BY Robert Taylor
Having heard Dr James Rucker speak previously at a number of engagements, primarily as part of a lecture series hosted by the Maudsley Psychedelic Society, I found he was a very soft spoken and thoughtful individual. Due to his role as a trained psychiatrist, I anticipated his personality to be introspective, thoughtful, and full of meaningful deductions about himself and the world around him. As an individual with a prominent position on the authors list of some of the most impactful neuropharmacological studies, however, I knew he would be a titan of topical and scientific knowledge, and my goal therefore as I walked to interview Dr Rucker would be to marry these two personalities into an approachable and complete individual for this piece, giving insight into the normality of such an exceptional individual.
Dr Ruckers background is one of extreme personal circumstance. “I had a severe depressive episode whilst in medical school, lasting around three or four months”, Dr Rucker stated. “Whilst this was a foundational experience for me, I was aware of the repercussions of such an episode, as depression runs strongly in my family”. I asked whether his episode drove his decision to enter psychiatry after medical school, which Dr Rucker affirmed after a moment’s pause. “I think perhaps I would have gravitated towards psychiatry regardless. But I originally wanted to be in urology, or an oncologist actually when I entered medical school.” Dr Rucker mused. “This depressive episode sort of orientated me towards trying to understand these very ineffable emotional experiences that we have that are so fundamental to our lives, driving everything we do – impulses of desire, despair and elation”. I asked whether there was a correlation between his interest in oncology and psychiatry, perhaps the raw emotional component that underlines both these diseases. His reply surprised me. “I was born in 1970,” he stated. “Just about the point when personal computers were entering the public consciousness. I remember having a Texas Instruments computer. It must be noted that depending on the sociocultural context, the analogies for the brain change. At first it was seen as a steam engine, generating will and motility, then it became the computer, and now as we are moving onto quantum ideology and computing perhaps a new, better metaphor will take its place. For me the computer is a perfect analogy for my means to an end, and that gives us a little bit of an insight into the way the human brain works, and how our moment by moment experiences now are almost predicated on our previous experience.”. I clearly looked a little confused, as he then continued: “Just like with the early computers, the relationship between the operating system and the executable programmes was much more obvious, however now that computers have got more complicated, so has the degree of separation between the most basic of code and the output. The same idea works in biology, with underlying genetic code clearly having an immense impact on the perceptual world a human resides in. On a more basic level, we understand to some extent the relationship between genetics and evolution of cancers, however the brain is a touch more complex.”.
Hereby, Dr Rucker made clear the difference between a computer and a human brain – the human brain has a means to influence its own underlying code.
Dr Rucker is absolutely correct that experts are to this day somewhat perplexed by the complexity of interaction between biology and perception. Currently according to NICE guidelines in the UK, depression can be identified by a GP through use of questionnaires designed to determine the existence of self-reported mood symptoms, and first line pharmacological treatment may be initiated. Despite this ease of diagnosis, a significant portion of major depressive disorder patients do not recover within a year, especially in groups with particular risk. Furthermore, utilising non-specific treatments as well as trial and error management schemes can bring distress to patients, as well as prolong their illness, in a field where early intervention remains the best predictor of recovery. “I had psychoanalytic psychodynamic psychotherapy which I found to be uniquely powerful,” Dr Rucker continued. “It took 2-3 years, but it blew my mind at how successful a tool this method was to me. It showed me the importance of attending to not just what is out there, but opened up a world inside of me and showed me the importance to attending to ones own mental state too.” The point Dr Rucker was making was clear – personalised approaches, allowing for not only a unique pharmacological, but also psychodynamic intervention, was the future for a field that often relied on a one-size-fits-all approach. Hereby, Dr Rucker made clear the difference between a computer and a human brain – the human brain has a means to influence its own underlying code. Modern personalised medicine approaches suggest a new method of treatment, in which use of genetic and biomarkers as a diagnostic tool in a per case basis would allow front line physicians to assess the likelihood of responding to individual treatments, negating time-consuming and dangerous medication changes.
