know, just overview for the listeners who aren't familiar, what is ketamine? When did you start realizing that it had psychotherapeutic possibilities? What types of things can it be helpful for? Introduction.

Jeffrey Becker: I've been using ketamine in clinical practice for about 13 years. I became interested in it when I was in medical school [00:03:00] actually. I studied mysticism in undergrad. I was a religious studies minor with focus in mysticism. What I ran into was really very interesting descriptions of what ketamine did psychologically, and it also had some people like [William James 00:03:19] describing nitric oxide and what that did psychologically. I really saw a lot of similarities between some of what the mystics would describe and what [00:03:30] people were describing when they used dissociative anesthetics or NMDA receptor antagonists basically. So I got deeper into trying to map the similarities across these two fields and then got deep into the neurology as a result of that. I worked with Huston Smith at the time and a couple of other doctors and advisors at UCLA, and ended up developing a comfort with how ketamine works, [00:04:00] with the potential that it might bring as far as healing psychological holes, spiritual, and it's turning out, I didn't notice at the time but even physical molecular healing, and started using it.

I went out and started a practice. I spoke with a number of anesthesiologists and became comfortable with an approach, a protocol for using this kind of stuff, anesthetic dosing with kind of [00:04:30] a twilight anesthesia. There is some analgesia at least, there's a lot of pain relief in the ketamine treatment that can be nice with some patients. It's a low enough dose so you don't have to have a lot of the surgical protocols in place in order to use it. What I've found over the years is that it can be profoundly, profoundly effective for patients, and the research is now in the last 10 years, [00:05:00] I think ... I can't remember when the first paper came out, but we've got about 10 years of literature now and it's really exploding. It's [inaudible 00:05:10] here for a ... It's taking off, the number of papers that are coming out.

As far as my news, what I have found most interesting is not just the immediate relief of [00:05:30] depression, which is profound and wonderful, but what can be disappointing is that that sometimes fades in people. What I have been focused on and interested in more is how to create lasting change through the consciousness changes that ketamine can bring. So a lot of focus now on the symbolism and the inner truths that come out. It's a little bit akin to what might [00:06:00] call psychedelic therapy. I think it's a bit different in that it's not as easy necessarily to take and apply the information people get from a ketamine experience. It's a bit more noetic and a bit more ephemeral. It kind of fades and I find that people need tools and they need, in a lot of times, to kind of study it ahead of time and study afterwards some of the phenomena [00:06:30] that are occurring so that they can place it properly, kind of create a new paradigm for themselves.

Daniel: Okay. Just to make sure that the basics are clear for most people. Ketamine is an anesthetic, which primarily developed as an anesthetic, and it is used as a recreational drug in lower doses than anesthetic as a dissociative, relaxing, et cetera. And the psychotherapeutic properties [00:07:00] were discovered after its anesthetic use, and most notably have been used for treatment-resistant major depressive disorder and bipolar disorder, and typically it goes ... give someone the drug, no psychotherapy, no noetic insights, one to two weeks of relief from depression. So that's obviously from a just straight up physiologic process, there is some kind of neurochemistry that is having some effect. But if you want it [00:07:30] to last longer, what you're exploring is, is it just that it's changing biochemistry, or is it changing biochemistry in a way that changes perception, meaning making, identity, some aspects of computational rather than just chemical neuroscience, where if the person becomes aware of it and applies it, it can be part of the psychotherapeutic process.

Jeffrey Becker: Yeah, that's been an interesting aspect of the debate, is that a lot of the [00:08:00] literature will describe the psychological effects as a side effect; it just needs to be managed, that it's a negative side effect, it's something bad that we wish we could get rid of. Rather than using it to create leverage, they see it as something that you should treat away, and in fact a lot of the centers will actually actively give agents that will reduce the psychological effect. No judgment there. Some people, it's actually a bit much. They're not necessarily [00:08:30] up for the level of information that the ketamine might bring, and the psychological changes might be too scary for some individuals, but we are starting to find that if you treat away the psychological effects, it actually probably looks like the effects of ketamine are not as strong, that it's not as antidepressant.

On a molecular level, we definitely see changes, increases in brain-derived neurotrophic factor. There's new synaptic connections. There seems to be kind of [00:09:00] a release in the frontal lobe and you see a lot of activity in the frontal lobe and [inaudible 00:09:07] it during active treatment and afterward, you see changes that look a lot like learning and kind of new potentials, new potentialities in terms of brain function. It's really exciting that it's happening both at a body or a chemical level, at a mind level, and for a lot of people at a [00:09:30] spiritual level, to get an integration of body, mind, and spirit with a single treatment. It's not often we get that in psychiatry so it's fun.

Daniel: The way you're describing it sounds exactly like the way I think about most categories of psychedelic-assisted psychotherapy. Even though psychedelic is so broad a category, it's almost meaningless in terms of the types of psychological and physiologic effects, and so ketamine as a dissociative is only in the broadest definition related to that category. [00:10:00] But if what we're saying is, using some kind of neurochemistry to create a state induction, and that state induction provides different types of insights, and that those insights, if they are really brought to the surface, catalyzed, integrated, can be the basis for lasting psychological change. And so this is kind chemical for psychological insight as opposed to just trying to [inaudible 00:10:27] a change of chemical state.

Jeffrey Becker: [00:10:30] Absolutely.

Daniel: Now, when you say some people try and treat away the psychological components, so we can easily imagine that if someone's dissociated and they start coming back, that there's questions around identity, questions around what's real, deep existential types of things that come up, and if you don't know how to approach that, someone can get freaked out. But if you do know how to approach it, you can actually do really deep existential [00:11:00] psychology with someone and help them get better ontology of self and universe. Is that kind of what you're doing with people?

Jeffrey Becker: Yeah. I think that the power with this approach, it really folds out in two different ways. One is that the patient themselves become both prepared to receive information and are not as scared when it arrives, and look forward to and [00:11:30] see as a process, incorporating that into their lives and into their decisions. Sometimes again, I mean, I can tell ... I probably would be smart to give you a couple of case reports just quickly to illustrate the point. What I find is true is also that this is helpful to the clinician.

