Cannabis & Psilocybin: New Avenues In Sleep & Wellness

Lida Fatemi, DO, MPH

Thank you so much for having me. Dr. Wells.

Audrey Wells, MD

It is great to talk to you because I think the work that you are doing is cutting-edge. We are going to talk about CBD and psilocybin in the context of sleep today. I want to start with CBD, which is something that I get asked a lot about because as more and more states incorporate cannabis and even cannabis, including THC with CBD, into their legal systems, I think people are curious about what effects it might have on sleep.

Lida Fatemi, DO, MPH

Yes, it is a wonderful question, as we are seeing this resurgence of plant medicine come about for therapeutic benefits as used as medicines. Dr. Wells, today I am going to tell you how little we know about plant medicines and how they affect our bodies in general, especially when it comes down to sleep. As we know, sleep is the foundation of our well-being. I do have a lot of clients and patients who end up using cannabis, and I looked at the research regarding CBD and cannabinoids in general cannabis. What we are seeing are the categories of the species that we talk about: the sativa species and the indica species. If you go to any dispensary, they are going to categorize them as such. I am not going to get into the weeds of why they were called such. We are just going to go through the overview of what we are seeing. 

One sativa tends to be more of an opiate, so you do not want to use that at night. The more indica species, the more of the downers that you can use closer to sleep time. Now, I have a lot of elderly patients because I do hospice medicine as well as palliative care, and a lot of them have sleep issues and pain issues. When you look at it in conjunction and you are trying to use something more natural to help the patient with their pain, we see that it also affects their sleep positively because they are not in as much pain. CBD itself is anti-inflammatory. Now there are other subtypes. There is also CPG, which is anti-inflammatory and very good for pain. If I have patients on opioids, which I do very often in hospice, research has shown that when you put the two together, the cannabis product plus the opioids, there is a synergistic effect. Therefore, it helps the patient sleep better at night. 

Now looking at, if we have randomized controlled trials, double-blind, we are, there is one study that is coming out. It is still the study design is up, but it is not completed yet. They are looking at CBN. If I were to tell you a particle product to use, I would be lying and say, Do not use that only extract go for the entire plant. All plant-based medicines are the best. anecdotal from my clients and patients, what I hear is a CBN helps them at night to sleep. I am super curious to look at the sleep architecture when we use these plant medicines. I am curious, if you do not mind sharing your expertise if you have seen or if you have seen studies looking at the sleep architecture regarding plant medicine, specifically cannabis.

Audrey Wells, MD

That is such a good question. I think it is something that underscores the cutting-edge nature of plant medicines for not only sleep but also things like pain, PTSD, and trauma. For me, when I look at somebody who has a sleep problem, oftentimes there is a competitor for sleep. I mentioned pain and PTSD. Anxiety is another big one, so common. I think it is very attractive to think of a natural remedy for that, which is why the cannabis question comes up so much. There is not a whole lot known. To your point, the research is relatively scant in terms of how cannabis affects one’s sleep. 

But I can tell you that there is probably a great deal of personalization on the table, so people will need to do some trial and error to find out what works for them. I generally recommend a higher CBD ratio over the hallucinogenic component THC. But people who respond well to it tend to like it. They tend to work out a minimal dose that helps them to sleep well, and they tend to notice that it does not cause a lot of the hangover effects that are associated with some over-the-counter medications or even the long-term cognitive impairments associated with the use of prescription sleep aids. I do see it as an option for folks who want to improve their sleep. I am so happy to have your collaborative experience as well.

Lida Fatemi, DO, MPH

Yes, no, I love that. It is just all about discussion and collaboration. We learn the best that way. It is also interesting that we see an entire endocannabinoid system within the body. We have CB1 receptors and CB2 receptors that are modulated based on what is happening with the being, and everyone is different. You cannot just map out 50 people and say, This is how it is because it is constantly CB1 receptors, which are predominantly in the brain; they lessen in numbers or different cells, and then they show themselves depending on how much an individual’s also using cannabis, which is fascinating. It is this constant movement, and we are so alive. There’s always change happening within us. To be concerned and considerate of that, I think is important because we do see that as CB receptor owners and the cannabinoid system changes. It also changes with depression, anxiety, pain, and so forth. Yes, this field is in its infancy from a research standpoint, and that is what makes it super exciting. 

