Episode 116 Transcript: Psychedelic Assisted Therapy
Elisabeth LaMotte:
From the National Association of Social Workers, this is Social Work Talks, and I'm your host, Elizabeth Lamott. And today, we're gonna be talking about psychedelic assisted psychotherapy. And I am so excited because Mary Cosimano is joining our conversation. She is one of the most experienced psychedelic session facilitators in the field. She has been with the department of psychiatry at Johns Hopkins University School of Medicine with their department of consciousness and psychedelic research since 2000 when they began researching psilocybin. She is such an inspiring leader in the social work field. Mary Cosimano, welcome to Social Work Talks.
Mary Cosimano:
Thank you, Elizabeth. I'm happy to be here.
Elisabeth LaMotte:
So let's just start from the very beginning. If you could tell our listeners what led you to choose the field of social work.
Mary Cosimano:
Mhmm. Well, I I know we talked a bit before and I wasn't sure you'd want me to share my journey because it may not be the typical one of social workers. Maybe. But honestly, I didn't know what I wanted to do. I know that's not unusual when you begin college. And so I started in accounting because my father said, you're good in math, and that's a good place to start. Always will help you. So after a semester, I realized that is not what I wanted to do in front of a computer.
Mary Cosimano:
Didn't know what I wanted to do. And honestly, I had a boyfriend in sociology. And I thought, sociology sounds more like me, and then I get to be in classes. So I went into sociology. And a couple years later, I transferred schools, and they got the transcripts mixed up and put social work as opposed to sociology.
Elisabeth LaMotte:
Oh my gosh.
Mary Cosimano:
Yeah. I know. But I thought, you know, that actually sounds more like me and where I'd want to be at. So I kept it at that. And that's how I started my career in social work.
Elisabeth LaMotte:
And how did you find your way to Johns Hopkins University School of Medicine back in 2000 when the research for psilocybin was beginning.
Mary Cosimano:
Sure. So that's, that could be a very long story, but I'm gonna make it shorter. You know, when I kind of always have not known what I wanted to do and just kind of lived in the moment of what felt right at the time. So I didn't have any specific area of social work I wanted to go into. It turned out it just started gravitating interestingly toward the elderly population. One of my first jobs was working in home health care with going into their home and taking care of them, whatever they needed, bathing, shopping, cleaning. And not surprising, if anyone's worked with the elderly or has, you know, elderly family members or, whatever. This is 2 of all of them, but I am 91 years old.
Mary Cosimano:
And I would go and I'd say, what can I do? And we had a list because she had to know that it was state run and they had to have, you know, needs that they spelled out. And I'd say, well, what about the oh, Mary, I've already done that. And I said, well, what about this? Oh, I rubbed her not. And she went through the list and she goes, I just want you to sit down and talk with me. And that was just true with all of them. They just wanted to be listened to. And so that was really I remember thinking that at that young age in my early twenties of that importance. And then I got a job when I moved to a retirement community that was just opening.
Mary Cosimano:
So I was in the beginning stage of the development. And so I was the social worker and activities director, and I was the one who was who worked with the people that were coming in, which at that you know, going from usually it's because they can't stay in their big home or their home they had or their spouse has died. Often, they've been together 50, 60 plus years. So they're not only coming to this new place, downsizing their life often without a partner. And again, it was the same thing. It was just, you know, be there for me, listen to me, and have a different Be present. Mhmm. Exactly.
Mary Cosimano:
So that and then I moved into different areas. And, and then my son was born, although I went back to graduate school before he was born. I knew I wanted to have my master's when I came out, of being home with him, which I wanted to do. And so I got my master's, had my son, and was lucky enough to stay home with him for many years. It was one of the greatest joys of my life. And then I worked at his school, and I loved that. I I did some school guidance counseling, and I did some teaching, substitute teaching, but my main role was at his school as a 1st grade teaching assistant, which I loved. I loved being with the school, the children, and the parents.
Mary Cosimano:
It was very much a community. And then I was asked by doctor Bill Richards, who did this work back in the sixties seventies, who was hired by Roland Griffiths, our principal investigator, who got the psilocybin studies approved to start after being dormant for almost 30 years, which was a huge in itself just to have that to be come back because it had been rescheduled to schedule 1, which it still is, and had this reputation, as many of us know, such dangerous drugs and etcetera. So it was really because of his reputation and his expertise and years of work at Johns Hopkins, that he was able to get it through. And so we, you always have 2 guides when you, in our studies, our clinical trials for each person. And so they asked Bill Richards. They knew he had been in Baltimore, and called him. He said yes and then you need a second one. And he and I were in a meditation group together.