What Dr Rucker was advocating for was the ability of drugs to not just affect our brains but to change our minds, thus manifesting an inherently personalised approach to treat mood disorders.
“My intellectual fascination is the way that drugs can affect the brain and therefore affect how and what an individual can feel, think, and believe,” Dr Rucker continued. “Drugs affect elements of our consciousness that we then struggle to describe in words, things that we all experience and are central to our experience as conscious beings but however are beyond the grasp of language”. This explanation was a significant deviation from the psychiatric doctrine of just a few decades ago, in which drugs were regarded as tools to influence the inner machinery of our brains. What Dr Rucker was advocating for was the ability of drugs to not just affect our brains but to change our minds, thus manifesting an inherently personalised approach to treat mood disorders. I ask which specific drugs showed this potential and why previous pharmacological interventions had failed to be as effective as once hoped. “Drugs like psychedelics” he replied, “have a property that doesn’t allow them to be described, leaving them to be less traditionally intellectual but giving the experience a challenging mystical aura. The non-verbal stuff that exists between us but is hard to get at but really does touch the core of who we are and our relationships”. I ask whether drugs are necessary for such an experience, and Dr Rucker replied: “In the Maudsley, you see people who have no hope with traditional methods, for example, drugs, therapy, ECT and more holistic methods such as yoga and meditation. This begs the question as to the nature of the disorder, and how much more dynamic and susceptible to experiential changes it can be in different individuals”.
“Drugs affect elements of our consciousness that we then struggle to describe in words, things that we all experience and are central to our experience as conscious beings but however are beyond the grasp of language”.
I ask him what his own experience is with more holistic methods, as he previously stated the importance of psychotherapy in his own recovery. Do activities that encourage mindfulness have the potential to fill the niche that psychotherapy, and potentially psychedelic drugs, hold? “I got into Yoga, which has actually been part of my life for many, many years,” Dr Rucker replied excitedly. “I think all of these holistic methods, as well as reports of these psychedelic medicines, made me curious about how our bodies and our brains interact with our environment. I always found that after a few years of psychotherapy, I was able to extract myself from needing antidepressants to maintain a stable perception of the world. Questioning how I am in control of this allows you to build your relationship with yourself and your conscious experience, and affect how you are feeling”.
Clearly, holistic methods promoting mindfulness work in a different manner to classically prescribed drugs, spurring a more long-term shift in cognitive control over one’s own condition. This effect is in line with how psychedelic drugs are thought to function too – promoting plastic changes in connectivity to dissolve potentially harmful circular thought loops under the right conditions. Furthermore, the well-documented dissolution of the default mode network; a collection of functionally connected regions in the brain thought to be correlated with the emergence of the ‘ego’ during psychedelic experience is thought to be responsible for the unique feeling of ‘oneness’ associated with loss of boundaries between the self and the environment. This effect is perhaps the most well documented within both scientific literature, as well as traditional recounts of religious ceremonies involving alkaloids such as N,N-Dimethyltryptamine (DMT) in the Amazon, and Ibogaine found to be used by tribes within the Western Sahara region of Africa. These effects seem to expedite the process Dr James Rucker described when discussing the potential for holistic approaches to treatment, meaning long-term changes can be facilitated whilst undergoing treatment via psychedelic medicine.
I asked Dr James Rucker as to how he found himself researching the effects of psychedelics on patients with treatment-resistant depression: “I was asked to be a psychiatrist during a medical trial at Imperial using psilocybin,” Dr Rucker remarked. “I took part in this whilst undergoing my higher psychiatric training to be a consultant. I signed the first legal prescription for someone to be administered psilocybin in May 2015 which was a bit of a personal step, as well as a large leap in the history of drug policy liberalisation.” Clearly this was a huge step in terms of a shift in the public and governmental perception of psychedelic drugs, as despite the UK government still classing both psilocybin and LSD as having no potential for clinical value, licenses for research on humans were finally being granted. Currents are shifting in the US too, as demonstrated by the number of scientific journal articles being published on effects of psilocybin across time (see above).