Audrey Wells, MD

For sure. I am excited about it. I want to say that too, no matter what treatment is discussed for aiding in sleep or aiding in end-of-life care, I know you are experienced with PTSD, trauma, pain, etc., no matter what intervention we are taking. I think it is always great to have the pillars of good, healthy life practices supporting that. What I mean is; good sleep practices, healthy nutrition, and plenty of physical activity. We need those things not only to be well-functioning human beings but also to support the treatments that we are going to talk about today.

Lida Fatemi, DO, MPH

Absolutely. In fact, in my coaching program, as you mentioned, it is psilocybin-assisted coaching. But really, the plant medicine comes in as one of the tools. It is not everything. It is all of what you talked about and many more tools that we implement into our lives. We understand the research behind it. There is so much benefit to optimizing our neurobiology, our physiology, and also the part that we, a lot of us, forget to talk about is our spirituality because that path of self-discovery is what it teaches us the most. Having a guide help us with that is essential. 

Also, through that, we have been connected with our community at large, which we also see huge health benefits from, all of which cause mortality, including cardiac mortality. There is a lot of great data behind that decrease in all-cause mortality by 35%. Having a community that you feel connected to means you can pick up the phone whenever you are in trouble, and you have 12 people picking up the phone and trying to help you out. Those are all really, really foundational to our overall well-being in life.

Audrey Wells, MD

It makes so much sense, and I am really glad to hear you put a number to it, too, because that helps me understand that people have looked into this. It has been defined. One of the things I want to explore with people who have sleep problems is their relationship with themselves as they lie in bed at night, in the cold, the darkness, and the quiet. Sometimes that is the first time out of all of the time in the day that people have some white space to let their brain run freely. But that can be problematic for people who have trouble with insomnia, and for those who suffer from sleep apnea, these nighttime awakenings to breathe and to bring their blood oxygen levels back up can induce a stress response that makes it difficult to get back to sleep. One of the things I talk about is your emotional status. Whatever you are feeling in your body and also in your mind at the time of trying to get to sleep is important to make it into that loss of consciousness that we understand as sleep.

Lida Fatemi, DO, MPH

Yes, absolutely. If you are an avid meditator, versus if I have never sat for 5 minutes because my thoughts are just, everywhere, or just breathing, that is one of the very important physiological things we do automatically that we are not conscious of. As soon as you bring conscious awareness to it of how to breathe and how to breathe so that we can get into our parasympathetic side because the majority of the day we are in a sympathetic, overstimulated state. and I think the days that I was an academic hospitalist, I would say, and I did look at the time and all of that to see how much of the time I felt sympathetic throughout the day. 

At the beginning of my seven days, I was more calm. because I have all these life practices that are still working and seeping into my daily practice, and then by the end of the seven days, day five, and on, it would be much more difficult to keep that equilibrium in my autonomic nervous system. I would feel like being in that sympathetic, overstimulated state for almost 100% of the day. Of course, my nighttime sleep was affected. That anxiety just thought, Did I do the thing for the patient? Did I tell the resident to do this, or did I teach enough, whatever it is that internal dialog is, it translates, and we know about brain waves. As we are in the high beta waves throughout the day, we cannot or do not know, what tools to utilize to go into the alpha waves so that we can land nicely in a sleep state. Then sleeping is going to be an issue.

We see that in all psychiatric illnesses, I do not want to call them illnesses just because we make diagnoses based on symptoms. In recent years, in my research, in all the wonderful books and research that I have come across and with the psychiatrists I have spoken with, mental discomfort or suffering all stems from trauma, past trauma that we have not examined, or it has just been too much to examine and go there. Once I see us move through those traumas of the past and bring in self-love, then I see people’s sleep get much better because that is an essential tenant in my coaching program that it also teaches people.

Audrey Wells, MD

That is amazing. I have always thought it was a little bit ironic that the sympathetic nervous system sounds so pretty. It sounds nice and sympathetic. But that is the fight-or-flight nervous system, everybody. This is the agitation that we need to draw on when there is a threat in our environment, and in the modern world, it does not work so well. Oftentimes, people stay in that highly vigilant state for longer periods than is necessary because of the way we respond to modern stimuli. 

I think one thing that I have always noticed, and I am proud to call you a friend, is that you are so deliberate about helping somebody with their personal growth out of respect for medication. These are plant medications that we are helping someone get an effect from. Whether you are talking about cannabis or CBD or the plant medication psilocybin, these need to be administered very intentionally on a backdrop of self-growth, awareness, and moving forward, cultivating those principles as somebody goes through treatment with these substances. I want to transition to psilocybin now for people who are not aware. Can you give some background on how psilocybin is used?

