psychedelics

the-nature-of-consciousness,-and-how-to-enjoy-it-while-you-can

The nature of consciousness, and how to enjoy it while you can

Remaining aware —

In his new book, Christof Koch views consciousness as a theorist and an aficionado.

A black background with multicolored swirls filling the shape of a human brain.

Unraveling how consciousness arises out of particular configurations of organic matter is a quest that has absorbed scientists and philosophers for ages. Now, with AI systems behaving in strikingly conscious-looking ways, it is more important than ever to get a handle on who and what is capable of experiencing life on a conscious level. As Christof Koch writes in Then I Am Myself the World, “That you are intimately acquainted with the way life feels is a brute fact about the world that cries out for an explanation.” His explanation—bounded by the limits of current research and framed through Koch’s preferred theory of consciousness—is what he eloquently attempts to deliver.

Koch, a physicist, neuroscientist, and former president of the Allen Institute for Brain Science, has spent his career hunting for the seat of consciousness, scouring the brain for physical footprints of subjective experience. It turns out that the posterior hot zone, a region in the back of the neocortex, is intricately connected to self-awareness and experiences of sound, sight, and touch. Dense networks of neocortical neurons in this area connect in a looped configuration; output signals feedback into input neurons, allowing the posterior hot zone to influence its own behavior. And herein, Koch claims, lies the key to consciousness.

In the hot zone

According to integrated information theory (IIT)—which Koch strongly favors over a multitude of contending theories of consciousness—the Rosetta Stone of subjective experience is the ability of a system to influence itself: to use its past state to affect its present state and its present state to influence its future state.

Billions of neurons exist in the cerebellum, but they are wired “with nonoverlapping inputs and outputs … in a feed-forward manner,” writes Koch. He argues that a structure designed in this way, with limited influence over its own future, is not likely to produce consciousness. Similarly, the prefrontal cortex might allow us to perform complex calculations and exhibit advanced reasoning skills, but such traits do not equate to a capacity to experience life. It is the “reverberatory, self-sustaining excitatory loops prevalent in the neocortex,” Koch tells us, that set the stage for subjective experience to arise.

This declaration matches the experimental evidence Koch presents in Chapter 6: Injuries to the cerebellum do not eliminate a person’s awareness of themselves in relation to the outside world. Consciousness remains, even in a person who can no longer move their body with ease. Yet injuries to the posterior hot zone within the neocortex significantly change a person’s perception of auditory, visual, and tactile information, altering what they subjectively experience and how they describe these experiences to themselves and others.

Does this mean that artificial computer systems, wired appropriately, can be conscious? Not necessarily, Koch says. This might one day be possible with the advent of new technology, but we are not there yet. He writes. “The high connectivity [in a human brain] is very different from that found in the central processing unit of any digital computer, where one transistor typically connects to a handful of other transistors.” For the foreseeable future, AI systems will remain unconscious despite appearances to the contrary.

Koch’s eloquent overview of IIT and the melodic ease of his neuroscientific explanations are undeniably compelling, even for die-hard physicalists who flinch at terms like “self-influence.” His impeccably written descriptions are peppered with references to philosophers, writers, musicians, and psychologists—Albert Camus, Viktor Frankl, Richard Wagner, and Lewis Carroll all make appearances, adding richness and relatability to the narrative. For example, as an introduction to phenomenology—the way an experience feels or appears—he aptly quotes Eminem: “I can’t tell you what it really is, I can only tell you what it feels like.”

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mdma—aka-ecstasy—submitted-to-fda-as-part-of-ptsd-therapy

MDMA—aka ecstasy—submitted to FDA as part of PTSD therapy

Groovy —

If FDA approved, it would require the DEA to reclassify MDMA.

Girl with an ecstasy tablet on her tongue.

Enlarge / Girl with an ecstasy tablet on her tongue.

A corporation dedicated to studying the benefits of psychedelic drugs filed an application with the Food and Drug Administration this week for approval to use MDMA—aka ecstasy or molly—in combination with talk therapy to treat post-traumatic stress disorder.

If approved, it would be the first-of-its-kind combination treatment—a psychedelic-assisted therapy. An approval would also require the Drug Enforcement Administration to reclassify MDMA, which is currently in the DEA’s most restricted category, Schedule I, which is defined as drugs “with no currently accepted medical use and a high potential for abuse.” The category also includes LSD, heroin, and marijuana.

The public benefit corporation (PBC) that filed the FDA application was created by MAPS, The Multidisciplinary Association for Psychedelic Studies, which has been supporting this type of work since 1986. The application is based on positive data from two randomized, double-blind, placebo-controlled Phase III studies, which were funded and organized by MAPS and MAPS PBC.

The first study, published in Nature Medicine in 2021, involved a total of 90 participants with moderate PTSD. It found that MDMA-assisted talk therapy (aka psychotherapy) significantly improved Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores compared with participants who were given talk therapy with a placebo. In the second study, published in September in Nature Medicine, the finding held up among 104 participants with moderate or severe PTSD (73 percent had severe PTSD).

In both trials, participants took 80 to 180 mg doses of MDMA or a placebo at the start of three eight-hour sessions, which were spaced around a month apart. Between those experimental treatment sessions, participants also had three 90-minute sessions for participants to process the experimental experience.

MDMA—3,4-methylenedioxymethamphetamine—affects neurotransmitters in the brain, increasing the activity of serotonin, dopamine, and norepinephrine, to be specific. This leads people who take the drug to experience euphoria, hallucinations, sharpened sensory perception, and sociability, but it can also induce confusion, depression, and paranoia. Its use in psychotherapy has been explored for decades.

In a statement this week, MAPS PBC CEO Amy Emerson celebrated the FDA submission. “The filing of our [new drug application] is the culmination of more than 30 years of clinical research, advocacy, collaboration, and dedication to bring a potential new option to adults living with PTSD, a patient group that has experienced little innovation in decades,” she said.

MAPS founder and President Rick Doblin also celebrated the submission this week, saying in a statement: “When I started MAPS in 1986, the FDA was still blocking all research with psychedelics. … By breaking that barrier, we have opened doors for others to conduct their own promising research into psychedelic-assisted therapies with psilocybin, ayahuasca, ketamine, and more. The novel approaches undertaken in psychedelic-assisted therapy research have led to fundamental shifts in our understanding of how these devastating mental health conditions can be treated.”

So far, the MDMA-assisted therapy has drawn criticism for its expected inaccessibility. The treatment outlined in the two MDMA trials involves lengthy—and likely pricey—therapy sessions with highly trained therapists. The Washington Post published an estimated price of between $13,000 to $15,000 per treatment round, and it’s unclear for now whether it would be covered by health insurance if approved by the FDA. “Most people in the world won’t be able to afford these clinics,” Allen Frances, a Duke University professor emeritus of psychiatry, told the Post.

Now that the NDA is submitted, the FDA has 60 days to determine whether it will be accepted for review and whether it will be a priority or standard review (six months or ten months, respectively), MAPS PBS noted. MAPS is seeking a priority review. In 2017, the FDA granted MDMA “Breakthrough Therapy,” designed to help hasten the development and review of drugs for serious conditions when evidence indicates they may substantially improve upon current therapies.

The only psychedelic with FDA approval to date is esketamine, a variation of ketamine, which was approved in 2019 to treat treatment-resistant depression.

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