Mary Cosimano:
And this was probably now, what, 25 years ago? After the classes, one of our meditations, he said, can I talk to you? We sat outside. I remember the beautiful evening and he told me about it. And I didn't know. I didn't know. I only knew the psychedelics from, you know, when I was in the college days, how it was really more recreational. And I knew a lot of the fearful myths, you know, that your child could be born with birth defects. And I didn't know any of the studies that had taken place back in the fifties, sixties, seventies, actually a lot?
Elisabeth LaMotte:
I didn't either until I started researching this topic. It's fascinating. So for our listeners and viewers who don't know much about it, could you give a quick overview of psychedelic assisted psychotherapy as you have researched it with psilocybin at Hopkins? Mhmm.
Mary Cosimano:
So more like how it began, you know, when Howard then, and I think it was 1945 when he came up, you know, LSD, found LSD. The early trials were really mostly with LSD. And at the time, you know, they started these trials in the fifties sixties and in early seventies till then it was, you know, went dormant. But a lot of the studies at that time were, like, thousands of studies, but they didn't have the rigor as much of the rigor that we do today. So they weren't seeing Israel, you know, this is what it is. But that was so promising, a lot with alcoholism and with end of life. Okay. Yeah.
Elisabeth LaMotte:
Yes. And so as you talk about your early experience working with older people even when you were quite young, I can't help but imagine that that then prepared you for at Hopkins, the way there have been these groups, both if I understand it correctly, cancer diagnosis often terminal is 1. Another is smoking cessation.
Mary Cosimano:
Mhmm.
Elisabeth LaMotte:
And another is depression.
Mary Cosimano:
Mhmm.
Elisabeth LaMotte:
Is that correct?
Mary Cosimano:
Oh, those are. Yes, we've had many others, and you can talk about that later if we want, but those 3 very much.
Elisabeth LaMotte:
Mhmm. Those 3, studied very much at Hopkins.
Mary Cosimano:
Yes. Mhmm.
Elisabeth LaMotte:
And, what I notice about you as a facilitator or a guide you could say either. Right? Facilitator or guide. They're both appropriate terms. Yeah. And and I guess I'll step back for a moment and say, I first learned who you are from the film that streams on Netflix, Fantastic Fungi. You are in that film, and in that film, which I would certainly encourage our listeners and viewers to watch, You have such a gentle, elegant way of being with the volunteer. And I sense it also reading the chapter that is available in the show notes section of our website about what it takes to become an effective guide. But were you always that way, and can you share with us some about how you have developed your clinical skills in this area over the years?
Mary Cosimano:
Well, that's a good question, and thank you for that, compliment. So I really have to go back to my mid twenties when I started my journey of who I am, why am I here, what's the meaning of life. I've always been that kind of a thinker, you know, the mind and, questioning, questioning. And so that has been the most important aspect of my life of what's most important, not necessarily a high paying job or or a prestigious job. It's what is right for me and myself to be myself the best I can be. So I've always followed that. And, and so I think with that, or not think, I know that with that, it's about going inward and how can I be? And we can talk about this later if we want. It's very much a part of me talking about love and love is our true nature.
Mary Cosimano:
But that's my, what do I say? My reason for being, is to be my true self, my authentic self, which I believe is love, which is connection, which is removing all the barriers that we learn, from our peers, from our parents, from society that block us from that. And when we can remove those and be in this space of who I really am, the more I can be with you, who you really are, without any of the stuff that keeps us from being on that level together. So it's this we're all here together. There's no hierarchy in consciousness, which I had been. I had been in this trajectory or this meaningness of my life for 20 years before I started Hopkins. So it would just be so natural for me to be with someone because what the studies or a relationship when we have, you know, someone who agrees to participate is you're just you're just with them. And who are you? And why are you here? And what do you want that you don't have? How do you wanna see your life that's not working? And how can we be together to move
Elisabeth LaMotte:
forward? I mean, one of the first things you learn as a social worker is this idea to be where the client's at.
Mary Cosimano:
Yes.
