How to Change Your Mind

Pollan reports on the history and revival of psychedelic research, combining archival work with interviews with researchers and with his own supervised experiences using psilocybin, LSD and 5-MeO-DMT. The book covers the discovery of LSD by Hofmann, the 1950s and early 1960s research period when psychedelics were studied seriously for alcoholism and end-of-life distress, the collapse of that research after Leary and the cultural backlash, and the resumption of clinical trials at Johns Hopkins, NYU and Imperial College from around 2006.

The scientific material centres on the default mode network, the brain system associated with self-referential thought and with the sense of a continuous self. Imaging studies at Imperial College showed psilocybin reducing activity in this network, and Pollan connects that to the reported experience of ego dissolution and to the therapeutic results. He reports the Johns Hopkins trials on end-of-life anxiety in cancer patients, where a single supervised session produced sustained reductions in depression and death anxiety, and the smoking cessation results.

Pollan's own accounts are the part readers remember, and he is careful to describe them without claiming that the insights obtained under the drug are necessarily true.

The caveats matter. The trials are small, unblinded in practice because subjects know what they received, and conducted with intensive psychological support that the drug alone does not provide. Expectancy effects are hard to exclude. Pollan is a sympathetic reporter and gives less space to adverse outcomes, to the people harmed, and to the risks for those with predispositions to psychosis. Regulatory approval has moved slower than the book's optimism suggested.