The Psychedelic Psychiatrist: An Interview with Graham Campbell

Graham has been interested in the therapeutic potential of psychedelic drugs since the late 1990s. This naturally evolved from his early interest in the interpretation of dreams, hypnosis and psychoanalysis.

He qualified as a doctor in 2003 from the University of Birmingham and trained in psychiatry from 2006. In 2012, he was awarded an MSc in Neuroscience with distinction from Kings College London and focussed on the role of inflammation in the aetiology of depression. He worked as an NHS inpatient consultant psychiatrist from 2012 at Mill View Hospital in Hove and trained with Imperial College London in February 2018 to work as an assistant guide for the trial comparing psilocybin with escitalopram for depression.

In March 2019, he helped set up the Brighton Psychedelic Integration Circle and was instrumental in organising educational events around psychedelics at Brighton & Sussex Medical School later that year. In 2020, he decided to leave the NHS after 17 years to devote himself full-time to psychedelic therapy research.

He now works as the Study Psychiatrist for a trial investigating N,N-dimethyltryptamine (DMT) as a treatment for depression. He is also a member of the advisory council for the Institute of Psychedelic Therapy, led by Maria Papaspyrou and Tim Read.

Q: How has music impacted your life?

A: Music has always been important to me. I was introduced to Jeff Wayne’s ‘War of the Worlds’ and English folk music on long car journeys as a kid. I tried to play some instruments and was a big fan of Queen before my teenage years. In the early 90s, I got into grunge before my rock tastes veered into the psychedelic realm.

Pink Floyd brought in the synthesisers and the influence of LSD. Their music triggered my curiosity around the creative and transformative power of LSD alongside the personal story of their band member, Syd Barrett.

Saturday mornings was about ‘The Chart Show’ on ITV. I loved Orbital (‘The Box Part 2’) and Depeche Mode music videos (‘Barrel of a Gun’ / ‘Enjoy the Silence’). These two groups took me into electronic music. It was then Mary-Anne Hobbs and John Peel on Radio 1 who introduced me to artists like Boards of Canada, Autechre, Luke Vibert and Aphex Twin. Warp Records artists have formed the trunk of my musical tree ever since.

I won’t be alone in saying that my adult life has been soundtracked by music; I use it as medicine, expression and a means of escape. Sometimes I use it to ground myself, find home and reconnect with myself again. No day goes by without music.

Over the past 23 years, I’ve tried to make electronic music when I’ve had the means, motivation and time. I’ve never found it easy and, when I started working as a consultant psychiatrist in the NHS, I often didn’t have the time or the head space. A few years back, I came to the conclusion that I didn’t want to get to the end of my life without being able to express myself with drum machines and synthesisers. I dedicated more of my life to getting to grips with the technology and messing about with machines.

Autechre with their gear

In October 2019, inspired by Jeremy Deller’s ‘Everybody in the Place’ documentary, and discussions with patients/colleagues, I led the formation of ‘Modulate’, a MIDI-synchronised therapeutic electronic music jamming space for people recovering from mental health challenges. We ran these groups fortnightly at Mill View Hospital – Brighton’s NHS psychiatric hospital - for people admitted to our wards.

The electronic music scene often espouses a philosophy of togetherness and tolerance; it’s what I’ve experienced as a listener and producer. Modulate inspired people and helped us relate to each other, patients and staff, in a way that side-stepped the usual dynamics in an acute mental health setting.

The energy of these groups kept them running until Covid pulled the plug. After a long pause, Modulate is rebirthing in the community – an audio-visual phoenix from the ashes! We’ve held our first pilot group in our new home at The Brighthelm Centre in central Brighton – long may it continue.

Q: What is your opinion on SSRI treatment for depression?

A: In my previous role as an NHS psychiatrist, I’ve seen SSRIs play a role in helping people come back from the edge of very serious mental health crises. I have also had a positive experience of being prescribed escitalopram myself. SSRIs can be very effective medicines and, if we get to the stage of having fully evidence-based psychedelic therapies, I believe that SSRIs will still have a role in the treatment of depression and anxiety.

