E81- Problems with Psychiatry, Psychedelics, Trauma work & Three Body Problem (Rose Cartwright returns)

Rose Cartwright is an author and screenwriter. She is the author of the 2015 book Pure about her experiences with OCD which subsequently became a Channel 4 television show with the same name. She is also a screenwriter and executive story editor on the upcoming Netflix sci-fi series Three Body Problem .

Her new book The Maps We Carry is out now https://www.waterstones.com/book/the-maps-we-carry/rose-cartwright/9780008591885.  

Watch this podcast on YouTube - https://www.youtube.com/watch?v=MyECqiNNj_4

In this episode Rose and Alex discuss her experiences including the pros and cons of the medical model, psychiatric diagnoses,  as well as Rose's experiences with meditation, psychedelics (such as psilocybin and MDMA) and trauma work.

Interviewed by Dr Alex Curmi. If you would like to enquire about an online psychotherapy appointment with Dr. Alex, you can email - alexcurmitherapy@gmail.com.

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Disclaimer: In this podcast we discuss self-experimentation with psychedelics, but we would strongly reccomend using medical supervision when using any kind of drug to manage your mental health.

Transcript

Welcome back to the Thinking Minds podcast. My name is Alex. I'm a consultant psychiatrist. Today I'm in conversation with Rose Cartwright, who's returned for her second conversation on the program. She's written a new book, The Maps We Carry All About Trauma, how trauma can affect the development of different mental health conditions, psychedelics and meditation. She's also a writer on the hit Netflix TV show three Body Problem. Today, we talk all about her new book, including the role trauma can play in the development of mental health problems. Her criticisms of the medical model of mental illness, her own experience with meditation and silent retreats, and her experiences using psychedelics to gain a deeper understanding of herself. We also talk about her work on Three-body problem, what it was like to work with the creators of Game of Thrones, some advice as to how to pursue a creative profession, and some of the important themes of three body problem as it relates to current world events. Today we discuss self-experimentation with psychedelics, but I would strongly advise not doing this at home. I'm making sure to use medical supervision. If you ever using any kind of drug to treat a mental health condition. Thanks for listening. And here's today's conversation with Rose Cartwright. 10s Rose Cartwright, welcome back to the show. Hello, Alex. Very happy to be here. Thank you for having me. You're our first recurring guest. You know, we have a few guests we've had in the past coming back, but you're the first one, so congratulations on that. Thank you. That's very exciting. You know, I'm a fan of the show. So pleased to hear that. We've got a lot of to talk about. A lot on your plate at the moment. You've got a new book coming out. It's Tuesday on new books coming out Thursday, and you've just had a psychedelic series on BBC radio four. You're a writer on the hit show Three-body problem, so there's probably way too much to talk about to fit into one podcast, but we're gonna try our best. Let's talk about your your new book first, the Maps We Carry. I've been lucky enough to to read this book already. I thought it was so interesting because you're so transparent about the difficulties that you've gone through, and it's quite unique, I think. Anyone that has a bit of success in the mental health realm. As soon as they start to encounter difficulties in their personal life, they can make people fall into imposter syndrome quite easily. I've even noticed it on a small scale myself, working as a psychotherapist. If I'm encountering some personal difficulties, I can easily feel like I'm a bit of a fraud, and I think maybe it's too much responsibility we put on ourselves sometimes. But let's roll the clock back. You know, your your first book, Pure All About OCD, came out in 2015. That then got made into a show on channel four. Can you outline for us? What was it like after that, how you're feeling and how that led into writing your second book? Sure, yeah. As you've just said, pure is a story of how I started getting intrusive thoughts. Very, uh, disturbing, violent and sexual intrusive thoughts when I was a teenager, when I was 15 years old, and I didn't understand that experience. It was terrifying. It was harrowing. Um, it sort of took over my life and. 1s I. It took me several years to find out that there was language for this kind of experience and, um, the language that I found or the framework that I found was that, um, I, I have a disorder called obsessive compulsive disorder and intrusive thoughts and compulsive attempts to neutralize the anxiety associated with those thoughts, um, are symptoms of of that disorder. And, uh, having kept those thoughts a secret for, uh, over a decade, I decided to, to start to talk about them. And because I'm a writer, the, the the natural way that I found to talk about those experiences was on the page. So I published an article that became a book that that then became the TV show pure, um, about, uh, about that journey of, of discovery of, of, of finally finding language for my, uh, for this very sort of shameful secret problem that I had. Um, and I sort of today I'm looking back on that and I sort of, I, I stand by most of what I said back then. I think that OCD on many levels made sense as a description of my problems, and I still do. I still identify with having had OCD. Um, what changed after the book came out, and certainly after the show came out was that, um, I started to encounter ideas that kind of challenged not my experiences, but challenged the way that they're framed as, uh, mental illnesses. Um, and that was very difficult for me because at that point, you know, my diagnosis, thinking of myself as having a disease of the brain, I that was very dear to my heart, like that was something that had helped me out of a deeply confusing time in my life. And it had been a a life raft of sorts. And when I, through my advocacy work, started to encounter ideas and speak to experts who perhaps thought differently about mental health problems, I was resistant at first. Um, and maybe I could have maintained that resistance only, uh, my mental health. 