“I got to know the patients we were attempting to help quite well, as I was able to interact with them whilst they were in a very impressionable state. Some of them did amazingly well, especially some who were intractable with misery and depression, and some of those are well now, which is an outcome that sounded impossible for them with traditional methods of treatment. As a result of this, and because I had a PhD and was so struck by this outcome, I had the opportunity to apply for my own grant at the IoPPN leading the Psychedelic Trials Group to investigate the safety and efficacy of psilocybin in healthy controls and patients.”.
I was very curious to find out why psilocybin had been chosen as the target for such a leap of faith. Clearly, due to social stigma and the Government’s cautious approach to allowing for this kind of research, researchers had one shot to prove that their hypotheses were not just deluded pipe dreams. The choice of drug therefore had to be extremely cautious and safe, and LSD seemed like the obvious choice due to its known safety and relative ease of synthesis, first being synthesised by Albert Hoffman in 1938. Dr Rucker however rebutted this point by simply saying: “Three letters – L. S. D”. Clearly this was not a scientific decision, but rather a social one. Dr Rucker once pointed out in a lecture preceding Bill Richards talk at the Maudsley Hospital that the worst enemy of good science was a Daily Mail headline. It quickly struck me that researchers such as Dr Rucker, as well as Robin Carhartt-Harris from Psychedelics Research Group at Imperial, were playing 4D chess, tasked not only with identifying the useful elements of psychedelic medicines, but undoing 60 years of political establishmentarianist attack on people who brought psychedelics to the societal zeitgeist. This was not all smooth sailing, as Professor David Nutt, Edmond J Safra chair in Neuropsychopharmacology at Imperial College, was dismissed from his position as Chairman of the Advisory Council on the Misuse of Drugs (ACMD) after publishing a pamphlet urging for drugs to be classified by their actual physical and societal harm. Clearly a more gentle approach was necessary to protect the field from poorly informed tabloid press, and the approach taken by future researchers such as Dr Rucker was far more cautious.
The process Dr Rucker and colleagues within his field have to go through to make research both adequate in its scope, as well as cautious in its nature, is exhaustive and tedious. I asked what the process for obtaining drugs such as psilocybin was in the UK, and whether now that he was a trusted individual it was somewhat simpler: “Well I don’t pick the mushrooms in the forest if that’s what you’re asking!” Dr Rucker laughed. “Around the time I received the grant for my research in 2017, I was approached by a private company called Compass Pathways who wanted to supply the psilocybin. Big Pharma doesn’t want to engage with psilocybin research because they can’t patent it, however Compass Pathways is investing in the system of treatment with psilocybin, rather than the drug itself. The process for keeping psilocybin within a research institute is still very laborious and somewhat bureaucratic, however now that the Home Office have supplied me with a license, it is much easier to obtain the drugs necessary”.
When I asked about the next steps, Dr Rucker was cautious to give too much away, clearly his distrust of the media extends even to student magazines: “Plasticity studies in animals are the next big leap I believe.” He replied. “In some ways, we are looking at the clinical effects before we are even aware of the mechanisms behind the observations we make in human studies.” Clearly his approach worked, as longitudinal data on cohorts exhibiting treatment resistant depression show significantly improved outcomes even 6 months on from psilocybin treatment.
I came away from our meeting acknowledging that the individuals in charge of finding a solution for the mental health crisis that is causing a tremendous amount of lost productivity within our society not only have our best interests in mind, but are actively seeking to alter the status quo. These people are passionate and practical, acknowledging the challenges of science and public relations, dodging malicious and uninformed opinions alike to bring truth and clarity to the forefront.