Having said this, I sometimes worry about our relationship with psychiatric medicines, particularly SSRIs; society’s dependence on them and the dominant philosophy of managing symptoms with less emphasis on understanding suffering in the context of the person’s life. They are probably over-prescribed. 17% of the UK population have had at least 1 prescription for an antidepressant issued (and dispensed) over a 12 month period. A proportion will not go on to take them (or take them for a few days before discontinuing due to side effects). Also, the figure does not discriminate between the many, many people who are prescribed antidepressants for reasons other than depression, e.g. amitriptyline at sub-antidepressant doses for pain or insomnia. It would be interesting to see a breakdown of the figure by clinical reason, but the problem is that prescription data is not routinely linked to the clinical reason for prescription in the UK!

My years of working with people in acute mental health crisis has strengthened my belief that our minds are highly complex, dynamic prediction and learning systems. Psychiatric medication is often helpful in restoring balance in the activity of our brain networks when we need it most, especially during episodes of severe mental illness and extreme crises. However, the richness of our minds, life experiences, and the meaning that permeates everyday existence, warrants a broader range of therapeutic interventions when people are struggling.

Q: Which books have had the biggest influence on your thinking?

A: Always the first books that come to my mind are Rodolfo Llinas’ ‘I of the Vortex’ and Douglas Hofstader’s ‘I am a Strange Loop’. They both amplified my fascination with neuroscience and complex, self-referential (nervous) systems. I’m often reminded of these books when thinking about consciousness and psychedelic neuroscience.

Dan Merkur’s ‘The Ecstatic Imagination: Psychedelic Experiences and the Psychoanalysis of Self-Actualization’ was the book I read back in 1998 that started my interest in the psychotherapeutic potential of psychedelic experiences. I remember it being quite dense but I was in my first year of medical school with only a Psychology A-Level to help me. This, alongside Timothy Leary’s autobiography ‘Flashbacks’, helped me understand how psychedelic experiences could improve mental health in the right context.

Q: You worked as an assistant guide for Imperial College’s Psilodep2 trial. What did you learn from this experience?

A: This is a big question!

I’ll answer with the first things that come to my mind.

First, clinical trials are complicated but I like the systematic approach to producing evidence open to analysis in an increasingly post-truth era. However, it is difficult for trials to be perfect and their limitations are usually open to scrutiny.

I was struck by how much time, energy, organisation and money trials need. They are massive undertakings to which a few sides of A4 paper don’t seem to do justice.

Working with the Psilodep 2 study also helped me understand just how different the approach of psychedelic therapy is. The complexity of our consciousness, coupled with the non-specific amplifying effects of psychedelics, make careful preparation, therapeutic rapport-building, care with the setting, skilled support and integration crucial to increase the likelihood of a therapeutic effect from these experiences. These elements may be quite easily overlooked in mainstream discussions around the benefits of psychedelics. This could increase the chances of under-supported use in unreliable settings and give the public the unrealistic expectation of a straightforward, drug-induced ‘reboot’ of their mind.

Another discovery for me was the concept of ‘inner healing intelligence’ and the aim of working with this (instead of the doctor or therapist being the source of healing intelligence). There were times during supervision discussions, where this process, occuring within the participant, was quite apparent. With life being a self-organising principle, and our brains being exquisitely complex learning systems, it made sense to me that the primary source of healing could be inside each of us.

Psilodep 2

Q: For anyone unfamiliar with psychedelics, how would you explain what DMT is?

A: DMT is a psychedelic drug that is very similar in structure to psilocybin and serotonin. I think of the experience as a powerful hyperconnected state of the mind/brain; one that radically changes the flow of information, subjective conscious experience and connects the experiencer with deeper parts of themselves.

As with most psychedelics, DMT experiences often defy attempts to transmute them into words. There are many ways of describing it and, accepting that there are sometimes similar themes between individuals, everyone’s experience is unique to them.