I have a busy practice in LA and sometimes I cannot get enough time to actually give a treatment myself, and [00:12:00] I have a couple of people that I trust out there that do a good job with patients. It's been a couple of times where a patient has come out and they've had a fairly deep realization about something and there's a bit of a mourning quality, a sense of loss of like "Wow, I didn't know that I had given up that power, or given up that aspect of myself, or forgotten that aspect of myself." And the tears that they shed when they come out scare the clinician, and the clinician [00:12:30] in a couple of instances [inaudible 00:12:32] next treatment would give the patient, without really explaining to them, something to kind of dampen the effect of the ketamine.

I had explained to my patient that you've scared them. You've scared them. You need to reassure them that it's okay and that you actually got something from that and that you don't need to make it go away, or that it's okay. And that's been interesting to hear that the patients kind [00:13:00] of also become part of the process and the clinicians, I would imagine, probably enjoy that. It's not fun to kind of ... I don't personally like the paternalistic ... that relationship. I think it creates a lot of discomfort for both parties.

Daniel: I would love to hear some case studies.

Jeffrey Becker: I think I had a really interesting one that is ... I think it's kind of a perfect [00:13:30] case study. I was working with a woman for years and she was what you would say is chronically depressed but what I would say actually, if you look at it more on a spiritual level, she was in despair. It was a loss in meaning, a loss of a sense of purpose, a sense of adventure in life, an agency, kind of [00:14:00] an authentic integration that [inaudible 00:14:04] out.

What was interesting was that she was very aware of death. Even as a child, she said that she would see death in life all the time, they were always intertwined, and as she got older and became an adult, she would find herself repeatedly at people's bedside when they were dying. Other family members, [00:14:30] sometimes the direct family members, sometimes she was only a friend, they somehow find a way to get out of the room when the person was about to die, and somehow she'd be the one that would be there and she could handle it. She would be [inaudible 00:14:42] as it happened. I could see this in her, this was an unrealized latent gift, that she didn't quite know what she was, and we were kind of working through it, but there wasn't ... And she got it, but it wasn't something that had a mandate [00:15:00] behind it. This insight did not have a kind of power that could change her life. Well, eventually she opted and tried ketamine.

In the first session, she came out and she actually was just kind of radiant and she said it was the first time ... She felt like she was cradled by God for the first time in her life, for an hour that felt like an eternity in the moment. That was [00:15:30] wonderful obviously. The next session, she came out and she was overwhelmed and actually it took a while for her to come out. She started to cry and it took a while to come out of that, and we talked a little bit about what was going on and she said, "I'm okay. I just didn't know what I was." And when she said, "What I was ..." It really was about her being. It wasn't about [00:16:00] what she thinks or what she knows or what she believes, or this is that, it's much more about what she is at a primary level of being. In the third session, she came out and she basically made sense out of it, and I think it's like a perfect trip hit. She came out of this third session and she said, "I should've been a nurse."

This is a woman who was in her early 50s [00:16:30] and no science background, and she found this information, this insight, this experience that her true being was so powerful that she went back to City College and did science core and ended up going and becoming a nurse on a full scholarship at a major university. They were so amazed by her that they just said, "Please come and we'll pay for you," and she's ended up in nurse leadership and she's out and [00:17:00] when I see her now, it's really powerful. What's interesting to me is that she's still sad, but there's no problem with meaning anymore. Her life is deeply meaningful and that's the difference. One could look at her and say, "Well, she's still depressed." She's not depressed. She's aware of death at a level that she will never escape [00:17:30] and now she's doing something with it. It's mythic, it's powerfully mythic work that happened in three treatments, a total of three hours. That's a very extreme and a very clean ... I like how clean that case report is, that you see these kinds of stories when you work in this field. It's really powerful.

Daniel: I [00:18:00] think the distinction that you make you here is actually a really interesting one, which is there's a restoration of meaning for her without removing sadness, because sadness can sometimes be just the appropriate emotional response to reality ...

Jeffrey Becker: Yes.

Daniel: ... [inaudible 00:18:16], and if she's focusing on those things that can be there, but there can be a certain kind of love, joy, fullness along with the sadness, if there is a framework for it. So this is very much [00:18:30] like an existential psychotherapy tool in this case. I've heard a lot of people describe that the process of experiencing something that was akin to parts of what they thought death might be like, and experiencing kind of the rebooting of layers of self that started to come as they were kind of turned off and came back online and they could see them, actually helped them [00:19:00] address fears of death they had. Was that something that you found as common capability?

Jeffrey Becker: Absolutely. So the paradigm that I use when I'm working with patients is Jungian, and that basically we are made up ... the duality. We have our ego, which is a smaller aspect of our wholeness, that is in many ways kind of based in fear, [00:19:30] in striving, in predictive anxiety and trying to get things done. We need this part of ourselves to pay the rent and hunt for nuts and berries and compete in a competitive world and do things that we don't want to do, sometimes, so that we can be safe. It's not always a safe world so we need this badly and yet it's also very alienating. It's very alienating from a much, much richer core, [00:20:00] which would be ... You might call it the 'unconscious' if you're talking more of a Freudian ... but it's the self in the Jungian paradigm.

So you have the deep self, which is a rich ... It's a richness from which what we are comes, and then we have the ego, which is a diminished subset of that wholeness that can become alienated from the original whole. What I [00:20:30] strongly believe is that ketamine is kind of an ego solvent. It kind of dissolves the ego. The pyramidal cells in the brain, they're heavily controlled by a GABAergic interneuron net, basket cells, chandelier cells, these cells that control the pyramidal cells, sometimes actually with an axon, around the axon, inhibitory around the pyramid cell. They're called the axo-axonic cells or chandelier cells.

[00:21:00] That this over restrictive inhibitory tone, once it's lifted, people experience what they are, and then as the ketamine leaves, they start to see the programming come back on. They start to remember, "Oh yes, I'm a father, a mother. Oh yes, I'm a doctor." If you go far enough, it'll probably be, "Oh yes, I'm a human." That might be the starting point. It is fascinating to [00:21:30] see those programs come back on board. I will point that out to people as well. What and realize how many of these premises are negotiable, that maybe they're not useful anymore. Some of the premises about how you see yourself might be something that we can work through and let go of, that might be old programming.