Elisabeth LaMotte:
And that has echoes in what you're describing, and I wanna read one of my, I would say, many favorite passages from your article, about training guides. You write, the ethnobotanist and psychedelic researcher, Terence McKenna, said that he believes all of our problems can be boiled down to a single issue, excessive ego. Our work is to shed the ego and come from a place of authenticity, love, connection, presence and letting go. I strongly believe that a fundamental outcome of the use of psilocybin is for a participant to reconnect to his or her authentic self, to know oneself. It is that major positive outcome if that is the major positive outcome of this approach to psilocybin use, it seems that it would also be important for us as guides to be in alignment with that as well. Hence, I am convinced that the desire and willingness to work at knowing one's true authentic self is one of the most important attributes of an effective guide. I'm just telling you I'm just repeating back what you just said to me, but I wanted to share that. And, Mary, I wanna thank you prior to this interview for both sharing the chapter that is on our show notes section and for encouraging me to read Michael Pollan's incredible book, How to Change Your Mind.
Mary Cosimano:
Mhmm.
Elisabeth LaMotte:
There's some concepts in there that I wanna talk about that I just think are so interesting. I read the book. I wanna read it again. So to start, one of the things that he mentions is that of ego that we were just talking about. Mhmm. Can you say more about ego and where you understand that in terms of psilocybin and psychedelic assisted psychotherapy.
Mary Cosimano:
So wow. So that's an interesting topic. Right? So there's, if anyone has read or, you know, read anything or heard talk about psychedelics, psilocybin, one of the things that is often said is that it helps with ego dissolution. And it's interesting, being with this, thinking about this over the years as I've, you know, been with so many people. And so what does that mean? You know, we know we know that ego is important. We know we need it, but of course it can come over inflated. And I I'm sure you'll ask me, but at some point I wanna talk about the side of the things that could go wrong. Because, you know, most people hear a lot about only the good, but it's really important.
Mary Cosimano:
Yeah. So ego, so what it seems to the places it can seem to take you, the psychedelics, is this altered state. You know, it's not your everyday normal state. It, like, it seems like it opens up. It removes these like I was talking about earlier, all of these barriers and these walls that we have put up, you know, and it seems to often remove them. And so that boom, you're left here. And this wide open place that is often the experience, I mean, it can be frightening very much, you know, it can be joyful. It can be all these different things.
Mary Cosimano:
But as far as the ego dissolution, often is the experience of well, here's one little way to say it. I know there's others.
Elisabeth LaMotte:
Mhmm.
Mary Cosimano:
So I talk about fun and play and joy as one of the teachings of the psychedelics. There's many teachings. Love is our true nature. The present moment is all there is, different acceptance,
Elisabeth LaMotte:
Connection.
Mary Cosimano:
Pardon me?
Elisabeth LaMotte:
Connection.
Mary Cosimano:
Yes. One of them is the joy of life. And a nickname for psilocybin some people may have heard is silly-cybin. But what that actually is referring to is this place that people can and it's not unusual to go to where all they realize is that what we thought was important, how we look, how much money we make, how many publications we put out, you know, how the world sees us. All of these things that have been those blocks, they're, they're meaningless, which are all the ego things. How important am I? Those are gone. And there's this knowing that that is not important. That what is important is just being here for each other. And to me, that's the dissolution of the ego. Yes. Let me just say this quickly and then I'll let you go.
Mary Cosimano:
Please. Please. Another important piece that I believe, that everyone does not believe this, but oftentimes, I mean, there's people coming into the studies who have often read a lot, heard a lot, and they have these ideas of what, you know, it means to have, you know, the experience. And it's often very different from what they've read because everyone's unique, but they'll say, oh, I had the most incredible experience. I had the most feeling of oneness and and at peace with myself, but I didn't go far enough. I didn't have ego dissolution. I knew I was still here. To me, if you go so far out, you don't remember anything, which we have had, it's not that common, you don't remember anything.
Mary Cosimano:
But what is to me is what is happening is you're in that place of stepping back from the ego.
Elisabeth LaMotte:
Right? You're the witness. You're the observer. And that you want. You want that in your experience. So, yeah. It seems like taking psychological space from the ego in terms of unhealthy parts of yourself, it also sounds like and there's writing about this in the literature, a kind of reclaiming of childlike wonder and curiosity. And I promise we will talk about the risks and the concerns, but, but while we're on this track, another topic in this area is brain plasticity, brain flexibility.
Mary Cosimano:
Mhmm.
Elisabeth LaMotte:
Can you say something about that, in terms of what you observe and how that relates to the experience?
Mary Cosimano:
Yes. And that's why I'm not gonna talk a lot about it because I'm not a scientist. I have learned a lot being, you know, at Hopkins with the scientists and researchers. But, what I have is where I believe we're at now. There's so much talk about neuroplasticity and growing new neurons and new neural pathways and networks, and there's promise of that. But the bottom line is that it is still unknown. The research is all with animal models. So it seems like it could carry over. But it seems like there's this neuroplasticity and this period of time they call the critical period where your brain is more open to allow this to happen.