Lida Fatemi, DO, MPH

Absolutely. This is my favorite subject. Psilocybin is an active compound, a psychoactive compound found in over 200 species of mushrooms. It is a tryptamine in its chemical structure, and it has been utilized since ancient times. In ancient Greece, if you want to look at the Eleusinian mystery rites. Where women, who were healers, were considered healers in their society at the time and in their community. They would create these medicines. There would be mystery rites a few times a year where they would bring people out of the community. The philosophy, the philosopher’s communities. 

Well, if you look at the historical evidence, you will see that Plato, Plutarch, Socrates, and Aristotle were just a few of the philosophers who went through these Eleusinian mystery rites to gain insights into their higher selves, expand consciousness, and also bring healing into their communities. They went through these rights. There is a wonderful book I long to read called The Immortality Key: The History of a Religion With No Name. He goes into depth about the research and the evidence behind all of this. But we do see evidence from even 9000 years B.C. in Algeria on wall arts that they were using psychedelic mushrooms, or psilocybin mushrooms, at that time for conscious expansion. There is the Stoned Ape Theory, where Terrence McKenna talks about apes using psilocybin mushrooms to expand and be able to communicate. Connection is a really big thing that we see when we use psilocybin mushrooms. 

Psilocybin is in the mushrooms. When an individual ingests the mushrooms in the body, it is converted to psilocin, and still, a scent is what interacts with the receptors in the brain to produce the effects that we see being produced now on lower dosages; on microdoses, we see a different effect. We have a self-perspective effect. To give you a range of ideas of what perceptive or microdosing means, or to give you a range of effects as well, it helps to visualize or think about it cognitively for about five milligrams to about 250 milligrams of psilocybin mushroom is considered microdosing. 250 to about a gram is a mild dose, and then from a gram to two, you have a moderate dose, two grams, and then two grams up to five grams is what we know as a macro dose or a large dose. You can utilize this plant medicine, which is fascinating in so many different levels of dosing, to get the particular effect that you are looking for and intentionality is everything in how we are going to choose what dosage to use, in what setting, and in what situation. 

I have clients who want to use the micros and want to know more about them. They want to be able to use it in their lives and integrate it into their daily lives. They want to feel more connected to their children. That is what you do after the micro. Micro is what you can utilize in that setting to enhance your life, increase communication, and increase those heartfelt connections with yourself. Number one, and with your loved ones. Then, when we get to the higher doses, you will find that the individual is incapacitated and will need a guide by their side to be safe. You are going to leave it up to you to ask me questions about that. Dr. Wells, I have covered a lot, but please.

Audrey Wells, MD

I think this is really good information. For me, it comes down to asking the question that a lot of people are wondering now, which is who is a good candidate for psilocybin treatment, especially given that currently in the United States, it is not legalized everywhere. In that context, who would you recommend and look into this a little bit deeper to find out if there is a match?

Lida Fatemi, DO, MPH

Great question. It is a challenging question. I would say, given the status of legalization, it is legal in Colorado, legal in Oregon. In Australia, it has legalized and allowed psychiatrists to use that medicine in their practice. Canada is very open to it, and they believe they have legalized it, maybe in British Columbia, even though in other states and the rest of the world it is considered illegal. People are using it. As of now, 15 million Americans are using psychedelics to help themselves through their trauma and mental health suffering. I am sorry. I want to backtrack on other countries. In the majority of South American countries, they do not even see it as something to consider in their legal realm at all. 

That is why a lot of retreats, that I even do. They are in South America or Central America because they are plants. How can you illegalize a plant? That is the battle that we are fighting in America now through organizations that do incredible work, such as decriminalizing nature. Dr. Larry Norris is a friend of mine as well, and he is a co-founder, and he is responsible. He and his team are responsible for this decriminalization and legalization movement that is happening throughout the cities; 22 cities have already gone through this. Decriminalization is pushing a lot in California, starting with Oakland. I would say that when you look at the research behind psilocybin being the number one researched plant medicine in this very moment and time, you will see it being used in so many different realms. Starting with depression, anxiety, PTSD, OCD in autism, neurodegenerative disorders such as ALS, post-stroke, TBIs, and so on. 