Daniel: Okay. I'm curious regarding the neuro-physiological mechanisms at action. We were just talking about inhibiting [00:22:00] the inhibitory neural cells and neural networks. I usually think of ketamine largely as a NMDA antagonist, specifically glutamatergic more than acetylcholinergic antagonist. The cells that you're mentioning, the chandelier cells, basket cells, are primarily GABAergic networks. Obviously there's a glutamate GABA interaction. Can you speak [00:22:30] a little bit to what we currently understand regarding the physiologic mechanisms of action? I heard you saying something around inhibiting the inhibitory processes so that something is kind of freed up so that there's some type of pyramidal cell activity that gets to increase. I'm curious to just hear you talk on that.

Jeffrey Becker: For most people, to take a step back. So, [00:23:00] vast majority of what we would call 'thinking' is simply at the simplest level, it's pyramidal cell excitation and pyramid cells talking to each other, and interrelations and nets of relationships that are linking to deeper structures, to emotional structures, to physiology, to high cognition, and kind of linking up [00:23:30] a lot of different ideas to become a whole experience. These pyramid cells are excitatory in their basic nature, and there does need to be a controlling process over them and this controlling process is generally considered at the simplest level. There's a lot of complexity to this of course, there always is, but at the simplest level, we will sometimes call it a GABAergic interneuron net.

What we mean by that, it's GABAergic, [00:24:00] GABA, G-A-B-A, it's gamma-aminobutyric acid, and that is the amino acid neurotransmitter that is inhibitory. GABAergic receptors will flux chloride and will make it more difficult for a neuron to fire, so when a GABAergic neuron kind of talks to a neuron, what it's [inaudible 00:24:25], "Hey, quiet now." GABAergic interneurons, as we say, it's an interneuron net in the [00:24:30] sense that they are all over the place and it's a net, not a trap. So, when we have neurons that start in one location and [inaudible 00:24:40] back to another location, that's kind of different than this. This is more of a whole interwoven fabric. These neurons talk to each other as if to say, "Hey, I'm turning off that thought. Are you turning off that thought?" "Yeah, I'm going to turn it off. Are you going to turn it off?" They all are kind of sampling what each other [00:25:00] is doing, and a lot of what they're doing, again, is inhibiting certain thoughts, certain patterns, certain ways of thinking.

What's an odd bit of logic here is that if you think about what it might be if you were to lift that off, that's what I would say you could say that you are. I don't know what we are other than just the gestalt of experience, [00:25:30] right? What is kind of interesting is at a logical level, if you have this inhibitory net that takes what you are and makes it smaller than that, then in some ways if that's the ego, if what's left over is the ego, then the ego could be seen as what you're "not not". Most of the time we don't use double negatives in playing with [inaudible 00:25:55] logic, it can be very specific and appropriate obviously. So I think the ego [00:26:00] is what we are "not not" in the process of this inhibitory tone and the self is what we are, and ketamine allows us to stop being what we're "not not" by inhibiting the inhibitors and allowing them to be released from constraint.

Daniel: Now the first person experience of that is obviously going to vary from person to person, from session to session, and based on dosage, but typically the first person experience of that, [00:26:30] how would you describe it?

Jeffrey Becker: I think what is interesting is that the very beginnings of ketamine experiences are often described as feeling like one's had a drink. What's interesting is that alcohol does have NMDA receptor antagonism in it, so there is something familiar about it for people. But what ends up happening with the real treatment is [00:27:00] that it goes a lot deeper and it's kind of like a, "Oh," and a kind of releasing of layers and layers of basic premise programming, and there is an experience that is kind of non-verbal.

I, again, have [inaudible 00:27:24] onto Jung to understand what the space it because he described it so well. What people [00:27:30] are really interacting with in the ketamine space are archetypes. It's a symbolic world in an archetypal space, consciousness, and as such it's really not a language based space, and if people try to speak too much, it will very, very quickly diminish what they're experiencing. The meaning will kind of wisp away and become difficult to hold onto. It's hard enough to grasp anyway. And that's [00:28:00] a wonderful thing to work with with people. It's to open them up to the idea of what archetypes are as a different way of understanding what knowledge is, maybe even knowledge with a [inaudible 00:28:13].

Daniel: One of the things I've heard people describe often in the first person experience when they were specifically treating for depression was that [00:28:30] the usual experience of the world as themselves they have, the narrative they're running, is all gone. And yet there was not nothing. There was consciousness that was aware of something, and then as they started to come out of the experience, because oftentimes the height of the experience is so different than normal consciousness that you can only remember a fragment of it, like dreams. But as one starts to come out in normal consciousness, it's booting. [00:29:00] It boots in layers and so it's kind of like they notice language booting again, and they noticed the coordination of perception, and then perception and motor capacities, so they start getting agency. And the world, before they get their normal narrative itself, which is why bad shit is always happening to them, why nobody loves them, why they're not ... not enough, whatever, but that shit boots later. And so there's a while where they're experiencing the world [00:29:30] and able to act in the world without that normal dysfunctional narrative self layer that they've had, and they get to realize that in that time they're not depressed. And then when that narrative layer starts to boot again, the depression kicks back on and ...

Jeffrey Becker: Totally.

Daniel: ... then they have a reference frame from being without it, which they might've never had before. They're going to be, "Oh, I'm actually depressed because of a pattern of perception in meaning making," and they're saying that. So then they have to go and do deeper CBT [00:30:00] or DBT, whatever other processes to change that, but it gave them a reference frame experientially that they could map.

Jeffrey Becker: Absolutely. Yeah, I think there's a lot of power in receiving a map, and they actually have gotten a chance to look at where you want to get to before it ... just kind of shooting for something you don't know where it is yet, I mean, how do you find your way. That is a very powerful experience for people and that, what you're getting at, [00:30:30] it's why I actually will ... When I'm working with people I'll explain that doses that get someone just into the transpersonal space and not so far out can be actually more useful psychotherapeutically because of that type of work, of being able to experience themselves with maybe one foot still on the earth, can act as a bridge. If people go [00:31:00] too far, sometimes they're actually confused enough when they're coming back in, that that's not useful and it's not actually that stuff comes on at such baseline layers that they don't actually get to make sense out of it until they're almost out of it completely. It's interesting.

There's a lot now about what's the best dose and all that. I think some of it is a little bit ... [00:31:30] Western medicine tends to want to nail stuff down a little bit too tight sometimes. This is such a powerful tool. I don't know that it's going to be so simple, but I think there is something, different people kind of need different experiences. But that being said, there are practitioners out there that really believe in strong doses, powerful, powerful dissociative effect and trying to basically create a deep religious experience [00:32:00] for the patient and help them experience that, but that's actually where the healing is. And I do too. I just don't know that it needs to be quite as aggressive as some of what's going around there.