Mary Cosimano:
So that's, and plasticity can is a thing that happens. I mean, it can be just changes in, you know, the neurons. So it can be good or bad. I mean, there is hyperplasticity, which happens with drugs like heroin and cocaine and those, which is not good. And metaplasticity is what seems to happen with the psychedelics. And that's more of this, underlying, I don't know if underlying is the right word, but this more ability to, you know, have it work for you. I guess that's a lack of knowing how to scientifically say that. Psychological flexibility is something we have found and that, so that is something we've studied and, you know, one from our lab brought a study of that forward.
Mary Cosimano:
And it's this, as you can imagine what that means, psychological flexibility. You are more open to and that's another thing that often happens is you're more open to, oh, maybe this and this, and I can see why this happened and why that person thought this. So it's not just this narrow focus and the same with themselves. Maybe I'm you know, I have this, but I also have this.
Elisabeth LaMotte:
Right.
Mary Cosimano:
Right.
Elisabeth LaMotte:
It seems that people often describe an insight that sounds obvious, but it's something about the process in which they obtain the insight that is so deeply meaningful. I will share just this one quotation from the book How to Change Your Mind on this topic, Michael Pollan writes. Mendel Kalin, a Dutchman, in the Dutch postdoc Imperial Lab uses a metaphor related to snow. Think of the brain as a hill covered in snow and think of thoughts as sleds sliding down that hill. As one sled after another goes down the hill, a small number of main trails will appear in the snow. And every time a new sled or thought goes down, the preexisting trails, it's almost like a magnet. Those main trails represent the most well traveled neural connections in your brain, many of them passing through the default mode network. In time, it becomes more and more difficult to glide down the hill on any other path in a different direction.
Elisabeth LaMotte:
So think of psychedelics as temporarily flattening the snow. The deeply worn trails appear, and suddenly the sled can go in other directions, exploring new landscapes, and literally creating new pathways. I just think that's so interesting. Okay. I I know that's not the end of the story. So who is not a fit for psychedelic assisted psychotherapy, and what can go wrong? Mhmm.
Mary Cosimano:
I do wanna answer that, but what you just read, I'd like to show this. You know, there's,
Elisabeth LaMotte:
It's in a book. It's in the book, but tell us about it and please describe it for our listeners.
Mary Cosimano:
Okay. So this is a picture of the brain. Robin Harris came out with this. I forget. It's been quite a number of years now. But they found that the default mode network has decreased during a psychedelic experience. And that's the default mode network is what keeps us kind of the ego in check, and it's all, you know, whom I want, you know, what, you know, I'm and get these these loops of, you know, I'm no good, I'm worthy to keep these patterns of, you know, in place. And at first, when this first came out, this theory, it was like, this is it.
Mary Cosimano:
This is what happens. And it's now they know it's something, but not there's many other, you know, mechanisms that might be going on. But what I love about this diagram is this one is the brain as our normal everyday.
Elisabeth LaMotte:
At rest.
Mary Cosimano:
At rest. Mhmm.
Elisabeth LaMotte:
It's much more of a clear circle.
Mary Cosimano:
And the different networks of visual quartet goes to the auditory, audited to auditory. Then you have a psychedelic, and this is what happens. And this is kind of like that snowfall. This is what we have, the same ones over and over and over and over. This and and then all of a sudden you have this, and it's like, oh, wait a minute. There's these new pathways, these new snow trails, all of these things. And what to me, what the difference is, because it can sound so simple, like you said or has been said and it seems, is that often we know these things intellectually, that we really are, here for each other, that we really have this connection with each other, we really are in love with. And that's all cog- so much of that is cognitive.
Mary Cosimano:
But what happens in the psychedelic experience is this embodiment. It's one of the mystical, one of the characteristics of the mystical experience is this noetic quality, where you know without a doubt that what you experienced is more real than every day. And it's that embodiment of the experience to me that causes the pain, the ability to change and to go forward making change.
Elisabeth LaMotte:
Yes. And, I mean, so many of our listeners are social workers in private practice
Mary Cosimano:
Yes.