1s Meant that I couldn't ignore it because I was. After the show came out, I had what I thought of at the time as a massive relapse symptoms, and I was really at rock bottom and desperate for answers. So the search had to continue. And that search led me down quite a different path. Um, looking at my problems in quite a different way. And it ultimately led to me interviewing a bunch of people working in your field and in neuroscience and in psychedelics, too. And yeah, it became my new book. The maps were carry. What were the new ideas that you began to encounter? And importantly, how did they contradict the beliefs you had about your problems before? There was an idea out there in the ether when I was growing up that, um, chronic serious distress is down to a malfunction in the brain and that that that is the root cause of the distress. And that explains the distress and because it's a simple idea, um, it was very appealing to me. Um, and it wasn't necessarily something that I bought into. It was just there. That's how I understood what I was going through. Um, and I started to learn that, um, certainly, you know, something going on to use your language at a biological, biological level of analysis in OCD or anxiety or depression, probably when my OCD was at its worst. If you scan my brain, no one ever did but you, you would have seen a neural activity that correlated with my distress. Um, but where my view evolved is that I don't necessarily see that, um, brain activity is the root cause of my problems. Um, I think the root cause of my problems, um, essentially is, is chronic stress in my childhood. Um, and that's so it's not necessarily that the new information I was learning contradicted what I understood before. It just, um, it sort of changed the aperture slightly, if that makes sense. Yeah. And in an important way, your your path really reminds me of what I've encountered when I've read about personal growth, and particularly what I read when it comes to psychotherapy and how you as you mature and you encounter different challenges in life, you go through different paradigms and you can find a paradigm that can really help you, and it can really help you for some time, maybe a few years even, and then it can start to wear off. And there's that expression, um. Today's epiphany can be tomorrow's crutch. Mhm. So it sounds like for you getting that initial diagnosis of OCD, which actually had to work really hard to get, you had to kind of discover it for yourself first rather than someone telling you, if I remember correctly from the book, but that that's framework as you described really helped you. But then you realized actually there are limitations to this. Mhm. And you were being prevented from understanding your problems as deeply as, as you could have. And then that lack of depth Mendoza limit to the degree that you could grab. Yeah. Yeah I'd agree with that. I mean you know the, the new book is an exploration of different models that people can use that are helpful to understand their mental health. And I think that, um, you know, we need a plurality of models, um, and actually a, you know, that that kind of flexibility and not seeing your mental health problems in one specific way is really important. But it also, it wasn't it wasn't as simple as. Finding a new worldview that was more helpful. It was more, um, 1s I realized that actually, there's not as much evidence as I thought there was for the ideas that I had for this idea that OCD is a mental illness, like illness, like any other illness. Um, I went looking for that evidence and I found myself, like, unconvinced, whereas I think there's overwhelming evidence, um, which chimes with our common sense intuitions about the world that, um, mental health problems tend to stem from, um, overwhelming stress in the environment. Um, I know that's a that's a really simplistic summary. Um, but yeah, ultimately, yeah, it was what was helpful personally. But it was also I had to find out what the experts were saying and what they weren't saying and how well evidenced each claim was. And I think that makes sense. And obviously it's a very from we've had conversations offline about the senses vary from individual to individual and from condition to condition. But I actually released an essay on the podcast last week about psychiatric medications and how we can use them sensibly. And one of the principles I outlined in that is certainly that our understanding of what's happening biologically and basically all mental health conditions is at the very least incomplete. There's a lot of mystery. I do think that is largely because there is a huge amount of complexity, because so many different factors are interacting with each other someone's biology, someone's psychology, and then all the different social factors, obviously, something like chronic stress can have a huge, you know, impact. And you know, we know this from adoption studies. For example, you take a condition like schizophrenia, which has something it's something like 50% heritable, which would suggest that 50% of the condition would of the condition would be attributed more to differences in environment and 50% to genes. What that means that the environment is clearly having a huge impact. And so it really it really feels like people can have genetic predispositions, perhaps. But unless there is that environmental trigger, people can never develop a particular condition at all. Mhm. I mean so let's get into it then. So you know the example you give with schizophrenia, like if you'd asked me ten years ago what I thought that meant, I would have said that, you know, that everyone that has a diagnosis of schizophrenia that comes out of a doctor's office with a with that diagnosis has in common the same specific biological signature. 1s In their brain, which is not which is not the case, which is not the case. But but I think, um, a lot of people in psychiatry use, like you will say something like schizophrenia and they know that it's a, it's a construct. Whereas people like me, laypeople think you're talking about something that you found in the brain that is that is schizophrenia. And I think that that there's a lot of confusion around that. And it took me a long time to sort of unravel that. Yes. And that's a point I found myself having to say more and more often as well, which is I don't I don't think you can get away from the fact that our diagnoses are constructs. I think that's true. And and they're constructs based on clinical presentation. So they're based on. A collection of signs and symptoms that we know, uh, go together very often. Uh, whereas I guess what you're saying is that the way medical professionals can communicate can give the impression that this kind of, uh. Oh, we found this particular thing going wrong in the brain. Mhm. Yeah. Yeah, exactly. Um, and it's, you know, diagnoses are based on um, presentation, but also each clinician's interpretation of that presentation as well. So I think there's a lot I think there's a lot more subjectivity around the diagnostic process than I understood. Like if you think about like when I landed on an OCD diagnosis, the way I characterize that, and this is a sort of, uh, a trope I see out there in the mental health advocacy space that that was the correct diagnosis and that every other diagnosis leading up to that was wrong. And I don't when I spoke in that way, I don't think I really even understood what diagnosis means. Um, and like what? Like if it's subjective, how can a diagnosis be correct or incorrect? It's correct