🫠 Psychonaut POV

Welcome to Tricycle Day. We’re the psychedelics newsletter that blinded you with science. And now we’re hitting you with (electronic mail) technology. 👾

Keith Kurlander's first psilocybin trip landed him on the ledge of a 19th-floor window. Not exactly a ringing endorsement. But two decades and at least 25 ayahuasca ceremonies later, the co-founder of the Integrative Psychiatry Institute argues these medicines are exactly what our mental health system needs.

We asked Keith about the trip that almost killed him, why he thinks mental healthcare has become a game of whack-a-mole, and what therapists need to unlearn before working with psychedelics.

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Well, I've tried to swear them off many times, but they just kept finding their way back into my life. At 19, I did psilocybin for the first time, alone in my dorm room on the 19th floor. I got very overwhelmed and ended up on the ledge of the window, with this realization: I've always felt this way. I'm in despair. I'm better off dead. A hallucination of my little sister, who was 5 at the time, is what talked me down.

That experience didn't cause my mental health challenges, but it made things significantly worse. What followed was a long road. I spent years trying to understand what was actually happening inside me, eventually finding my way back to psychedelics through ceremony.

In my 30s I did about 25 ayahuasca ceremonies, and I got very dysregulated. But somewhere in that process I began to understand what I was actually dealing with. The medicines weren't resolving my trauma so much as showing it to me. I traveled back to very early, somatic states. These were implicit memories I couldn't name but could feel in my body. They showed it to me so clearly that I couldn't avoid them. I had to do something about it.

Along the way, between my own journey and years of clinical work as a therapist, I discovered that healing isn't just about the mind. There are four areas where injuries can drive mental health challenges: spirituality, mental and emotional state, physical body, and lifestyle. You have to address all of them. That's the journey I've been through, and it's what we teach at the Integrative Psychiatry Institute.

I think of psychedelics as disruptive medicines rather than suppressive ones. A suppressive medicine, like an antidepressant, works by reducing symptoms so you can function. That's a legitimate tool. But you're not touching the underlying pattern.

Psychedelics do something different. They disrupt the physical, psychological, and spiritual patterning in your system. It's like throwing a wrench into a cogwheel. Some things break, but when the gears start turning again, you have a window where you might land in a new configuration, where things move in a little more harmony. You get to look at memories or beliefs from the outside in. You have more malleability. Behavior change feels more accessible, at least for a period of time.

On the biological side, many of these medicines interact with the default mode network, where a lot of our rigid thinking patterns and sense of self are anchored. When that softens, there's an opportunity to reform in a more adaptive direction. There's neuroplastic activity happening, including new neural connectivity and dendritic sprouting. So they're disruptive and generative at the same time when they work well.

The reason I call it a pattern interrupt rather than a cure is that the disruption creates an opening, but it doesn't do the work for you. What you put into that window—the preparation, the integration, the other healing modalities—that's where the real change happens.

The core argument is that the mental healthcare system is primarily broken. Reductionism served us in some ways. It gave us medications that have genuinely helped people. But along the way it caused us to stop asking about causes. We became a system focused almost entirely on symptom reduction. It has become a game of whack-a-mole. A symptom pops up, you hammer it down, another one appears. We’re seeing very high rates of mental health challenges globally, and high rates of treatment resistance to the medications we have. Whack-a-mole's not going that well.

Within the therapy world there's a related but different problem. Providers are siloed. A therapist trained in psychodynamic theory sees the world through that lens. Someone trained in cognitive behavioral therapy sees it through another. Very few clinicians are trained to look at the whole picture of a person, which includes their body, nervous system, spiritual life, and behavioral patterns. All of those are places where injuries can live.

The root cause we're most systematically missing is trauma, specifically trauma understood not as an event but as a state of the nervous system. Think of the nervous system as a brake and a gas pedal. When one or both are chronically over- or under-functioning, you get dysregulation. That state can show up as depression, anxiety, or chronic physical illness. This is why we so often miss it.

What's interesting about psychedelics in this context is that they're quite good at rooting out trauma. Sometimes they surface it and you do further work afterward. Sometimes, within the session itself, the nervous system has a major release and returns to something more homeostatic. That's what makes psychedelics uniquely suited for this work.

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The first thing therapists need is capacity for big experiences. In a psychedelic session, people can go to very extreme places, and therapists have to be able to sit with that in a way they're genuinely not used to from conventional practice. For example, someone might say something that offends you, or they might try to take their clothes off. You need to know how to handle that calmly and ethically, and that requires real preparation.

The second thing is suggestibility. People on psychedelics are highly suggestible, which means what you say carries far more weight than it would in a standard session. You have to be especially careful about suggesting what a client's experience might mean. In regular talk therapy, a gentle reframe can be helpful. In a psychedelic session, the same move can derail someone's process or implant a narrative that wasn't theirs to begin with.

What therapists often have to unlearn is their existing sense of how healing works. In psychedelic therapy, a client might go down a line of inquiry that in a regular session you'd redirect immediately. In the altered state, you watch it and realize it's going somewhere meaningful. There's a different intelligence operating that some call the “inner healing intelligence.” I like to call it “life force.” It’s the part of a person that already knows what it needs. The facilitator's job is to follow that, not manage it.

Being solid in yourself matters more than any specific technique. If you're not stable when a client goes somewhere very difficult, you may become part of the problem.

When I was younger, my view was simple: psychedelics are dangerous. That was my lived experience, and it wasn't wrong.

What I think now is almost the opposite. Psychedelics are something we desperately need. The mental health crisis is enormous, and we don't have enough treatment options. These medicines are imperfect, but so is everything else we currently have for the mind.

As science progresses, I expect to see more precise instruments for treating mental health. A better understanding of the brain and nervous system will give us more targeted interventions, some more mechanical than chemical, in the direction of neuromodulation, for example. But we're not there yet. What we have right now are medicines that can do real, meaningful work when used thoughtfully, and we should be using them. The shift for me wasn't from fear to enthusiasm but from fear to necessity.

Pick up his new book, Psychedelic Therapy, or check out the Integrative Psychiatry Institute.

That’s all for today, Cyclists! Whenever you’re ready, here’s how we can help.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.