Elisabeth LaMotte:
Who are, you know, just as with this study, working intensely with human suffering, and yet, I think we've all had the experience of the sense that someone is stuck Mhmm. Or that the thoughts are inflexible or that the ego seems impenetrable. So it's just so interesting to think about this other possibility. And, of course, it then does lead to such excitement and a kind of bubble of expectations of a cure all. And so if you could challenge that here and tell us what the limitations or concerns are as you see them.
Mary Cosimano:
For sure. So there are many to be aware of. And that's, to me, the beauty of our clinical trials, which, you know, were brought from the way they ran them in the earlier years, decades, and have followed through with pretty much everyone who does them. And that is this container, this safe container, which is a difference from taking it on your own, taking it to a party. And what we bring forward is, yeah, these experiences can and often are harrowing. And you can have experiences of just feeling like literally feeling like you went crazy, Literally feeling like you're gonna die. Literally feeling like, you're never gonna come back. And, you know, you can say these things, and we do, and and to and it does help with the preparation and how to deal with that, but it doesn't it doesn't really capture it like anything until you experience it and it's real.
Mary Cosimano:
So and it's and I'd like to bring back the ego part that we were talking about because to me, when people are in those states, it's because they haven't been able to allow the ego. It's the ego coming through. You can't, you can't stop me. I'm not gonna die. I'm not gonna let go. I'm not gonna, you know, go crazy. And that is where this, you know, holding on and controlling, brings this about. So if you're in an environment and we've done studies on that, where if you don't have the proper set and setting safety guided sessions integration, you're much more likely to get in trouble.
Mary Cosimano:
So that's a piece.
Elisabeth LaMotte:
I think that our listeners very much understand the setting in terms of the setting being Johns Hopkins or some other research facility. Can you say more about the set? Because that's such an important piece of it.
Mary Cosimano:
Sure. And that is your mindset, where you're at and that thank you for that because that really speaks to having this, to me what, you know, the way we run them as a container. Because when you do you know, they always have preparation sessions before, and the preparation set sessions are about putting the set in. You know, it's developing safety so you feel so safe with us that you can allow yourself to let go. It's that being able to let go and relax and allow the experience. And so by having this in place, the set that your mind is, Hey, you, not only might you experience this, but that's a good thing. So you're really saying, because I believe it and we do, that if this happens, it's inside of you, it's coming up. It wants to come up.
Mary Cosimano:
And so we're here. You're safe. You're not, we're not going anywhere. Allow it, dive into it, ask it how can, you know, what can teach you, you'll always come back. So that's one way for the set. And if you want me to talk more
Elisabeth LaMotte:
How important do you think it is with the mindset that some goal be articulated or identified, whether it's
Mary Cosimano:
Mhmm.
Elisabeth LaMotte:
I'm afraid the cancer is gonna come back or I'm afraid of dying because my cancer is terminal and I am dying, or I want to stop smoking. Like, how important is that in this whole journey?
Mary Cosimano:
Mhmm. That's a great question, and that's what the preparation is about. It's about, and I say this, I say when we start, this is about you telling your story, and we're gonna go all all over all we're gonna touch all the different aspects of your life, like your education, your upbringing, your, you know, what's important to your experiences with psychedelics, your experiences, etcetera, you know, with about 10 or 12 different things. But and and, of course, you can't share them all in your lifetime, but the highlights and the lowlights. But what I say is that what we mostly want you to share are the things that are most fearful, that are most shameful, that are the, you know, grief. And the reason is because if you have brought them out, you know, it's like if there's something, closed inside and you're able to tell it, it releases this weight on our hearts. It lets our nervous system get back into place. We've had people share with us, things that they've never told anyone.
Mary Cosimano:
Because I say, you wanna tell us that. And because if you have that, if that comes up, if you've shared it, you're more likely to let it come about.
Elisabeth LaMotte:
Yes. There are several directives about if you see a door, open it and walk through it. If there's a staircase climate, which, you know, is really so brave and without that directive, it could be such a different experience, it seems. Mhmm. Are what I couldn't help but think about personality disorders as I thought about the question of where will this go moving forward.
Mary Cosimano:
Mhmm.
Elisabeth LaMotte:
Do you think that if somebody meets the full criteria for a personality disorder, like, let's say, antisocial personality disorder or narcissistic personality disorder? Could this help with that? Or is that too large in scope?