if it chimes with, um, if someone personally identifies with it and it's correct if the clinician in their subjective opinion, which I'm not saying it's not based on expertise and strong literature, but it is ultimately subjective. Um, yeah, I've lost my thread, but I think you got it. Yeah. And different problems can co-occur and different problems can can, uh, contribute to each other. So, for example, I see a lot of patients with assess a lot of patients with ADHD, which, you know, is is very controversial in the media space, but. 1s Very frequently when you're assessing people who very likely meet the criteria for an ADHD diagnosis, they have a history of anxiety and depression in the past, and very typically they're diagnosed with anxiety and depression several times before. Eventually, they feel like it's not really the most elegant explanation for the whole scope of different difficulties that the that they've encountered. But of course, if you have undiagnosed ADHD, which would span a huge amount of problems, problems with concentration, distraction, staying on task, hyperactivity, impulsivity, sensory overwhelm, it's much more likely that you're going to experience something like anxiety and depression. Uh, you're going to encounter things would be more difficult for you. So it's not surprising that problems can compound each other and co-occur. And maybe this is something you've experienced as well. Uh, I mean, yeah, it absolutely is. You know, I've received many different diagnoses over the years for my problems, ranging from, you know, OCD, obviously depression, generalized anxiety disorder, body dysmorphic disorder, and like. 2s At each point of diagnosis. I think they those labels like, seemed to offer a ray of hope. Um, and, you know, a way to understand my problem. What I was what I'm grappling with in the new book is that, like, ultimately, I think that that it was a it was a false consolation. Um, and that those diagnoses didn't actually lead me to solutions that really helped. And my concern is that, you know, especially you mentioned ADHD, like we've seen just explosion and explosion of rates of diagnosis of ADHD and um, I. It's tricky because if you sort of express skepticism of that explosion, it makes it sound like you're denying that these people are suffering. And I'm not doing that at all, like I think. Um, I think people are 1s going to doctors and presenting with symptoms that look like ADHD because like, they're genuinely suffering and they're struggling, um, and they're looking for answers. But but what I see out there is that a lot of people think that when, when they come out of the doctor's surgery with that diagnosis, it means that they've, um, yeah, that they have this specific problem in their brain that they share in common with everyone else with ADHD. And. Problematically, that there are targeted medications that can solve that problem, and I don't I you know, while I think medications can be very helpful and should stay an option on the table, I don't think it's as simple as I've got a diagnosis and I'm going to go and take a medicine to improve the symptoms. 1s Yeah, absolutely. I think with all of these conditions, it really comes down to how the diagnosis is delivered. 1s I mean, yeah, how the diagnosis is delivered and how sufficiently transparent you are about the diagnostic process and the limitations of the diagnosis as a concept. And then further to that, when it comes to management, uh, how should a person think about managing their condition? So when it comes to ADHD, for example, it's important to be transparent about what the diagnostic criteria are and that. 1s A diagnosis. It cannot, at this stage in the game, be pointing to a specific brain abnormality. Because we're not testing for brain abnormalities, we're testing for a range of clinical symptoms. Um, and should they meet the criteria, there'll be a whole range of ways of dealing with their difficulties, which would really depend on their specific situation. So when it comes to ADHD, lots and lots of, uh, patients have experienced trauma traumas, more likely in your history if you end up with a diagnosis of ADHD. And this is, of course, the case with a lot of mental health conditions. And so part of the treatment should involve addressing that trauma with specific therapies that can actually target it. Obviously. Then there are lifestyle factors various psychological techniques medications. All of these play a role, but by being transparent about the diagnostic process and taking a more holistic view, I do think we can come up with plans and pathways for for patients, which are a bit more elegant and a bit more individually tailored to their needs. Mhm. Yeah. Yeah. The I, I've asked um I've asked a few doctors I think including you. Like what. Like um how and why diagnosis is justified. And um the response that I've had back is that um, it's justified because it offers, uh, comfort to the person who's struggling and it offers them a way to understand themselves. Um, but do you think that. 1s I also think that diagnosis is the result of just the way it's always been done. Do you think that, like, if it hadn't been done like that for the past 50 or 60 years, like, would that be the go to way that you would help people understand their problems? I think there are other things that diagnosis offers. Um, I think there is quite a lot of truth in, in diagnosis in that it helps us to understand that different, seemingly unrelated problems often co-occur together. So with ADHD is a good example, it might not be obvious that someone who has problems, uh, organising themselves, organising their time, say, developing a routine, um, organising their personal things, and someone who also has problems with significant restlessness, fidgeting, um, someone who says things impulsively without a lot of self-control. It's not obvious that those problems are necessarily related. Uh, but when we, you know, carry out the research and find out that a lot of these problems actually go together in this cluster and a syndrome, if you like, uh, it can help to people explain things which are otherwise very hard to explain. And then I also think it helps them find a degree of community, because even though people who people who have diagnoses of ADHD can still present, uh, very much in unique ways, there are still a lot of commonalities that can be found. You really you do see the same stories over and over again. It's important that a person doesn't over identify with the label and just make their life about, for example, having ADHD, because there'll be so much about themselves, which is nothing to do with the diagnostic label. Yet at the same time, connecting with other people through those common arcs can help them not only have a bit more comfort around it, but can help them meaningfully. Um, then actually start to start to tackle the issue. I think it does. Diagnosis also informs what you should do, uh, about your problem. Now, if