It is being studied, with positive results. Now we are seeing more of the positive results in high doses, macro doses one time. A lot of times, the individual just needs one session or maybe two sessions in their entire lifetime. That is what makes it so incredible because none of us want to be dependent on a multitude of medications, or anything for that matter, that is not easily reachable to us. The shift that happens with a macro dose is that the caveat here is that you have to do work. I love that you mentioned the emphasis on self-growth and self-evolution because that is everything that I do in my program: we do extensive, deep coaching beforehand. If somebody wants to be interested in the macro dose, then we will go to a South American country and do a retreat. I am there with them. Then, afterward, we do a deep dive into integration. 

How do I bring the things that I saw, felt, and experienced during my big dose session into my life at this very moment? What does that mean? How do I do that? There is a lot of embodied practice that can be utilized. I also have a community of healers. They are the majority of them are Ph.D.’s in their field, psychology, and they have extensive plant medicine, background, and experience to be able to hold space afterward as well. I do the majority of the work, and then if I need help, there is always someone that I can call up and connect the individual with to get even deeper into their integration. Integration is one of the most important parts of it. The entire container is everything. If there are people that I turn down, if they do not want to do the work, I say, This is not the path at this moment for you, and that is okay. Everyone has a time. That is the macrodose. 

I also do work with microdosing for individuals. I educated them. Again, people are using it. We are talking about 15 million Americans already using psychedelic medicines, and most of that is psilocybin from what we gather. To me, I am, and people are already using it. They know where to get it from, and they know where to source it from. Again, those are things that everyone should be concerned about and should be asking questions about. I am always available to answer questions because I want people to do the right thing. But with microdosing, I educate them on how to utilize it. Most of the people who reach out to me are physicians again because we are burnt out. Burnout is also another symptom of a deeper issue that has been going on for a long time. 

I have female physicians or female physician moms who reach out to me. A lot of them have had depression for ten-plus years or since childhood, anxiety since childhood, or PTSD that they do not know what to do with, and they do not want to be on medications anymore. Again, I do not take them off medications because of the coaching relationship we have. But I will work with their therapists and their psychiatrists, and we will create collaborative efforts to get them what they want because we all have a dream life that we want to live and we deserve it. We deserve to live it. Why cannot we utilize better methods to bring that into our lives and get closer to it? We can, and we can.

Audrey Wells, MD

This is such a helpful discussion because I know a lot of people who are watching our conversation will not have had this information come up on their radar before. Your description is beautiful because it is this arc of self-growth and self-development, of which psychedelic medication is a very important part. We are not just talking about a magic pill or a magic elixir here. This is a big process that people undertake so that they can achieve a degree of spiritual growth, mental health, and well-being. that is more profound than what they had previously known. It is fantastic to hear that psilocybin is coming up as a possibility. 

I will add that in my research on psilocybin, I found out that Johns Hopkins has been doing a ton of research. Stanford has been doing a ton of research. These are credible institutions that undertake this path mindfully. What they are finding is exciting going forward as a new option for people who would benefit. I am sure in your work, as in palliative care and hospice, you have also had the experience of helping people through their end of life, even managing feelings around cancer and heavy mental burdens. Can you speak about that and what you have noticed?

Lida Fatemi, DO, MPH

Absolutely. Heavy burdens are what I have experienced from suffering. When we go through life, we all have challenges and pain in the body. We have painful moments where we are suffering. In life, we have pain, but we do not have to suffer.

Audrey Wells, MD

Tell me the difference between pain and suffering. I think that is interesting.

Lida Fatemi, DO, MPH

Yes. We can have physical pain from an accident that we were in, and we can have chronic pain from that. As I am speaking to you now, I have pain in my upper back and shoulders. I have been in a few accidents in my lifetime, and I am sure some of it has to do with whiplash. I get it, and my workouts in it get better. I get that some treatments get better, but it is always there, up and down. There was a time when I would so focus on it that it would get worse and I would feel this feeling of being down and just depressed and shoulders down. My entire posture would be affected. I would feel this suffering. When I was feeling more depressed, I would feel it in my posture even more. I would feel the pain more. As my self-evolution as you have blossomed. It is an everyday thing. It is not that it is not a destination. It is every day, every breath, and every moment that we are choosing to go on this path of self-discovery or not. That is a very individual and personal choice. But I decided, okay, I have had enough. I would not suffer anymore. I started taking steps towards that trajectory. 