Mary Cosimano:
Yeah. Well, that's such a good question and unknown. You know, when we started the studies back up again, we were so cautious about who we would take in, from all aspects, from the medical to the psychological. And so we would really not, you know, bring in people that when we started, we didn't if someone had high blood pressure, they were automatically out. That's it. After a few years, we realized if it's my you know, if it's under control, they can partake. So that was huge, right there. One of the things that, the psychotics, you know, the schizophrenia, bipolar, that
Elisabeth LaMotte:
was an automatic. Because And interestingly, I mean, I think our our listeners and viewers would wanna know, if I have this correct, that because it became such a taboo and all of this promising beginning was halted for decades
Mary Cosimano:
Mhmm.
Elisabeth LaMotte:
When it started again, it was first with people who had cancer because of an idea that it would be easier to get permission if somebody was already likely to die. That's in Michael Pollan's book. Is that your understanding that that was part of how they were allowed to start studying this again?
Mary Cosimano:
No.
Elisabeth LaMotte:
Well, I thought he does that to somebody in the book, and I thought that was so interesting in terms of how they broke through and were able to start studying it again.
Mary Cosimano:
Well, our first study was with healthy normals. That's the term that I like, you know, who's normal, who's healthy, you know, in the big picture. But it was who didn't have any kind of, you know, mental health diagnoses. But our first study was looking at, can it bring about a mystical experience, a spiritual experience with healthy volunteers? Our second study was with healthy volunteers, looking at dose effect, what doses might be most effective. Our third study was with the cancer population and end of life. So in that Thank
Elisabeth LaMotte:
you for clarifying that. Mhmm.
Mary Cosimano:
Yeah. Yeah. But it was the first indication other than healthy, normal that we were able to go. There had been a lot of studies back in the sixties with end of life and how helpful it was, at that time. So Yeah.
Elisabeth LaMotte:
I think that was the part I was tuning into. When you talk about the kind of experience, there is an interesting, I think, overlay here between the scientific and the psychoanalytic or the psychological. In terms of one being so concrete and researched focused and one, being more focused on meaning and deeper psychological roots. And this really is a relationship between the 2 in terms of who is studying it and how it's being studied.
Mary Cosimano:
Right. Right. So I'm not sure what your question is.
Elisabeth LaMotte:
I'm just I. That is something that I was particularly taken with in learning about this. But as you know, the more I read about it, especially because Michael Pollan always does take part in his research. So in the book, he writes about LSD, taking LSD, taking psilocybin, taking toad venom, and the different experiences there, and I certainly find myself curious about it. Do you think that guides should have had some experience with it to more deeply understand it or where is your perspective on that?
Mary Cosimano:
Yes. That is a big, you know, topic. I would say most people in the psychedelic field think there's no question that you should have experience. I actually am a little bit different, in that I'm not, I'm not necessarily sure. One of the reasons is there's other ways to have altered states. And we know that breath work, that when it was, you know, banned, the psychedelics, that's when Stan Groff came out with the holotropic breathwork, which very much can mimic, meditation can. There's people who can be spontaneous. So there are different ways and many people do have that.
Mary Cosimano:
This is a more tried and true way to have that. But the thing is just because someone has had an experience, to me that can be a block too, because experiences are vastly different. Yes. There's still that territory of being out of your normal state. But it can be so prejudiced to, oh, this is what I had. So this must be what you're experiencing. And that can really be a block. So,
Elisabeth LaMotte:
That's a really interesting perspective. What would you say then are the most important qualities for a guide? You certainly train people and have so much experience.
Mary Cosimano:
Mhmm. So, you know, we can go back to the very first thing. It's presence. Mhmm. Working on yourself. And I could stop there. I mean, I could say a lot around that, but to me, it's being able to very simple, which isn't simple to get to, but it's be any therapist, any counselor, any, you know, guide, whether it's with a psychedelic or with your, you know, patient or person or just with each other, more and more present, meaning more and more focused. And that means having done work on yourself that has removed as much as you can, it's never, at least for me, it's never removed and never will be in this lifetime for me.
Mary Cosimano:
But you've removed so much that you are able to be fully with them without, Oh my stuff and this stuff and that stuff that can take you away. And being, and I say the 2 things, being present and being in love, which means in connection. And that's when we can remove that. And that to me is what it's about.
Elisabeth LaMotte:
Yes. I think it's a big part of why we're here. And I would certainly encourage all of our listeners and viewers to watch your absolutely beautiful TED Talk about love and connection. It's available in our show notes section, and you can Google it. I would also encourage them to read your chapter on guides to see the film Fantastic Fungi and to read Michael Pollan's book, How to Change Your Brain. In addition, for the social workers who want to train and learn more, where would you suggest that they go?