you can tackle that in a more simplistic sort of mechanistic way. And if you think about a problem with ADHD, for example, the most simplistic way of thinking about ADHD would be like, there's too little dopamine and noradrenaline in your brain, and therefore you should take a drug which increases that. And while there's truth to that, it's too simplistic. And then there are other things you need to take into account. For example, trauma and chronic stress may have impacted you in such a way that makes these problems more likely. And then you have to figure out how to unwind that stress. I'm not sure. Did I did I answer your question? Yeah, you did I yeah. I was saying that, you know, that I've heard doctors say that they think diagnosis is justified on the basis of. Uh, it's comforting. And you and you think it's. It's deeper than that, which I appreciate and I don't disagree with. Yeah. And it doesn't help us to inform the management, but it's all about the I think what it comes down to is the skill and the nuance with which to diagnosis the delivered, the degree of transparency. 1s The end the degree of humidity. 2s And then how, uh, open and holistic your, your, your management plan is. That's how I see it. Yeah. Uh, in terms of your journey, then where. So what specifically happened to you and where did you go? What ideas did you discover that really helped you? So where I left off, uh, after the TV show came out and, you know, we opened this conversation by talking about imposter syndrome and that a lot of people feel like after they've told their mental health stories and they run into trouble, that they then feel like frauds and imposters. And I certainly did, um, you know, there was a lot of attention coming my way after the TV show came out and, um, having sold what I thought was a redemption story of how CBT had helped reduce my symptoms and having had this massive relapse. Um, I, I was at rock bottom, and that was a, a very challenging level of cognitive dissonance to get my head around. You know, I had people emailing me every day saying, thanks so much for telling your story. Like, you know, can you give me the email address of your therapist or like, give me any tips for like what worked for you? And I'm there, like self-harming, um, and coming face to face with the reality that like, everything that I thought had worked from like my sort of medical worldview to the specific treatments like, hadn't worked. Um, and I was in a really, really bad place. Um, and, you know, there was a, I was I was able to appreciate later that there was still like a spark in me, um, still like a, a bit of me that wasn't beaten and, you know, still had curiosity and still had energy to put towards trying to get well. And, um, I was following the psychedelics clinical trials. Um, having, um, attended a couple of talks, I started watching very closely what was going on there, started reading quite a lot of literature. 1s And, um, a lot of the stuff I was reading about how psychedelics can help people become unstuck was very resonant. And the way that, you know, this word, trauma kept coming up. And whilst I was aware that I'd been through really difficult things when I was a kid, um, and I'd tried to explore those things through talk therapy, there was a part of me that was still very blocked off to the pain and the reality of all of that stuff, and something compelled me to explore psychedelics further. And, um, you know, I was very aware that taking psychedelics, especially when you're having a mental health crisis, is a risky thing to do. Um, equally, I felt like it was a risk worth taking, given that, um, I felt I couldn't really get any lower. And I thought if I lost my mind, you know, there's nothing to lose, so, um, I. 1s Found a couple of psychedelics guys in Amsterdam. 2s Um, when in completely terrified. Which, you know, I think a degree of, uh, fear and anxiety around psychedelics is appropriate, um, because it's a huge experience. Um, went in and had a massive, um, sort of devastating five gram truffle journey. And, uh, it was it was one of the worst days of my life. But, um, almost also one of the most revelatory, you know, in the. Sort of the reality of the pain of the things that I've been through, just like hit me in a very, as they often do on psychedelics, simple and profound and unambiguous way. Um, and I came away from that experience with a sort of new lens on my problem. And, um, I can talk a little bit more about, like, the childhood stuff that sort of led to me feeling the way I did. But, um, essentially, yeah, it was that that was a that was a turning point moment in which, well, a sort of catalyst, a one catalyst in a series of catalysts that led me to reframe my problem. What do you think in terms of the psychedelics, uh, experience itself? 1s Uh, what happened and how how do you think that led you to a deeper understanding of your problem? It was a extremely intense experience. It was, in many ways, a kind of classic bad trip in terms of like, all the sort of nightmarish qualities or the incoherence. Um. 1s What I would think of as a sort of ego death type experience whereby nothing existed. Um, and at the peak of the trip, I had a very powerful vision, a well before the peak of the trip I was. It was a really beautiful moment where I was surrounded by my entire family, and I was enjoying this, like, proximity to my mom. There was tenderness there. There were safety there. Um, and at the peak of the trip, all of that got sucked into a colossal black hole in the sky, and I was screaming and bashing my fists against my ears, begging my mom not to leave me. Um, and, you know, really kind of like blockbuster nightmare stuff. And, um. 1s Coming, coming round from that experience. Um, I just I just mysteriously understood. I was like, oh, yeah. Like, all of my problems are at root about the pain of dealing with a mom who had bipolar disorder and who was repeatedly taken away from me and put in psychiatric hospital. You know, we're talking for, you know, the first 20 years of my life that was going on longer, actually. But, you know, my entire up until I was 18, my entire childhood, um, and, uh, you know, it, you know, in short, those experiences, like watching her go through what she went through, um, hearing the things I heard, you know, it devastated me. And I think that my OCD evolved in my adolescence, um, as some way to kind of cope with, manage, contain, or distract me from that overwhelming stress. And, um, it's it's at once a very simple answer, but also very complicated one. Um, and, you know, you can have that insight, but that doesn't lead to, um, uh, healing. And that was, you know, the book is about like that, that healing process. Yeah. And I think that that leads to your, I guess, the one of the fundamental points you're trying to get across in the book, which is. Uh. Um. An unsophisticated medical model that views your OCD process purely as an illness. 