Daniel: I don't personally have quite as much experience with the dissociatives like ketamine. I have a lot of experience, myself and other people, with [5MEODMT 00:32:25] and with the whole range of traditional kinds of psychedelic- [00:32:30] assisted psychotherapy, LSD, MDMA, mushrooms [inaudible 00:32:34] et cetera. And they're all meaningfully different. They all have a meaningfully different set of general benefits, indications, but they all kind of share the process of disrupting normal perception and identity, and then giving someone a reference frame of a different possibility, and getting to [00:33:00] recognize how much someone isn't experiencing reality but is experiencing a perceptually narratized ... a distorted version of reality. And then they get to recognize that they actually have the power to change those perceptual frameworks. That seems to be one of the things that's kind of common to all of the state altering psychotherapeutic processes.

Jeffrey Becker: Yeah, which is really, if you think about what that means, it's a teacher, which is [00:33:30] wonderful that you can actually receive instruction like that. Some teachers tell us stuff we don't want to hear but ...

Daniel: It's funny because you were talking about having worked with this lady for a while and in three sessions what she's done. I have a friend recently had their first Ayahuasca ceremony and she said, "A bunch of shit that you've been saying to me for four years made sense of the first time." It kind of cognitively made sense but couldn't cross the chasm of having any experiential [00:34:00] reference where the idea grounded, and it grounded and then it automatically became meaningful in a way that it wasn't before. That's one of the things I think is most special about it, is someone hearing that their perceptual meaning making framework is what creates their emotional reaction is very different than actually not having that emotional reaction of that framework. It's tasting the strawberry versus having some idea about the chemistry of the strawberry [inaudible 00:34:28].

Jeffrey Becker: Yeah, I've heard that one. Heard that one. [00:34:30] That's why, really, I always point ... Some people will ask me, they'll say, "What would you recommend that I do? I'm thinking about taking mushrooms with a friend," or you know. And beyond kind of the basics of safety instead of setting and just making sure that you trust who you're with, I often will tell people, "Just get the weird stuff out in the open at a time. [00:35:00] Don't have there be something unsaid that needs to be said." Those are just good clean psychic practices, but at a minimum just say, "Read, read, read." There's some wonderful minds from the secular-humanist kind of American ... amazing American era that produced some of the most amazing writing that you'll probably ever see. [00:35:30] I think that that can be a great if you're going to go on ... You're going to go to Europe, you get a guidebook, and you read the best guidebook you can find if you're smart.

Daniel: Now, you're mostly referencing [Graf 00:35:44] and Huxley and [Shogun 00:35:47] and these folks?

Jeffrey Becker: Yeah, and Huston Smith and definitely appreciate those guys a lot and really, really [inaudible 00:35:58] special people.

Daniel: Okay. [00:36:00] I'm curious to just do a little more on ketamine therapy and then we'll expand it. One part on the psychedelic-assisted psychotherapy. Experiencing the chemical and knowing how to actually interpret the experience afterwards are totally different things, which is why certain settings and facilitation makes so much difference. [00:36:30] If someone takes a psychedelic and they see things that look like demons and they're told that that's because in the astral plane demons are after them, then they're scared and they need crystals and metaphysical tools and whatever. If they're told that's a symbolic representation of stuff they're afraid of, like maybe their dad from childhood, and they go face it and the demon turns into dad, then turns into dads in their child and [00:37:00] they recognize the legacy of trauma and whatever.

The meaning making of what the symbolism is determines pretty much everything, right? Like in terms of what they're going to lastingly encode. The experience itself is much less important than what they'll harvest from it, which is why giving the right facilitation is such a big deal. So I don't generally just recommend people to go, "Yeah, go experiment with ketamine on own, experience with psychedelics like ..." It's important to actually know that you're getting facilitation for how to interpret the experience as well. Do you want to say anything about [00:37:30] that?

Jeffrey Becker: I think you said something very, very important here. I think that this whole arena is ... It's so powerful that it's not a surprise that there are niches and nooks and crannies that people can live in that maybe shouldn't really be given power in the space. I hear stories that make me sad sometimes [00:38:00] about people being taken advantage of and I think that the capacity for people to fall prey to the guru trip on both sides, either wanting to be a guru or wanting a guru to turn to, I think we need to be careful. Anybody always needs to be very careful about it. It's a very [00:38:30] dangerous model. I think it can be okay but it's sometimes not. I don't really have any perfect rules on how to sort it out because I think humans are complex and so ...

Yeah, it's a wild west out there. It's hard to know how to guide someone towards the right [00:39:00] fit for them, but I think maturity in the guide is of the utmost ... it's very, very important, and I think if you look at their life and you don't see the signs of maturity, I think you need to be very careful because it's what people do and not what they say, really, that one should turn to if you're looking for data about that.

Daniel: [00:39:30] You implied something that's actually a really tricky thing to look for, which is when you talk about the practitioners who want to actually treat away the psychotherapeutic process and take it as a purely chemical effect and say like, "No, no. Please don't have excess in drink or eat ..." That ends up not being good. And the ones who don't actually probably understand neuroscience well or at all, and maybe even don't understand what modern [00:40:00] psychology has started to piece together around the way the psyche and the nervous system interact, and they end up getting under regressive weird metaphysics. And so you've got on one hand, you've got people who are looking at something that could be called an existential or spiritual level but usually pre-scientific, pre-rational, good bunch of weird ideas, the guru trip thing, and then you have people who are looking at it from a scientific but then also [00:40:30] reductionist, existential [inaudible 00:40:32] when you measure the two options and they both suck.

Jeffrey Becker: I know.

Daniel: So there is another option that says how do we actually understand the nature of existence, existentialism itself, in a way that is also not irrational and it is congruent to what we understand about science theory, et cetera. Someone has to do both of those to do a good job in this space.

Jeffrey Becker: [00:41:00] It's exactly where I was coming from about why I love those secular humanists because they were deeply heart-based. They were deeply mature, most of them, and they were so smart. When you put those together, and you've got a good guide or teacher most of the time. I think those are a pretty good starting point at least. I have to say I have turned much more to people [00:41:30] that no longer are alive and just spread what they had to say for my own guidance in my life than I have actually found in individuals. Again, I worked with Huston Smith for years so I was very lucky there, but I'm minded that way. I can get so much from reading, but I think a lot of that literature has been forgotten, it's really ... I'm surprised at how much [00:42:00] people are just turning to derivative sources now, stuff that's being rehashed in a very, very diminished form in my opinion.