Mary Cosimano:
Mhmm. In addition to what you said. Yeah. Yeah. But I mean, truly, Elizabeth, because it has just, you know, exploded in the past few years, you can be very specific on what you want to, you know, look at. You know, do you wanna look at the studies with cancer at the end of life? Do you wanna look at it with depression? Do you wanna find out more about the brain? Just Google. There's YouTubes everywhere and then there's conferences everywhere and there's talks everywhere. So there's just so much information out there that, you know, your what you said was a good start, but it's just accessible.
Mary Cosimano:
Yes. And there's training programs. You know, I I, teach at CIS, which is California Institute of Integral Studies, which in 2016 started the first certificate program for psychedelic assisted therapists. And so I've been working with them and now there's like 30 or more Just by taking, you know, getting that training doesn't mean you're automatically ready to go into the, you know, or you're gonna be hired, but it does give you a basis of you know, so that it's another Starting point. Mhmm. Can I take a minute only because you asked about personality disorders? I got off track. And in case people were like, wait a minute, that wasn't answered. I can be very brief on that.
Mary Cosimano:
Where I was going was that when we first started, we were very cautious. And that was one that, you know, is tricky, personality disorders. And that's beginning to open more. And, of course, we hear all kinds of people and anecdotal, and and it's not, you know, they might be more difficult, but that doesn't mean it's not something to to look at and to be, you know, you know, look not to just automatically cut out, but the whole ego thing, it can increase the ego and we've seen it many times in many, you know, they take it and it's like, Oh, I'm, you know, I'm special. Interesting.
Elisabeth LaMotte:
Almost like the reverse.
Mary Cosimano:
Oh, yes. Very much. Mhmm.
Elisabeth LaMotte:
So could you share with us the most surprising or some vignette about an experience that has really stayed with you as a guide?
Mary Cosimano:
Oh my gosh,
Elisabeth LaMotte:
Elizabeth. I know there's so many, but
Mary Cosimano:
There's 100 and 100. Yeah. So one that has stood out as just one of the most beautiful visuals, in the because I mean, they have so many that brought the insights that helped him. It was one of our cancer patients. And, he was, he was young. He was in his forties. He had 2 children, a 69 year old and a 9 year old wife, and he was terminal. And he was given 6 to 9 months to live.
Mary Cosimano:
And he had been very prominent in his life, in his field, just a very, well thought of and educated and helped in his profession. And here he was, you know, in this, and he also was physically, even though he was so sick, he was still physically a big guy. And, I remember when we did the prep and at first it was real stoic, you know, I'm this and this is not in an, you know, ego way, just this is who I am. And then I remember asking him about his children and he just started crying. And so what, as you could understand, especially if you're children, the thing for him was how can I leave my children? My wife too, of course, but how can I? And so he was so tangled and focused that nothing else, that was it. And it was all in this very grief and, you know, not wanting to be where he was. So he had one of the longest sessions I've ever had. He was a big guy and at the time we went by weight, he was £250.
Mary Cosimano:
And it doesn't always happen in their session, but his sessions last long. So he they write a session report. That's something that volunteers do. We have them do it before they come in the next day for their integration, and they write down as much as they can. And then we go over that to integrate. So he had 3 parts. His first part was he was laying down, you know, I should have had headphones and music, and you could just see he wasn't talking, but you could just see he was relaxed. He was and there's little smiles, and he gets up after a couple hours to go to the bathroom.
Mary Cosimano:
And he's like, this is great. I'm done. I had experience with being 1. And of course he wasn't, he was very far from being done. You know, he's still very much experienced. So he laid back down again. And this is what he wrote. We didn't know at the time, except we knew he was in distress.
Mary Cosimano:
So the second part was almost 2 hours, maybe more, of and this is what he wrote after, being felt like I was in a trash can, being beaten and kicked and just battered and, I mean, horrific. And we went up to go to the bathroom. He said, The last thing I wanted to do was to go back down again, but I knew he wasn't done. And the best way to get through things is to go back under. So he said, so I encouraged him to, and he did. He said, I, it was the last thing I was so afraid of. I went back, he's laying there, this was hours later, and all of a sudden you can see this little relaxing, then you see this little bit of a smile, then you see this hear this little giggle. And so what he and then it was just so here's what the third part, which he named it is, is a cosmic gumball machine.
Elisabeth LaMotte:
Oh my gosh.