1s Who fails to grasp that a lot of your symptoms will be a defense, a way of trying to cope with all the really difficult things which happen to you. Yeah, exactly. Um, you know, in a way, and I think and I think a sort of. 1s A compassionate view of the medical model, which is one I tried to take in the book, even though I'm a critic of it. Is that like, uh, I needed I needed comfort, I needed a way to understand what I'd been through and in a way to think of myself as having a medical problem, as having a mental illness, and the problem originating in the matter of my brain, um, that sort of colluded in the protection from trauma. Um, and I think that's one reason why that story has become successful, because people go to doctors wanting that comfort and doctors understandably want to give it. Um, so, uh, yeah, I think, I think I do see it as a, as a barrier of some kind. And but, you know, ultimately it was that barrier that led me to only living half a life as well. Um, and psychedelics are helpful because they break it down for you and they show you what you've been avoiding. And that's also why they're terrifying. Yes. And it's it's funny how that that restriction. I'm struggling to put it into words, but you know that phrase living half a life stands out to me. Could you tell me more about that? Is that living half a life because you felt. You were blocked off from parts of yourself. I mean, I still I explore lots of different ways, um, of, of of thinking about the sort of symptoms of trauma and mental health problems in the book. And, um, no one, no one description like, captures it in its entirety. And like, as I've grown up, I've figured out different ways to think and talk about it. Um, what do I mean by living half a life? Um, I mean. 2s So looking backwards and like how I feel now. Um. 2s The healing is not just been about, um, a reduction in distress or anxiety or intrusive thoughts, but it really feels like a kind of all body experience, a kind of connectivity. And I know it's very trendy to talk about the nervous system now, um, and how, like, trauma healing can make you feel more whole and more grounded. But, um, that kind of language really, really does capture what it feels like to be, um, to be much better. Um, I feel like I'm. 1s Uh, in relationship with the world in a way that I wasn't. Um, you know, I notice things like eye contact and, like, you know what it's like to notice that when you smile like it makes someone else smile or like I'm more responsive to physical touch. I'm a nervous system. Feels alive. So, um. Before, I think my nervous system was very, very shut down. Um, because OCD or whatever, however you want to describe that mechanism had kind of constricted my ability, um, to be fully present and fully relational in the world because being fully present was terribly painful. And I think, um, if we if we use trauma language, uh, I think, um, the trauma response is quite crude. Um, you know, it's it's, um, it's like, you know, in the book, I describe it as like putting suppressant foam on a situation. It's not discriminating. It's shutting you down as a person. So, um. Yeah, you know, half a life, I think, um. Yeah, that's exactly what it felt like. And, uh, that trauma response is really good in the short term can really help you through a traumatic situation. But then it's problematic in the long term. And funnily enough, we see that a lot in, in physical medicine that I think I may have told you this at some point, a lot of chronic health problems result from scar tissue. So scar tissue obviously really good can stop you from bleeding, but you get scar tissue building up over years in your liver. That's cirrhosis. Scar tissue, uh, building up in your arteries. That's atherosclerosis. That can give you a heart attack, or it can give you a stroke. So it's this idea that our body, whether it's physically or psychologically, can do things that can really save our life in the moment, but then continue to interrupt our lives in the long term. Yeah. I, um, I like that metaphor. I think that medical metaphors are really apt. Often. Another one I like is the idea of an abscess. You know, like, um, an abscess. Is the body, like, walling off, um, a site of infection? Um, and, and that's important because it stops the infection spreading, but it causes problems because then the infection can never heal. And I think it was I think Paul Conti rheumatologist, uses that. Um, and I like it. I think it works. And to give people an idea how many psychedelics trips, uh, did you take? It was quite a repeated process, from what I understand. How many roughly do you think it took? At what point did you start to feel like a sense of kind of relief and, and things really improving for you? It's really I mean, it's really tricky to say because I don't necessarily draw a distinction between what. 2s It's difficult because psychedelic therapy is not illegal thing. It's not an established thing yet. So we don't really have a definition for what psychedelic therapy is. And, you know, is it is it psychedelic therapy? If I repeat the maps protocols in my bedroom and trip on MDMA on my own, I don't know, um, you know, is it psychedelic therapy? If I'm taking ecstasy at a rave and I'm having some profound insights about my life? Um, you know, arguably not, but, um, I, you know, I had very profound experiences in casual recreational settings. Um, and in terms of, like, formal psychedelic psychotherapy, so I did. 1s In total, I did three like, big, uh, like five grand. Uh, not quite five grand, two big five grams psilocybin journeys and one hippy flip, which is a slightly lower, about 3.5g of psilocybin with mixed with MDMA. So I did three big psilocybin trips and then, um. 1s Six more formal, um MDMA uh guided experiences. And then in and amongst that raving partying um but this was all over the space of uh. 1s For years. And so I did a lot of drugs. And were you having therapy? Uh, 1s outside of the psychedelic trips as well? Yeah. I mean, um, you know, there's a lot of talk about the importance of, like, not just it's not just a, uh, taking a drug. It's about everything that goes with that. Um, it's making sure you have psychological support, um, making sure integrating your experiences. And because, again, because there aren't, like, official channels through which you can do that. Um, I mean, there are people are rolling out things like integration programs, but, um, there's not much. So I was working separately with a psychotherapist, a brilliant psychotherapist. Um, and I was she wasn't the person who was in the room with me when I was tripping. 