As I stand here speaking to you all today, I have the pain, but I am not suffering from it. It is not something that is bringing me down. Oftentimes, at the end of life, we have forgiveness issues. We have issues in our relationships, and who does not? Life is made out of relationships—relationships with oneself. That is where it starts. Relationship with the air we breathe, the relationship with the food we eat, and with each other. What I see in my end-of-life patients is that if they are more at peace with themselves and with having those sacred quiet moments, just like we do before falling asleep or when we have woken up and are trying to fall back asleep, the individuals who are more seasoned in dealing with those spaces within themselves have an easier time transitioning. The individuals who had psychedelic experiences, we know this from the Hopkins study in 2015, which took 52 individuals with a terminally ill diagnosis who had a fear of death at the end of life. They administered, did intensive spiritual holding, and also did psychotherapy. Then they had a high-dose psilocybin session with them they did post-work with spiritual care and also with therapy and psychotherapy. They followed them for a while, and, inevitably, they all expressed that this was one of the top five most meaningful experiences of their lives and that their fear of death was gone. 

For me, it is what that also indicates, and the experts in the field say that when we are tapped into these expanded states that are unfamiliar to us, when we see that, all is well. When I move through those challenging portions of my journey and I have made it through, it is going to be fine. Everything is fine. I do wish that we were in a state where I could prescribe psilocybin as a medicine and you would know what you were doing. It is not just, Take whatever. There is a whole thing around it. There is. I call it a container because it truly is in my mind; it is where you have to do the work before I teach my clients and my patients how to breathe, how to meditate, and how to use writing and creative expression, which we know all of these modalities used to also help us connect with ourselves and optimize our neurobiology and our physiology, and how to hydrate even. How do we hydrate so that we stay hydrated through the day because we know even just hydration? If we are dehydrated, we feel more anxious, we can feel more depressed, and we have more toxins that are built up. 

Our physiology just does not work as well as it should, and so all these little things, little steps that are so reachable and accessible to every one of us when we add plant medicine, you just see it from a different perspective. There is less resistance to doing what is for us than to doing what is serving us. For a lot of us who have gone through trauma and do not know how to get through it, we have a lot of resistance towards things that are healing for us. Is that self-sabotage part that I do not deserve better? We do. When you come through on the other side, you are, and of course I can do anything. I deserve to feel better. I wish I had more freedom, legally, to be able to. I speak about it, but I cannot prescribe it. Some people, because it is illegal, are just completely, closed off to it, which is fine. I just think that, from a policy standpoint, it would be nice to be able to utilize these as tools. General in that patient population also.

Audrey Wells, MD

I think it is coming. I have to hope it is coming because I see it as a tool as well. One thing that struck me as you were talking is that we are both coaches for people who want to undertake this self-development process. I want to say that I am a coach for what keeps you up at night. Whatever that thing is, it is going to be the thing that you think of in the middle of the night. But it is interesting to me how coaching stretches your perception of not only yourself but also your situation. It is a workout for the brain, and I see these psychedelic substances as contributing to that, opening up to what is possible, what may be better for you, and giving a new perspective. I wonder if you might tell me about a situation that you have had that was maybe a success for somebody who had a situation that was difficult going in. Then, after going through this process, what were you able to notice? What benefits, what was the experience? I am really curious.

Lida Fatemi, DO, MPH

Yes, absolutely. One of my favorite clients has permitted me to use his name in my book, so I am sure he would be okay talking on air as well. But I am not going to. I am so, Yes, very respectful of, first of all, his courage to be okay using his name. But he is a gay man. He is in his 60s, and he is a Yang Jiang therapist of over 30 years who has been helping our community here for 30-plus years. He was experiencing extreme anxiety still after all these years of working on himself, evolution, and all of that. He reached out to me through a friend. We started working. He was very committed and feeling better. He did not want to live in a place of fear any longer. He was just done with that, and he wanted to bring more to his clients, also. We started talking, and I have a whole vetting process of seeing where the individual is or their commitment. If there is no real commitment, but they want to just use the medicine, I am not your person; this is too much work. But he was willing, and so he did. We started the coaching program. I educated him on microdosing, so he started with that process and breathing, he was an avid meditator, but we started doing meditation differently, incorporating breathing and mind-body connection exercises. He was very to me; he felt very disconnected from his body, very heavy, very cognitive, but not grounded in his body. 