Mary Cosimano:
So he had this experience of a gumball machine that instead of gumballs, it was moments. And so he takes out a moment. What comes to mind, a gumball? And he's looking at the gumball, the moment, and he's like, of course, I'm gonna ask about my cancer. And, you know, so that's his, this is all happening, you know. And, and when what he wrote when someone in my team heard it, that's like a physicist, what he wrote. He said, in order to know what my future is, every single future, every single possibility has to be in this because that's what life is. So we don't know. With that, he had this realization that moment is all there is.
Mary Cosimano:
The present moment is all there is. What am I gonna put into it? So then his next gumball machine is his first son. So he's like this big guy. What do I wanna put into my son? And he goes, yellow and sunshine and green grass. And then he takes out his other son. The next one is his other son, and the same thing. And then he started he saw this vine and it was the tank entanglement of his cancer with the sons, with his belief, and he just saw it untangling, you know, this separateness that it's all of this. And from that moment on, he told us, because, you know, we had integration and his wife told us, he was able to go home and be with his family, be with his boys, and see them in this moment and not as I'm dying this. And he died.
Mary Cosimano:
He made the 6 month follow-up. He died shortly after that. But he listened to our playlist, which his wife told us was a way of bringing him back to this session, that place of peace. She said, " I will allow whatever you wanna say because it was just so transformative. Isn't that amazing?
Elisabeth LaMotte:
It is amazing. I mean, I'm in awe of what you just shared and that it could be so powerful as it seems to often be. And I'm in awe of you, Mary, for how you are facilitating this journey for people who really, really benefit from it, and need it. And I have one last question.
Mary Cosimano:
But I just wanna say this as far as that goes, it's so important. I'm the lucky one. And I mean that. There's nothing that could bring me more joy or more meaning than to be in these experiences no matter what they are. And one of the early researchers, very early, who did lots of experiences with people, like 4,000 they said he did. He said someone asked him how he could, what is it like having done so many? Don't you get tired of it? And he said, and this is what I believe, there's nothing more meaningful, more joyful than to see, be a part of someone being turned on to themselves. And that's what it is when we have that. They realize they are okay.
Mary Cosimano:
They are worthy.
Elisabeth LaMotte:
Yes. So you were describing that, this is such a challenging, deep, and draining, exhausting, psychologically, emotionally, physically experience for people. And it made me think of one of the really interesting parts of the literature that describes studies with animals again and again and again, they do not choose to take this substance again as they would with nicotine, cocaine, and so many other substances. I just think that's fascinating.
Mary Cosimano:
Oh, very much. And, you know, like we've been talking about a little earlier, in those studies, the rats will take, you know, the heroin, the cocaine, the different substances until they die. But when they're given the psychedelic, they don't, they won't, they don't go to it. So it's so, it's not addictive. I mean, it can be abused. There's that for sure. But, it's also, physiologically, it's so it's the lowest of almost, I think probably any, wish I had that chart, of any of the drugs, as far as your body goes being harmed, and they don't have an LD 50, which how much you can take and die. Right.
Mary Cosimano:
Yeah. Not saying you want to, and it could psychologically blow up that mic.
Elisabeth LaMotte:
Yes. Of course, you don't want to, which brings us back to the importance of set and setting. But it is noteworthy that these substances, they're non addictive, and they do not have a threshold of toxicity that many other substances do.
Mary Cosimano:
Yeah. It's more the psychological where you can get in trouble that is really important to pay attention to. Absolutely.
Elisabeth LaMotte:
So building on that, how would you say your work has shaped who you are and how you show up as a person outside of work?
Mary Cosimano:
Yeah. Well, it's just what I said from the beginning. Nothing's been more important to me than to be who I am without, you know, just ordinary, authentic. And that means working on myself. And so the beauty of being in these experiences, it's a continual just, you know, togetherness of how are we going to do that? And they teach me ways and I share ways I've had. And so I'm constantly learning new ways and immersed in it. So that's my world, how can we be that? And so it just continues to unfold. Again, there's nothing more important and it's just in that energy, you're always in that space of thinking about it and working towards that.
Elisabeth LaMotte:
Like, amazing. Palpable, and I imagine it brings a lot to other people, not just in your professional sphere, but in all spheres. I could keep going and going and going, and I know that we do have to end. Mary Cosamano, thank you so much for joining us and for the important work that you do. Thank you, and thank you to our listeners.
Mary Cosimano:
Well, I wanna thank you, Elizabeth. You have made this such joyful for me. I just love your interesting questions and thank you so much.
Elisabeth LaMotte:
Well, it's been really fun to do this deep dive and learn about this. So maybe we'll have part 2 someday. I would certainly be up for that. Thank you very much. Thank you.
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