1s Um, but she was on board with what I was doing, even though she didn't. I couldn't necessarily, you know, condone it. Um, but but I would then, so I would trip, and then I would book in a session with her and talk about everything that came up. And, you know, that was that was a really important space for me to just, like, stay anchored even though I was, uh, you know. 1s I don't want to say. Yeah, maybe I do want to say taking risks. I was taking risks with my mental health. And it was important to know that, um, there's. Yeah, that I have somewhere to explore all the material that was coming up. And at the opening of the book, you talk about going on silent retreats and meditation and what role did that have in all of this? 1s So meditation, uh, has been huge for me. I can't imagine having my life having changed the way it has without meditation. It was actually meditation, so I had my first. And I feel like I should, uh, preface this by saying that, you know, I'm I'm an atheist and I'm a skeptic. And if someone if I'd heard myself say this, like, ten years ago, I wouldn't have believed it was me. But on a meditation retreat in 2017, I had a spontaneous, mystical experience. I had a full blown, altered state of consciousness, as strong as if I'd taken psychedelic drugs and I hadn't taken anything. Um, that was in 2017, which was in the midst of this appalling relapse that I was having, and I spent, um, more than an hour and a half completely free of intrusive thoughts or, or or any kind of mental health symptoms or even any sense of, like me as, um, as who I thought I was. It was a non-dual experience. Um, no mediation between myself and experience. Um, just experience. And it blew my mind. I came away from that. Like, you know, that was one of I mentioned earlier that there was a series of catalysts that led me to question whether or not I had a mental illness. I was like, well, if I've got a mental illness, how can the symptoms of it spontaneously disappear for an hour and a half? That doesn't fit with my understanding of the fact I've got a broken brain. Um, and it was that it was that experience. So, yeah. So my, my, my journey into psychedelics started with a sober trip. Um, and, um, the meditation has continued to support me, giving me a place to explore what's going on in my body, in my mind. Um, and, uh, is remains a very stable presence in my life and a way to access community. So, yeah, it's been invaluable. And I see meditation and psychedelics as fairly sort of adjacent practices in terms of the insights that can come up. Yeah, that that makes a lot of sense. And now do you still I used to do using psychedelics. Um, I haven't done any formal I mean, it's so funny saying formal because there is no formal like there's a network of underground guides offering sort of therapeutic services, but I haven't done any of that for over a year. Um, undoubtedly I will in future. Um, I still a few times a year we'll go to a day party, but I'm kind of a grandma these days. You know, the raving. The raving is happening much less frequently. Um, but, yeah, I mean, it's it's still a part of my life, and, um, I think it always will be. You spoke to Robin Harris recently on her radio program you did about psychedelics. People can check that out. I'll put a link in the description. What was he able to tell you about the current state of the science or what he's working on? Well, the scientists are very optimistic, as I understand, he's studying psilocybin for treatment of depression and anorexia. And fibromyalgia. Yeah. Chronic pain and yeah, seeing incredible results. Um, in terms of like, what's going on neuro scientifically, I can't summarize what he told me because it would be a disservice to him. Um, but it's but, um, yeah, I think there's, I think there's a lot of warranted excitement in the space and also, you know, skepticism like it's, um. 1s You know, we it feel in one sense it's late. It feels late to be talking about psychedelic therapy in. In another sense, it feels too soon. You know, we can't even have, like, a grown up, like, adult conversation about drugs and drug policy. And we're talking about prescribing these things to people in clinics. So it's a weird time. Um, but, um, you know, the clinical trials are ongoing. And from what Robin told me, like, it's all moving in the right direction, but but equally, I don't think it's a dead cert that this is all going to be rolled out. I mean, more so for MDMA, you know, it looks like that's coming imminently, especially in America. But, um, with psilocybin, it's there's still a fairly long road ahead. Yeah, it's definitely super exciting to see what's going to happen with that. And I do think it will help, um, break a sense of stagnation. That's that's been present within mental health for some time, kind of partly for some of the reasons that we've outlined today in parallel to all of this. At the same time as you've been writing your second book, you've been working on a Netflix show called Three-body Problem, which now, as I understand, is one of the most viewed shows in the world. What does it feel like to be a writer on a show that's doing so well that everyone's talking about? 1s Yeah. It's been really it's been really, really exciting. It's, um, it's a sort of new dimension to my career, you know? Um, 2s writing about mental health and writing books is, like, very, very dear to my heart. Um, and I think I'll always do it. Um, but it's not necessarily the most accessible way of getting your creativity out in the world. Whereas, you know, a TV show especially like, you know, big blockbuster sci fi, like it launched a specific day and everyone was watching it at the same time. And like my dad was watching it and my nephew is watching it. It's like everyone can kind of get on board. Um, and that was a really new experience, you know, and strange that it's happening at the same time as the book coming out. You know, those two launches happened within three weeks of each other because one, you know, one is reaching hundreds of millions of people. One will have a very, very modest reach. Um, and, you know, it's kind of a case of breadth and depth, though, right? Because the book might reach fewer people, but probably will hit at a much greater depth. 1s Yeah, I hope so. Um, but, yeah. No, it's been really, really cool. Um, I couldn't I don't think I could do the mental health stuff and, like, write books if I wasn't also doing the screenwriting. Um, you know, just practically. I need those strings to my bow. Um, but, yeah, you know, it was fantastic. You know, shooting a show like that is, is a really. It's a wonderful experience. And, you know, it gave me a lot of community, like a film set is a village, and you spend ten months there. Um, and that was a huge factor in, in my mental health as well. You know, I felt it when we stopped shooting. I felt the loss of not being surrounded by people every day and being engaged in creativity. Um, I think that's a really sort of under undersold aspect of mental health generally, is having people around you, like, united in, in something meaningful. Um, yeah. It's been wonderful. And on this project, you got to work with the creators of Game of Thrones. What what do you think you learned about the writing process from them? 2s Well, it's a big question. Yeah. Um, David Benioff and Dan Weiss, um, my