People can have deeply immersive experiences of travelling out of their physical bodies to new realities. Sometimes these spaces contain rich symbolism, interactive ‘entities’, deeply meaningful messages and very tangible multi-sensory and embodied feelings. Emotions can surface and may include fear, anxiety, elation, awe, deep love or a profound journey through a range of feeling states.

The fact that the experience may last half an hour in its entirety, with rapid metabolism of the drug by our helpful monoamine oxidase (MAO) enzymes, means that it could have utility as a psychedelic antidepressant treatment that doesn’t take a whole day. DMT may then be easier to incorporate into modern healthcare systems (if the evidence from clinical trials supports this).

Q: What excites you most about being the psychiatrist for the first clinical trial of DMT for depression? What should we expect to see from this trial?

A: I feel truly grateful for the opportunity to be the first psychiatrist to legally give DMT with therapy to someone with depression. I’ve worked with many patients whose depressive illness has been very difficult to treat. They have often felt stuck; disconnected from their feelings, from themselves, loved ones and from the world. If psychedelic therapy can truly offer another treatment option for depression, I very much want to contribute to the effort of making it licensed and available for the alleviation of human suffering.

Despite missing my colleagues in the NHS, who are still doing incredible work, I really enjoy working with the team at Hammersmith Medicines Research, including Michelle Baker Jones (lead therapist), Dr David Erritzoe and Dr Chris Timmermann from Imperial College, and the wonderful team at Small Pharma (the study sponsor).

I love my cycle/train commute from Brighton to London too. I’ve never done so much exercise in my life. Only my daily paper round as a teenager comes close. I’ve found that flipping out of my default mode network whilst winding through London traffic is actually quite meditative.

As the trial psychiatrist, I think I have a healthy dose of open-mindedness about the antidepressant activity of DMT. Of course, we all want it to work - there wouldn’t be a study if we didn’t - but as a clinician, the last thing I would want is the promise of another treatment that doesn’t really help my patients. Having said that, I’m hopeful and really encouraged by our experiences so far.

Q: You’ve said before that “Psychedelic therapy needs to get ahead of the sorry curves previous radical treatments have shown.” What do you mean by this and why is this such an important issue within the psychedelic space?

A: There are two aspects to this. Psychiatry has a history of experimenting with unpalatable treatments with the aim of treating very severe conditions. Like many areas of life, harm can result from a desire to help. The whole psychedelic research and commercial community must approach the treatment of mental health conditions with wisdom, maturity and responsibility. I think the vast majority will.

The second aspect is the over-exuberance that can happen with new treatments. This may lead to an under-appreciation of side effects. SSRIs have gone through this trajectory. Whilst I believe they are important medicines and help many people, a lot of people don’t achieve full remission and expectations for them are often too high.

If the evidence continues to be supportive of psychedelic therapy in larger (Phase III) trials, these treatments may help to change the conversation around depression and addiction, with greater appreciation of life experiences in their aetiology. Psychedelic therapies may also help to heal the divide between psychiatry and psychotherapy as we rebuild a shared focus on the individual from biology to spirit.

Q: What is the Brighton Psychedelic Integration Circle and how does it work?

A: The Psychedelic Society of Brighton was started by Dylan Burns and Maria Broderick in 2016. After the successful launch event, it continued to late 2018 as a book group before shifting focus to more therapeutic aspects of psychedelics in early 2019.

We took inspiration from the Psychedelic Integration group facilitated in London by Michelle Baker Jones and Rosalind Watts. This happened monthly in Hackney Wick and offered a space for people to discuss challenging psychedelic experiences in a supportive and non-judgemental group setting. Prior to this, I had never witnessed such a rich, dynamic and beneficial group. The emphasis was on integration and growth, as well as incorporating wisdom from the group around harm minimisation and self-care.

Travelling to London for these groups, and the psychological supervision sessions for Psilodep 2 (supported by Tim Read), became regular pilgrimages for me. The effort involved meant that bringing psychedelic integration to Brighton was a simple decision.