We started this work, and he also wanted to be able to write his poetry with more ease and creativity and felt a lot of blockages there, too. Throughout our time together, we tapped into his childhood traumas, where there was sexual abuse for years, and when he came out as an adolescent, being a gay person back then was completely unacceptable. We are talking a long time ago—50 years ago, 46 years ago—and his family never accepted him. There were those people who did and did not. But he just never felt accepted in his family; he had to come out and be his true self, and he ended up subscribing to a lot of abusive relationships as well as self-sabotage. I do not deserve more, I do not deserve better mentality, and he was the reason that was happening. It is PTSD that we are talking about, and he did not have the diagnosis of PTSD. But we all go through these things where we are ruminating about things that happened in the past and cannot move through them.

Audrey Wells, MD

It is something that keeps people up from sleep regularly. I hear this all the time: the monkey mind in the middle of the night or at the beginning, you just cannot settle. This self-exploration is necessary. I am so glad you are talking about this.

Lida Fatemi, DO, MPH

That is awesome. Yes, that is exactly what keeps us up at night. The amygdala, or limbic system, is super engaged. The mind and body exercise, including breathing, because I have been talking about breathing every 5 seconds. I feel it allows us to disconnect from the limbic system and connect with our bodies. The way I talk about it is to breathe through the nose and out of the nose, not the mouth. When you do that, the vagus nerve and the parasympathetic system are more likely to rest and digest part of the nervous system is more engaged, so we can be more in equilibrium in our autonomic nervous system. 

Then there is a body connection where you feel the chest rise and fall. If you want to try this at home, you can breathe through the nose, feel the chest rise, feel it fall as you exhale, and keep doing it for at least five breaths and see how you feel. I did this recently with a group of high school students at my daughter’s high school, and they all felt so much better after. I consider it a success when you can get into teenagers. But yes, we continued the work for months. We worked together for months, and he was, I was educating him about the microdosing he found his own, and so on, started using it at particular times. Usually. I also coached people on how to use it and when to use it. There are different protocols that you can utilize to see how they affect you, and there is a lot of self-discovery. That is the mainstay of all of it. 

Throughout that time, there was a lot that came up for him, and he wanted to dive a bit deeper. I held my macro dose session for him in a legal setting, and his initial experience was more of the colors, the beauty, the movement, and other things that you just are not tapped into. He got to know that he was an avid music listener, and that was a big part of his therapy throughout his life. That is what kept him safe in his space as a teenager. Yes. as he was growing up, and he saw a lot of that, felt a lot of that, heard a lot of that music, and felt synesthesia, where you hear music but you see colors. It is the integration of different senses into each other. We went through self-love practices, forgiveness practices, and a lot of holding childhood trauma and allowing it to go. 

Then months later, after the integration of the first session, he felt the calling to do another narrative session, which I am usually hesitant to do, but if the individual has given us enough space and time in between for them to digest what they have learned from that macro dose session, then, if it is more than four months later, I usually say, Okay, let us revisit what is happening. then we start the program again with them. Started the program again, seeing what was going on. It is a very different space that he is in. He was no longer, let me tell you, even in that first microdosing session, he slept for the majority of the hour, 15 minutes. We were together because of his nervousness. I had always felt this fear, response, and anxiety about where I was landing. It felt as if he were resting for a lifetime, and that was just a microdose. 

Later on, months later, this is an eight-month course. I am sharing with you quite a journey. He wanted to go deeper. That was his intention. This time, he wanted to go deeper. He wanted to get into the darker sides of things. Sure enough, that is where he went. That was a very challenging experience for him because, if you are not an experienced guide or a facilitator, it can be scary to have the being go through all of those things, there were times he would share with me that I do not think I am breathing; I cannot breathe. He was breathing. Knowing the research and having done this, I have experienced for a decade in my own experience. 

I have been holding space for about three or four years for other individuals. Having multiple people means maybe over 50, and having more than 50, I think, is a good number to have. I was able to help him through this journey of how you are breathing by tapping into your breath, and because of the work we had done for so many months. It was easy to get him back into that pattern of breathing. Feel the earth under you. How do we ground individuals who are going through these challenging moments and going back into trying to even cry? You could not tap into crying. You could tap into his feelings as we were going through the journey with medicine. 