Daniel: For listeners who are interested in some kind of psycho-spiritual explorations [inaudible 00:42:20] to be well-grounded with what neuropsych knows. What are some of the books you might recommend as good starting places?

Jeffrey Becker: [00:42:30] If one wanted to dive into this duality model in a way, in a book that was ... When it was written, it was considered a lay book. I find that a lot of people are surprised that that was a lay book 30, 40 years ago, but Ego and Archetype by Edward Edinger is just astounding how good it is, how deep and how accessible. [00:43:00] I just feel so grateful for that man. I am amazed at his ability to translate Jung into understandable terms and, again, to really ground it in experience and symbolism of human beings over time in multiple different cultures and [inaudible 00:43:18], and to bring you over and over again to an understanding of this kind of loss and then recapture of [00:43:30] what is lost through kind of moving through a liminal state.

So adolescence is kind of associated with this aching, painful becoming, which can feel very constricted and very uncomfortable, and then if we stay in the game and if we stay conscious and we stay brave, we will often find in our often late 20s or early 30s that there's a kind [00:44:00] of a reawakening to one's own original untarnished self, or the child or ... We have a lot of models for this. Some people don't find that again and actually a lot of people don't realize they've lost something. They forget that they've lost something and that's a different form of despair. It's a little different than what I was describing [00:44:30] in that case report, but I think there are lots and lots of people that are in that state that don't quite realize why there's things aren't shiny anymore, and that this "Is this it?" kind of thing. Finding that process within yourself and identifying it within your own life so that that [00:45:00] symbolism can get laid upon your own personal version of that universal story, I think Ego and Archetype is extremely powerful.

I think Huston Smith's book, the Forgotten Truth, is very special. If one wanted to dive deeper into mysticism per se, which is a very specific interdisciplinary study in religious studies obviously, but Stace's [00:45:30] book Mysticism and Philosophy, or [Hupold 00:45:34] has a book called Mysticism as well, that can be found ... I think one of them is out of print but they're both quite special in terms of being accessible. Those are my desert island books.

Daniel: Good. Thank you for sharing those. We'll put them in the show notes for people. [00:46:00] In addition to people being able to notice their ego structures as they reboot their perceptual meaning making frameworks, one of the things you're mentioning that I think is one of the key aspects of ketamine therapy for many people is this kind of reintegration of parts that were fragmented.

Jeffrey Becker: Mm-hmm (affirmative).

Daniel: And so whether it was sexual traumas or parts of sexuality turned off, or whether it was betrayals [00:46:30] or parts the capacity for trust or attachment turned off or things like that, whether it was wrongful punishments of parts of like curiosity and innocence turned off, there is definitely a disintegration fragmentation of self and dampening of total aliveness that happens from those unresolved traumas. So one of the things you're describing is that people, when [00:47:00] they're doing ketamine, oftentimes recognize that even if they didn't know that was happening.

Jeffrey Becker: Absolutely. What's been so ... I don't know what the word, it's fun. I mean it's just that the confirmational experience of watching patients over and over again come up with these deep principles and say them in the room and it had to be as if it's ... you can find the same principles [00:47:30] in writings from Teresa of Avila or Eckhart or ... This idea of fragmentation and kind of collecting one's power back into one place so that they can become themselves, it's this kind of mythic transformation. To see them getting that on that level, it's just a lot of fun to watch. It's special. I feel very lucky [00:48:00] when those moments happen, and if you go to ...

In Kabbalah, the idea that God's life is so powerful that it kind of broke the lenses when it came in, that we were supposed to be able to focus the light out into the world and we have to go and collect the shards and put it together to bring order, and then that is what we're here to do. It's not that that's an accident. That's what it is to be here. [00:48:30] So all of a sudden, it's exciting instead of just woundedness for woundedness' sake, it becomes that's the source of meaning that we need to make sense out of in our lives as we move through. That's our story.

Daniel: All right. Well, we could go down a very deep hole of existential meaning making and its relationship to woundedness, and that would be a fun [00:49:00] place to go, but I am curious to get back to ... With ketamine, if we're just looking at the physiologic benefits independent of the insights, and of course in a way that even talking about physiology, psychology, is a less clear distinction than is real, because when we talk about psychology [00:49:30] from a neuroscience point of view, we're talking about computational neuroscience, which is changing neural network algorithm patterns, which are of course related to ... but at a deeper level of process than the type of neurochemistry of what's happening inside the synapsis. But as we just looked at the physiologic effect, no psychotherapy happening, there is interesting phenomena like BDNF upregulation and [00:50:00] neuroplasticity type chemistry that is going to have some effect on brain structure, neural structure independent of anything else.

Jeffrey Becker: There are definitely groups that are doing great work on this. They're showing increases in, again, synaptic strength, kind of new synaptic growth. They're showing new relationships in areas of the brain that kind of turn on. [00:50:30] My tendency is definitely more on the mind and archetypal spiritual kind of arena in terms of understanding it, but one thing you see very much in the body when people become not depressed for whatever reason, it's actually not just ketamine. You see this ... It's kind of astounding to watch how much some kind of somatic [00:51:00] distress disappears and how there become kind of liberated energies that can be channeled in lots of different ways.

You could see people's ... their posture changes and their facial expression changes. They move more quickly and they get up more quickly, and there's life in their body as well as in their mind, and you definitely ... it's kind of powerfully see that with ketamine. And you see that in the hour [00:51:30] that it happens. You see people sit up instead of having a kind of broken, defeated posture, they all of a sudden sit up with kind of a strength and a determination in their posture that you hadn't seen before and things like that.

I think they're going to find out a lot in this next 10 years about what's going on and I think ... I welcome new treatments [00:52:00] that maybe don't have the difficulty of application. This isn't easy for people to get into the office and two hours of doctor's time, all the safety protocols and all that, between the expense and the opportunity cost. I think it'll be good when they sort out exactly what's going on at a molecular level, so hopefully it'll open up new treatment avenues.