co-writers and friends, they're, um, you know, they. They came off the back of Game of Thrones and, uh. They decided to try and make something arguably even more ambitious, and even just that as a move, as a play, it was really inspiring to me. Um, because they are under like so much scrutiny. Um, you know, the wind blows strongest at the top of the mountain, like they're at the top of the mountain when it comes to TV production. Um, so just like watching them, um, just, like, cope with the pressure of doing what they do, um, was. Yeah, was really inspiring. Um, they've taught me. They've taught me so much about characterization, about story structure, about, um, you know, the constraints of budgets on locations. And, you know, it was a really like 360 immersion into, into TV writing. Um, and yeah, you know, I also, um, you know, I was working under them, like, supporting them as producers as well. And, you know, it's not just writing. It's like taking your script to the point at which you're shooting and going up to the writers and giving them critique on their lines and their intonation. Um, so, uh, it's a much more involved process than writing a book. And, um, yeah, I'm, I'm just I'm lucky that I got to do it alongside them. Very lucky. And then I might ask different question, which is, what do you feel you were in a position to uniquely add to the show? You know, what could you deliver with your voice in terms of in terms of the writing on that show? I mean, I think, you know, it's a it's a room. The writer's room is like full of very, very strong writers. Um, uh, I don't think I'm necessarily unique in my dialogue because everyone's dialogue is brilliant, but, um, I what I love to do and think what I'm best at is, um, just like getting into people's ears and inhabiting characters in a really natural way that makes people on the page feel like real people. That's what I love to do. Um, many different aspects to writing, like, you know, structuring the story beat by beat in a writer's room with cue cards up on the wall is very different to sitting down and and running characters lines in your head and figuring out how they speak and what's going on in their heart. And that's the bit that I really love. And I think, um, I think. Well, I hope you can you can feel it in the dialogue that I created for that show. Yeah, yeah. For a long time, sci fi has been a really interesting genre to use, you know, fantastical ideas to, to express, you know, interesting or important themes about what's happening now. Uh, you see this with, with Dune two, which is also out at the moment, which is also, uh, which I would also highly recommend. And what are some of the themes within three Body Problem that you really gravitate towards, that you really think, oh, these are messages really worth expressing in the show. So, you know, humans have just found out that aliens are coming in 400 years, right? And, um, 1s but the show isn't about aliens at all. Um, it's about human beings. And it's, you know, for me, what I resonated with in the material and this comes from the books by Sitchin, which are just fantastical in their scope. Um, was this idea that was a question really is like, can human beings. Collaborate and cooperate when they face existential threat. And I think one of the reasons why this show has been really successful is because it feels like, and I think every generation feels like this, um, it feels like we are facing unique existential threats right now. Um, and, uh, you know, I've, I've seen it read into three body problem that, um, the aliens coming is a, you know, metaphor for climate change. Um, and, you know, climate change is a theme in the show. I don't think that's necessarily as sort of explicit top line, but, um, it certainly makes sense as an interpretation. Um, you know, in the episodes one and two that we, we show lots of deforestation. Um, yeah. When Jane invites the aliens because she feels like human beings are going to destroy the planet unless we have intervention. Um, but, yeah, I mean, I think, you know, impending aliens is is is a very broad metaphorical container for our fears right now. Um, which is why it was a fun, fun place to play as a writer. Yeah. And aliens always have been. In a way. Aliens, I guess, first became aliens, first injected into the popular culture right after we created nuclear weapons. And it's. I don't think that's, you know, a surprise. And I think, you know, among all the existential risks, climate change, pandemics, I think nuclear weapons, I certainly feel with particularly with the war in Ukraine, obviously, there's this rising feel of existential threat from World war, nuclear weapons, things along those lines and three-body problem. Definitely captures that sense of angst, that we can all feel that this could all go away very quickly, which is really a very new thing. It's only about 78 years old that any given human could feel like the entire world could collapse. I suppose in the past, as a person might think, okay, my society might collapse. But there's something categorically different about thinking the world itself may and as a result of human intervention. And it's you know, when I first interviewed for the show back in 2020, the boys asked me whether or not I was a sci fi fan. And I said, not particularly because I'm not. I love a bit of grounded sci fi, but like my background, you know, my reading background, my reading history is not in sci fi. But I said to them, what does interest me is metaphor. Um, and, you know, I, you know, metaphor has been really helpful to me in my healing from mental health problems as well. Like metaphor is like, um, comparing one or looking at one thing in terms of another. Um, and I. For me, metaphor is about integration and and and immersing myself in stories, um, and especially metaphorical stories was a really important part of, of of integrating my psychedelic experiences, um, of like staying open and exploratory rather than getting sort of fixed on another, uh, static idea about what my problem was. Yeah, absolutely. Absolutely. And what's, you know, it's so hard to succeed in a creative. Profession and you know anyone that is trying. You know, we're always looking to people who have achieved a certain level of success to try to learn from them. What advice would you give to someone who's either starting out as a writer or really in any creative field? What what advice would you give them as to how they can push forward? 