But the role of the guide is huge. How do we take them through forgiveness as they are going through these horrific things that he went through as a child? How do I forgive the perpetrator? How do I forgive myself for not knowing, for not being able to hold myself in a particular situation, for saying no? How do I forgive myself for not doing those things? It is a very sensitive, very vulnerable space that needs to be held with the utmost respect, love, and care. That is the setting that we talk about. When you look at psychedelics, research includes the guide and the environment that the individual is in and creating. How do we create a healing environment for the individual? Most of it is coming from the guide, and having that rapport with the guide is important. Do you want me to talk about sets, or do you have questions before we move?

Audrey Wells, MD

Let us move on to the set. But I will tell you that this description is so profound, and it is exciting for those who feel what they have done so far on their journey of self-exploration has been unsatisfying or that there is no end in sight. But I think the care with which you treat the medicine and the care with which you select ready people is just profound. Why do we not move on to sets and talk about the experience and some of the practicalities?

Lida Fatemi, DO, MPH

Thank you so much. Thank you for the comments. Dr. Wells. It is; this is very deep in me, and there is so much sacredness. I compare it to having kids as my most important responsibility and helping them be raised in a good way in a loving environment. This work is parallel to that. I see that each individual who moves through their challenges and their traumas, connects with their light, and continues on the path of self-discovery has so much to give to society. and I see that as a responsibility for myself as well. Thank you for recognizing. 

The set is the mindset that the individual goes in within a journey, and I do not just describe it as just the macro dose journey or the large dose but also in micro doses to see that as a journey of life in that day that, you are taking that medicine and all its sacredness and the connection that it is going to create for you throughout the day. The thing is, it is going to come up for you; how do I navigate through that? That is, as a whole, it is very similar to a macrodose in that they are both ceremonies. Not to take the micro dose lightly at all, but to also polish our mindset as we are going into a micro or macro dose, polish ourselves and our physiology and neurobiology, and optimize ourselves before going into it.  The word psychedelic was coined by, I believe, Dr. Albert Hofmann, who analyzed psilocybin, and ergotamine, and created LSD in Switzerland through Sandoz Labs back in the 1950s. The reason he called it psychedelic is because it is mind-manifesting. Whatever is in our minds, in the conscious or the subconscious, can present itself through a macro-dosage journey, and you have to be prepared for that and okay with that. We also know from the more mystical side of these journeys that the subconscious will not show you more than you can digest in the moment that you have chosen. This is my time to experience. 

Audrey Wells, MD

It is so fascinating.

Lida Fatemi, DO, MPH

Fascinating. The medicine to the medicine is also respectful of that. Now, again, this is going back to the role of the guide being paramount to your experience. It is the guide that is going to choose the dosage of the medicine that is going to be administered to the individual. Knowing dosages is super important. That is where the rapport that you build before getting to know the individual beforehand is so important in my work. To know how much they need at this moment in time? Because if you overshoot, you can take them to places that they may not be ready to see. If you cannot undershoot, no matter what amount of medicine you have, you can still work with it and tap into spaces that you could not see otherwise. But there is always a sweet spot for each very customized individual, at least in my practice, and that is what speaks to that individual at that moment and will bring up the most healing that the individual wants. That was setting all in one in a long answer.

Audrey Wells, MD

Yes. Your expertise shines through. You have been doing this for a while. I think you are seasoned in a way that people can have confidence that if they work with you, they are getting the best experience possible. I think your respect for this process is well-deserved and very important. As we wrap up today, I wonder if you can tell people where they can find you or how to get in touch if they want to know more or even work with you.

Lida Fatemi, DO, MPH

Absolutely. I have a website drlidafatemi.com. You can always contact me there, and I am also on social media. The majority of my posts are on Facebook. I do breathing exercises with my audience. I will do live, whatever is needed at the moment as we all go through trauma and difficulties in our lives. Again, Lida Fatemi is my Facebook, and I will share the handle with you if you want to share that in the notes and so forth. The other space is, you can read in the book Thriving After Burnout, which I have here, that I coauthored with 49 other female physicians who are wonderful and who are doing beautiful work in this realm of coaching and helping individuals through burnout. Yes. My book, Conscious Life Practices with Psilocybin Trauma to Self-Love, is also coming out in the next couple of months. I am so glad to be here. Dr. Wells, thank you so much for having me and helping educate the community on things that are coming up. But not a lot of people are talking about it.

Audrey Wells, MD

Truly cutting-edge stuff and a new way of thinking about one’s relationship with oneself, particularly as this is highlighted by sleeping problems. Thank you so much, Dr. Fatemi. It was a pleasure to speak with you.

Lida Fatemi, DO, MPH

Thank you.