Daniel: With regard to what's happening in depression, [00:52:30] depression is obviously too wide a term to be meaningful, but we'll just use it generally for now. Two fields in medicine that have really advanced in recent years is looking at depression as an inflammatory condition, so the rheumatology neurology intersection where there are types of depression that are almost thought of as rheumatism of the brain or the nervous system, and we're looking at upregulated inflammatory molecules, cytokines primarily that can cross the blood-brain [00:53:00] barrier, cause inflammation to the brain and it affects chemistry pretty widely. And then also cell energy dynamics and we're looking at either decreased ATP output or decreased some part of the Krebs cycle or the redox process, or something of cell energy leading to ... When you're talking about seeing the person move better, and obviously you start thinking about inflammation or being more vital, we start thinking about things like cell energetics, not just top-down neurological effects.

Jeffrey Becker: [00:53:30] Absolutely.

Daniel: I know in your practice, we started talking about ketamine because we haven't talked about it on this podcast yet and it's a super interesting topic, but it's just one of lots of tools that you use. It's also my understanding that oftentimes it's not the first tool you use, and that from a physiologic point of view, addressing things like neuroinflammation and cell energetics are some of things that you look at commonly.

Jeffrey Becker: Yes, absolutely. Process wise, it's been interesting over the years [inaudible 00:53:59] just to [00:54:00] watch the growth of my ... The breadth of my expertise kind of allowed, really, a re-engineering of how I approach things. I started much more top-down, being more spiritually oriented to start, and what I have ended up doing is actually very much the opposite. I now start really down at the molecular level, do a deep workup on metabolism, we [00:54:30] do genetics. Usually I use 23andMe. I've been a bit bummed out by the new chip. It's not nearly as deep a read in the categories I've grown to appreciate, but I'm still using it. It's the best thing I've heard currently, or most affordable and easy I guess. There's other things out there but ... And then if you marry that to good clinical work, really identifying symptoms and patterning and understanding how physiology [00:55:00] interacts, kind of coming up with a plan to help people with whatever is causing the system to not be working as well as it might, I think I just keep it that simple.

I don't know that I'm going to cure anything but I think if we can get the basic healing principles that we know work in the human body at work for us, if somebody's not sleeping or has such disturbed sleep, they're not getting the deep sleep and their growth hormones levels or their IGF1 [00:55:30] levels are low and they have fibromyalgia. Big surprise. Their tissues are sore and achy in the morning when they're not sleeping, so let's get them sleeping, and then we'll see what happens. And why are they not sleeping? Well, maybe they have insulin problems and they're getting low on blood sugars, and we really needed to change their diet. We need to really help them move away from carbohydrates and more towards fats and proteins for fuel. Maybe we have a problem B12. [00:56:00] It's normal but they have the [MTR 00:56:03] double copy, and they're finding some [inaudible 00:56:06] so quickly that they can't methylate properly even though their B12 and folate levels look normal, so sometimes treating those things directly, or that would be empiric to some extent.

The last [inaudible 00:56:22]. One thing I've learned is that labs can lie. You're looking at one compartment of the body in a single moment in their day, and then you're [00:56:30] extrapolating a completely different tissue compartment. It's like the brain, which are known to have massive gradients of vitamins across that blood-brain barrier, so it's a bit silly sometimes that we're relying on labs.

Daniel: So I have a question to this. When you start to look at genomic personalized medicine, obviously if we're looking at someone's genome, 23andMe or Illumina or whatever we're using, that's the same when the person was an [00:57:00] Olympic level athlete and then they had cancer, right? Like that's just genome; it's not their genetic expression at all.

Jeffrey Becker: Yeah.

Daniel: Now their genetic expression, which is being affected by everything, by their psychology, by their lifestyle, by their chemical exposures, by everything else, we don't have a real easy way to test transcriptomics or proteomics at large. Metabolomics is still a very early field. [00:57:30] So we look at clinical chemistry for whatever markers we're looking at, and the genomics can tell us one little part of predisposition, but if I see that gene, whether how that's expressing ... I don't fucking know. So for me, I don't really want to ever see somebody treat based on genes. I want to see them factor genes as along with the actual clinical chemistry and presentation. Is that how you think about?

Jeffrey Becker: [00:58:00] It's basically yes in a nutshell. Let me give you an example of ... [inaudible 00:58:08] case I just had last week, which was someone that had been a very powerful competitor in gymnastics and was able to endure a lot of pain and worked hard and found that they started to feel bad in their 20s, mid [00:58:30] 20s, and really, really crashed when they were in their early 30s. When we looked back at their history, we saw some of the signs of this, with problems with tissue repair compared to their friends, that something in their psyche caused them to push through, but their career did not go the way that they wanted it to because pf problems with cartilage and tissue and when they hurt their hamstring, [00:59:00] they'll be out for two weeks not one, these kinds of things.

Later, a very active mind, it started to cause her not to sleep very well, and her tissues were probably not repairing at the level they would if she was getting proper deep sleep. Again, you see this in fibromyalgia, common in very highly keyed up people. They've just got such a kind of powerful anxiety tone that sometimes it's hard to actually rest and turn the brain [00:59:30] off. And then what ended up happening is that she had a long run of antibiotics for about a year based on ... I'm not quite sure what I think of the line diagnosis, but whether it was real or not I'm not sure. But what was not done in that process was her mitochondria were not protected from cipro, and cipro is just horrible as [01:00:00] far the damage that can occur to mitochondria.

Some of the studies looking at this were frightening. Within 10 days you can see death products from mitochondria in the bloodstream and it starts to go up rapidly. What's amazing is how effective [Amycilosixtine 01:00:16] can be for that by rescuing the capacity to make glutathione, providing [inaudible 01:00:23] agent for [inaudible 01:00:24] a molecule for making glutathione. You can rescue mitochondria [01:00:30] in those circumstances but this story, it adds up. I can buy it just on its clinical face. I checked her glutathione levels though and they were very low. They were basically in the 10th percentile. And then we checked her genome and we see that she's gotten multiple [snips 01:00:51] of GSTM. She actually was missing the GTTM, I can't remember which one it is. Sometimes those [01:01:00] don't roll off the tongue that easily. But she was actually missing one of the enzymes which was known to be ... It's not a good thing to be missing out one enzyme. And you put that all together and you've got a coherent story.

