In this episode of the Psychedelic Medicine Podcast, Dr. Ben Medrano joins to discuss the intricacies of meaning making in psychedelic healing. Dr. Medrano is the former senior vice president and US medical director of Field Trip Health and has extensive experience in the evolving field of integrated approaches. He is also the current co-medical director of Nue Life Health where he is continuing his efforts in expanding access to ketamine therapies. Dr. Medrano additionally still serves as medical director of Field Trip NYC and DC clinics while continuing his private practice.

Dr. Medrano begins this conversation sharing a bit about his background and how he came to be interested in psychedelic medicine and the issues surrounding meaning making. He talks about his experience growing up in a family where mental illness was prevalent and how this planted the seeds for taking an empathetic approach to treating these conditions in his career as a psychiatrist. He also discusses his initial exposure to psychedelics in the Chicago rave scene of the 1990s. It was then that he first realized both the transformative potential of psychedelic-induced altered states and the potential dangers of using these substances without proper precautions or care for set and setting.

Following these formative experiences, Dr. Medrano began a practice of meditation within the Tibetan Buddhist tradition. It was through exposure to these spiritual practices and deep teachings that he began to see the importance of this process of meaning making and cultivate various resources suited to this project.

Dr. Medrano stresses the importance of self-awareness in realizing one's own approach to meaning making and how this has been shaped by unique personal experiences. This self-awareness helps one realize that a given patient may be approaching their own experiences from a very different angle, but there are still ways in which it is possible to support and encourage this personal meaning making.

Dr. Medrano stresses the importance of working with narratives in psychedelic healing. Psychedelic-induced peak experiences can be packed with insights and symbols which may be brimming with significance, but there's a lot of work to be done in understanding this material in light of the personal narratives of a patient's life. Through therapeutic integration, a patient can use their psychedelic experiences to critically examine their narratives and reflect more personally on the potential meanings of given revelations in light of how they understand themselves.

Additionally, Dr. Medrano distinguishes the roles a facilitator should play to support meaning making in high dose versus low dose contexts. When a patient is in the midst of a high dose psychedelic experience, Dr. Medrano emphasizes that the facilitator should primarily seek to affirm the experiences of the patient, being a calming and secure presence that doesn't introduce any additional complexity or uncertainty into an already intense experience. On the other hand, in lower dose, "psycholytic" experiences, the facilitator may take a more active role, helping facilitate the patient's meaning making in the midst of the experience through asking questions and engaging with ideas as they arise.

In terms of preparation and intentionally building psychedelic experiences more conducive to meaning making, Dr. Medrano emphasizes the importance of ceremony. Through a more ceremonial approach, a psychedelic experience can be given additional structure which may be reassuring for the patient, and additionally this provides an opportunity to more proactively incorporate things which may already be extremely meaningful for a given person. These can be practices such as prayers, or physical objects which have a certain deep personal significance. All of these help to encourage more meaningful content in the psychedelic experience, while also providing something grounding and familiar in the midst of altered consciousness.

Because of how effective Dr. Medrano has found various psychedelic therapies to be in helping people make meaning in life, he is primarily focusing his energies on expanding access to these powerful medicines at this stage in his career.

In this episode:

Dr. Medrano's background and how he got involved in psychedelic medicine and spiritual practices
How does Dr. Medrano help clients make meaning out of drug-induced altered states
Why Dr. Medrano refers to ketamine as "the great imitator"
The importance of understanding a patient's cultural and meaning making background
How to work more intentionally with set and setting and incorporate ceremonial practices
Shifting away from a "goal-oriented" perspective of psychedelic experiences

Quotes:

"I think telling our stories is part of this process of healing." [5:20]

"Just getting your mind blown by a psychedelic substance is not going to fix things. That's something I had to learn really quick." [11:00]

"I think for us to do this work, we all need to actually have a good sense of who we are and how we're approaching the conversation." [19:01]

"Trying to really invite in a sense of inspiration, energy, and support is really what the goal—or part of the goal—of ceremony is." [28:20]

"Really your role as a guide is honoring and affirming the experience. It's as simple as that. And being supportive. So, having a dialogue is not necessarily encouraged in higher doses." [31:22]

"Basically the process of integration is to not let anything that comes into the experience not be honored or seen in some way, to allow it to be explored, and of course not to push too much." [38:27]

Links:

Dr. Medrano's website

Nue Life

Nue Network

Field Trip Health

New article: Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: A retrospective study of off-label, at-home use

Previous episode: Psychedelic Apprenticeship: Validating Psychedelic Insights and Revelations with Chris Timmermann, PhD

The Body Keeps the Score by Bessel van der Kolk

Psychedelic Medicine Association

Porangui

Constanze Kainz

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