1s Mhm. 1s Uh, I mean, I would say what Dan y said to me. Trust your intuitions like um. 1s It's when you do creative work. There's a lot involved. And it's not just it's not just the creating part, it's also the sharing part. And, um, the capitalizing part. And that last part can be very, very reductive. You're constantly find that your ideas are simplified and reduced down in ways that you can predict. And, um, that can be really challenging. But and it's it's also inevitable in the climate, you know, whether, you know, the reason I wrote the book is because it's a it's offers real authorship in a way that many of the media don't. Um, but even then, you know, you have to like you, you have to let go of a certain level of control. Um, and you can only do that if you really stay true to, like, your vision for the creative project and just, like, know that, um. 1s That the gatekeepers don't know your subject like you know it. So just stick to your guns. I'm just like, just. Yeah, just just keep going. Yeah. And I guess even with a book, you have a lot more agency, but you can't control how someone might interpret what you're saying or how they may react to what you're saying. You can't. And, you know, like, you know, for example, I even just like the editorial process, like having other people write about your work that is dictating the way your work lives in other people's minds, and you can't control that. And you have to sort of become more resistant to to that. Um, I was interviewed by a broadsheet recently and in like over an hour's conversation, I probably said one line about brain chemistry or something along the lines of, um, whatever these chemicals did to my brain, it was really powerful, and I've no doubt that I did say that. But that was the one pullout quote that they use in. And, you know, and it's like, you can't and it's not it's not false. Like that's you know, I did say that, but but just even like the way things are weighted, um, you know, yeah. You can't control that. But it's okay. Yeah. And even going back to our previous, uh, conversation about medical models and the way we pick out information, I think it's a it's a very human problem to see the world through a particular lens, to overemphasize certain aspects of what you're seeing and to under emphasize others depending on your beliefs. So, I mean, doctors will do that. Therapists will do that. And we're all just trying to. I think most people 1s have the best of intentions. We're trying to figure out the world, but perhaps there isn't sufficient realization that we have these kind of limited lenses that we're peering through, which, you know, can lead to quite. 1s Strong ideological positions, and it's really the dialogue between different positions. I think that can help us to continue to move things forward and and to arrive at more sophisticated understandings of, of complex problems. Yeah, I think so, I think so, I mean, it was Aldous Huxley talked about that process as a reducing valve, and that consciousness is constantly reducing the amount of information we can take in about the world at any given moment. And, and the information we receive is the information that's going to be helpful to us to survive. But, but but you know, he encourages us after he did this big well, he got into masculine, um, to uh, to remember that that valve is there and that what we're seeing is not necessarily, um, the, the, you know, the full scope of reality as it's available to us and that there are other ways of seeing. And I think that's yeah, that's why psychedelics can be really helpful in a, in a mental health conversation that feels very, uh, in entrenched and intractable. Does it feel intractable to you at the moment? It does. Yeah, it really does. Like, because it's, um, it, I don't know, like. 2s Our mental health system is in a really bad way, in my view. Um, it's not working. It's, um, you know, even treatments that we're told are evidence based. Just. Too often and not working for people. Um, and I think, um, a lot of people are chronically unhappy and, um. 2s You know, I don't, I don't think. The. I don't think psychiatry bears the responsibility for that. I think these are like very broad, like social problems that are leading to people's distress. But, um, I think, uh. 1s I don't know. It feels like psychiatry is also very resistant to innovation, um, because of because it's badly incentivized and because it's an industry. And I think people are suffering as a result of that. So, um. I am excited about psychedelics potential, but I'm also a slightly nervous because, you know, I see I don't see things being in a good state out there in mental health care. Yeah, I think that definitely very, very big problems within, particularly NHS in this country, mental health systems that need to be challenged and in other countries as well. And I think that informed, uh, criticisms, critiques of the way we do things like yours and the way we, uh, the way you outline things in your book. I think stuff like that's really helpful so that we can actually improve and get better and arrive at more sophisticated understandings of things. Yeah. I mean, the balance I was trying to find in the book was like, um. 1s You know, I am at times quite scathing of the medical model of distress and, um, what I see as like the excesses of psychiatry over the past few decades. Um, but also I wanted to try and do that in a way, as far as possible. That was like. Uh. 1s You know, compassionate to the people working within psychiatry who've been trying really hard for a long time to help. Um, and I don't think it's that, um, that, uh, people working in mental health care aren't skilled or they don't care or they're greedy, or they're just pushing biomedical agendas for profit. Like, none of that resonates with me. Um, and I've, I've read a lot of critical psychiatry literature and a lot of it I'm very on board with, except that I find the tone of it quite grating sometimes that it's, it's sort of it's sort of repeating the credulity that's part of the problem in the first place. Um, so, um, yeah, I guess the book is an attempt to, um, be critical, but, um, but yeah, in a sort of consulate consolatory way if possible. Yeah. And I think that comes across and I also think that change happens at different levels. I know many psychiatrists and other mental health professionals that I don't think they would largely agree with what you put in your book. And I think it's once you get sufficient individuals within a system who start to change their way of thinking that then the system, I think the system itself is usually the last thing to change. 1s Uh, and I, I think I, I remain quite optimistic about the future, but I do think that change takes quite a long time, because systems have a tendency to stagnate and to remain quite ossified until certain thresholds are reached. Well, I'm glad you're optimistic. That's. That's good. There are reasons for optimism. Yeah. Okay. Well, thank you so much for coming back on the show. I'd encourage everyone to read your new book once it comes out in a couple of days, whether you're a mental health professional or not. Uh, and we'll put a link to the book in the description as well. Amazing. Thank you so much, Alex. Thank you. Maybe we can make it a hat trick next time. Yeah, there's. 3s I. 8s Thanks so much for listening this week. If you've got any feedback, as always, do get in touch. 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