So yes, the genes were involved but we didn't base it all on that. We also got the clinical picture and tried to come up with a story that works and then it's clinically correlated, not just clinically correlated but also correlated the labs and genetics. I think [01:01:30] if you can get all three of those pieces in place, you've got a tripod. I think you can a fairly coherent set of decisions about treatment and moving forward and then of course you watch what happens. You have goals and if you're cheating in those goals, and then I think it's a pretty reasonable way to practice. I think that at least it tries to use what's available now in ways that are reasonable and [01:02:00] mindful of them in the patients.

Daniel: Okay. So you mentioned a number of things and if we get into it, it starts to show how complex and multifaceted health and then even specifically neuropsych is. You said she was on antibiotics. Obviously we can look at the negative effect of antibiotics, and then not just antibiotics but any kind of chemical, whether we're talking about an antibiotic that's in [01:02:30] the environment like glyphosate or other kind of petrochemicals in our house environment like [Bortarogenic 01:02:36] compounds or other kind of pharmaceuticals we are on.

So we can look at all kinds of pharmaceutical and environmental exposure, and then not just the organic ones but the inorganic ones like heavy metal exposure. We can look at ... You're mentioning lime, a whole host of subclinical infections that might be possible in the mouth and the sinuses and the GI tract and the blood, [01:03:00] whatever. They can all have possibly neurologic effects. We can look at things like mold and mycotoxin exposure. We can look at the just purely psychological elements of what's affecting nervous system. We can look at the genetics across many branches, like what's going on with their [COMT 01:03:22], their MAOB, or things that are going to be body wide, like methylation, sulfation.

[01:03:30] And even if you just look at methylation, you look at the top people working in methylation getting so nuanced in terms of do I have to treat CBS before COMT before MTHFR, and do I do any that? Or do I do [Walsh 01:03:47] kind of ... just look at their whole blood histamine and treat based off that. Do you have a way that you put all this together? Do you have a methodology? Obviously you've got people like Bredesen Protocol that are taking [01:04:00] some elements and putting it together to look at neuropsych in places like integrative functional medicine. Is there a general protocol or does it really depend on their clinical presentation if it showed up sore and inflamed versus not? Are you going to look at different things? Can you speak to how you start to parse that?

Jeffrey Becker: Yeah. This is one of these things. I think for my own sake I need an acronym, really, because it's interesting, each person. I think the basic ideas are [01:04:30] longitudinally working with someone. Education is paramount. I think if you don't explain what you think is going on and why you think that's going on and what you want to do about it at a level that the patient walks out understanding, you're going to be dead in the water in doing this kind of work because you need the information feedback from the patient as you work with them, and they can't feed back information to you if you don't [01:05:00] educate them about what's going on. And you also just get better outcomes at the simplest level, but I think if we are fine instruments for reading and aggregating complex data, one of the most important things is to have a solid rapport with the patient and to be connected to them in terms of the paradigms that are being applied. So there's that.

I remove toxic processes, [01:05:30] whether it's somebody that just hasn't gotten the news and is having a tuna fish sandwich every single day of their life and has caught [inaudible 01:05:40] and other reasons to be worried about their mercury levels, things like that. People who drink too much alcohol, get them to understand what that's doing to them and get that out of the picture. Lifestyle toxicity as well and just their personal toxicity as well. [01:06:00] Those things get back to a lot of what we were talking about before. And definitely a deep workup. I think everybody deserves that who doesn't feel well, and I very rarely see a broad enough workup to catch all things at the same time. I think it's often done ...

A lot of times, I have people gather all of their labs that they can get their hands on. I don't care if it's 30 years old. I just say, "Get every lab that you can possibly get your hands on," and it's great fun. You go [01:06:30] through and there'll be a smoking gun from 10 years ago. You'll watch the onset of B12 deficiency in their CBCs that nobody's noticed. They've gotten older and they're not absorbing their B12 and you watch their MCV climb. Then all of a sudden, I can make the call and I know what's going on before I even check labs. Of course I confirm it.

I think that you've got to frame the story of what's happening not in a moment but [01:07:00] over a long period of time or it's not going to make sense to the individual you're working with, and it really won't make sense to you either because people are ... they're living in time, so to not see it as something that's occurring. And then, like we talked about, I think you bring in, to some extent, the linchpin, a lot times will be genetics. You'll get people where it's like, "Oh, well, [01:07:30] no wonder," and then sometimes you'll get people ... It's not that common that you'll get ... I'll get people where I was pretty sure I was going to find something and I don't in their genetics, but when you've got 500, 700 genomes and if you're good at, again, aggregating data, you get to where you kind of know what you're going to find. And then if you confirm that with labs, then you start making a plan.

I have a fairly simple [01:08:00] approach. It is using a lot of molecules that guys use in Qualia and, again, energetics and protection from free radicals, and kind of decrease aging processes as best as possible with natural molecules, but again also getting the things out of the story that may be pushing your aging rate forward or sapping your [01:08:30] energy, be it body, mind or spirit.

Daniel: You said something that I'm so happy you said it because I would say maybe all the doctors that come on this show say something similar and almost all other doctors don't, which is that the main diagnostic tool that you like to use is a really deep clinical intake to create a medical timeline that makes sense. And you can't do that in a 5 or a 15 minute session.

Jeffrey Becker: Yeah.

Daniel: And if you're [01:09:00] going to be looking at their labs over the course of years or decades, and not just their labs but asking about when their symptoms kicked on and what was happening and, "Oh, did a divorce or death happen then? Did a moldy house happen then? Is that when their back injury happened?" Getting a deep enough history of both the exposures, the trauma, when the symptoms came, and the labs, and correlating it. To me, until I see that, any kind [01:09:30] of confidence I have feels actually scary, like I don't want to have a confidence until the whole story makes sense. And there's just no way to do that quickly, and this is where the economics of medicine right now is a problem.

Jeffrey Becker: It's frustrating. There are so many reasons, the system is broken. It's no one group's fault. It's just so complex. The delivery of care and [01:10:00] the kind of ... I don't know, the expectations of patients sometimes to just have there be a simple answer. Sometimes people don't want this. They don't want it to be this complicated.

Daniel: The thing that is exciting for me is in a world where we treat almost everything that is not acute, as incurable, like, those are the two categories. It's either acute or incurable because the non acute things don't have one cause, [01:10:30] and the cause isn't necessarily obvious, and so if we're looking for singles obvious cures, it's incurable, right?