The original group was me, Dylan Burns, Maria Papaspyrou, Renée Harvey, Martin Lunn, Greg Donaldson – all therapists and psychologists. We met monthly in the centre of Brighton with attendance of up to 18 people in total. Each circle confirmed our collective belief that providing space for those discussions was valuable for people. They helped build a sense of community and mutual support.

Of course, Covid made it hard to continue during 2020 and we were initially hesitant to try and replicate the circle online. However, we continued with groups (when lockdown easing allowed), with one group nestled on Brighton Beach when a jammed lock barred us from our venue. Our circle is evolving with wonderful new facilitators in Rebeca Bandiera, Tom Schutte and Jocelyn Rose. We now have a mix of online and in-person sessions every 3-weeks.

Q: Do you think the ‘Psychedelic Renaissance’ is all hype and wishful thinking? Where is this field heading?

A: Psychedelic use is on the rise, according to the Global Drug Survey, and many more people are talking about these substances on social media. If you add all this to the massive financial investment that the psychedelic industry is attracting, it is quite natural that there will be hype and some grand claims.

One such claim by Paul F. Austin from The Third Wave is that microdoses of psilocybin mushrooms with other botanicals, will likely become the predominant form of psychiatric medication by 2030, overtaking conventional pharmaceuticals, used to treat depression, anxiety, ADHD and bipolar affective disorder (BPAD). Whilst I’d like it to be true that very low doses of plant-based medicines could replace antidepressant, antipsychotic and mood-stabilisers, it is a bold statement in light of recent evidence against the efficacy of microdosing a psychedelic. This claim, if taken seriously, could encourage people managing BPAD to stop mood-stabilising medicine in favour of psychedelics. I couldn’t counterclaim that people with BPAD could never benefit from a psychedelic experience, but I have supported a number of people whose mania with psychosis was significantly linked to ayahuasca or LSD use.

Whilst availability of psychedelic medicines for mental health conditions in the UK relies on Phase III trials, people have used psychedelics for thousands of years to open expanded states of consciousness. Many have experienced benefit from research experiences in the 50s/60s, (illegal) underground psychedelic therapy, retreat centres, and careful personal use.

I believe in a future role for psychedelic therapy alongside our traditional approaches to mental healthcare. This would help widen the Overton window within mental healthcare towards more trauma-informed understandings and approaches. But there must be a mature and responsible approach to care with psychedelics; it will go wrong if we try and bend them excessively to fit our existing models of care. Cost pressures may naturally lead to a whittling away of the therapeutic container; screening, preparation, support and integration. Organisations offering this therapy will have a responsibility to preserve very high-quality care without diluting the humanity of this approach.

One important development is the recent creation of the Institute of Psychedelic Therapy (IPT). This has been created for training and the professional development of psychedelic therapists in the UK. IPT has been built from the ground up on the principles of ethical practice and deep relational psychotherapy. There is a strong spirit of shared learning, support, and accountability. I feel reassured that this organisation exists and I think it will become a steady beacon of safe and ethical practice as the field advances.

If the MHRA and EMA review the evidence favourably, I would like to see dedicated psychedelic therapy centres, all accredited and connected with the communities they serve. I also hope that these treatments can be offered for free, or at significantly reduced cost, on the National Health Service, complete with the time needed to support patients therapeutically.

People need to have choice with mental health treatments; there is no single best approach. Antidepressants will continue to suit many people if they find them tolerable, effective and the right approach in the context of their lives. Those same individuals may later decide that they want to engage in deeper exploration of themselves and their experience of the world, managing their mental health condition without regular medicines. Having more options available for people clearly contributes for a more patient-centred philosophy. 

Psychedelic medicines provide us with an exquisite opportunity to bring together neuroscience, psychiatry and psychotherapy to treat mental illness, offer healing and facilitate personal growth. They may be medicines that help to free us from the avalanche of psychological suffering affecting our societies.

Let’s follow the science and find out…

Institute of Psychotherapy