Jeffrey Becker: Yeah.

Daniel: In that world, when we're looking at autoimmune neuro-degen cancers, psychiatric dynamics, recognizing that there are actually solutions that can help people is just so exciting coming from the, "You just have to be medicated forever or your life's going to suck." And so, yes. Not everyone recognizes [01:11:00] that in a system as complex as a human physiology, and physiology, psychology, environment complex, they are going to need to do more than one thing possibly to restore balance. If someone's at all thinks about it, and realistic about it, they go, "Okay, that makes sense," but that there is actually a path forward is a thing that is so enheartening for me.

Jeffrey Becker: That's what's I think can be really unsatisfying about western medicine. [01:11:30] You see a lot of doctors that are frustrated and I feel for them. They didn't necessarily ... they just were not exposed to certain ideas in medical school. We can get mad at them, but I really think most of the doctors that I know and worked with and studied with and trained with, they all had their hearts in the right place. They wanted to help people and they do a lot of times, but when they bump up against complex, kind of syndromic processes of people not feeling well that's [01:12:00] occurring through across physiologic, kind of [inaudible 01:12:05], it just moves through different arenas of physiology, it's hard for them to anchor what's going on. And if you give them 10, 15 minutes, it'd be too much for anybody to ask to do that, really.

Daniel: So I'm curious ... I know your practice is full and you're really working on developing some new [01:12:30] technologies to hopefully bring some of the things that you like to wider audiences. If people are interested in finding good integrative practitioners that can do integrative medicine, functional medicine, neuropsych work, at Neurohacker we're actually working on a program to curate doctors that have the best training and training them, but that's not released just yet. So for now, is there a resource that you can recommend where people can go find practitioners [01:13:00] that there's a higher probability will be helpful for them?

Jeffrey Becker: Yeah. I think that the integrative boards have done a good job of training and vatting, and I think that the process that's involved in being a diplomat from ABRHM or Institute for Functional Medicine. That's a lot of work to move through their process, so if somebody's bothered to be certified through them in a psychiatric mode, you [01:13:30] can be pretty sure that they are interested enough to be worth seeing or at least interviewing and experiencing what they have to say. I think Andrew Weil was involved in this early on and he has his fellowship, and you could see who sponsored his fellowship and it's in whatever city you're in. So I think there's growing resources to kind of vat on that front and see [01:14:00] at least some filters, put some filters in place, and find doctors. Now, when you go in and see them, you have to use your own intuition and experience to determine whether you want to keep working with them of course, but it's a place to start at least.

Daniel: And if after listening to this, people are curious to explore more about if ketamine therapy is appropriate for them, what would they look for to find a practitioner that might be a good practitioner?

Jeffrey Becker: [01:14:30] One of the interesting web resources is the Ketamine Advocacy Network, which was started by patients that had had such profound experience during research that they ended up ... I'm not actually quite sure how they found each other but they started an advocacy community to A: get the word out. B: to some extent, I think they were worried about access and [01:15:00] felt that it was important that the voices be out there so that this didn't get locked before doctors had a chance to learn how effective it was. So there's Ketamine Advocacy Network and I think that you can sometimes find doctors' names in user groups and things like that.

There is the Society for Ketamine ... let's see. Society of Ketamine Providers, [01:15:30] I believe. It's started by Steven Mandel. Steven put this together to bring practitioners together so that they could be, A: sharing ideas, B: having a place to [inaudible 01:15:48] essentially. I don't know that they do any specific vatting, I can't speak to that they're ... determining that it's a high-quality clinic, but I know that a lot [01:16:00] of practitioners do register with them. Nowadays, really honestly, you can google and find it's just popping up all over the place. I would always encourage people to understand that if somebody's just started, that you might want to just know a little bit more. They might be wonderful in what they do or might be an opportunistic clinic. It's [01:16:30] just any process, I guess, just due diligence.

Daniel: Just a fun thought in closing for this session. When you think about the future of integrative psychiatry and all the different aspects of physiology from genomics to clinical chemistry, to the various sources of underlying cause to working with neurochemistry directly, and all of the types of psychology and integration [01:17:00] across them, what would you say you ... Where are some of the things you're most excited about on the horizon emerging?

Jeffrey Becker: Well, really what we've been talking, which is this new modes of data and create the ability to hold down such large amounts of data, like you said, there's some limits to genomics [01:17:30] and [SNP 01:17:32] analysis, but I think if we put computers to work and we marry symptoms and history of symptoms over time with labs and genetics, I think we will be able to provide people answers that work and answers that use natural [inaudible 01:17:51], molecules or meditation or these kind of things. And not only that, but prove that it works so that we can [01:18:00] stop defending ourselves within the functional space that it actually really does help to give [inaudible 01:18:08] and quarantine people that are tired and things like that. I don't have enough time to do the research at the level that will be required to prove this to doctors that are used to studies with hundreds and hundreds of patients, but you see it in your practice every day when you do it. I look forward to our field [01:18:30] being legitimized with larger numbers and a lot of what you do with computer science and systems analysis, really.

Daniel: Being able to not just do clinical trials on things that ... We currently don't have clinical trials, but also not everyone's going to respond the same way to acetylcarnitine or CoQ10 to know for whom it's right, and not just have a clinical trial on a molecule but clinical trials on processes [01:19:00] of identifying which things to do for which people, which starts to get into the personalized medicine and [inaudible 01:19:06] one optimization process. That is the kind of like bioinformatics meets bio sciences, this is super exciting.

Jeffrey Becker: It's really helpful. I think it is always humbling to apply everything you know and get it wrong with someone, and hopefully the more data that we can pull together, the more [01:19:30] we can quantify and gather outcomes, the less mistakes we'll make [inaudible 01:19:39] even when we're doing our best.

Daniel: Jeffrey, thank you so much for being on the podcast, for sharing with us your fascinating topics and your experience from medical doctor-psychiatrist to someone studying mysticism and really looking at what's happening at the intersection of this physiology thing and this [01:20:00] psycho-spiritual thing. Really novel, valuable, perspective to share with us, so I appreciate your time and I appreciate the work you've been doing.

Jeffrey Becker: Thank you, I appreciate you too. You do good work.

Daniel: And I look forward to being able to take some of these conversations deeper in the future.

Jeffrey Becker: Thank you.

Daniel: Take care my friend.

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