| Welcome to this video and I am so pleased to welcome Professor David Nutt. |
| Professor, thank you so much for coming. |
| My pleasure, John. |
| So far, anyway, let's see how it goes. |
| Yeah, well, yeah, we'll see, we'll see. |
| Now, I became a registered psychiatric nurse a few weeks after my 21st birthday. |
| Oh, wow. |
| Things went a bit sideways after that, but that's what I did when I was 18, 19 and 20. |
| So, yeah, pretty happy memories, really, for most of it. |
| But you're a doctor, you're a psychiatrist, you're a professor, you're an academic, you're a writer, and you're, to be quite blunt about it, a world-leading expert in psychopharmacology. |
| So tell us a little bit about yourself that you think might be relevant, and what the heck is psychopharmacology anyway? |
| Well, it's a word you've already mastered, which I'm impressed with. |
| But then that psychiatric training. |
| If you learn when you're young. |
| Yes, quite. |
| So psychopharmacology is the study of drugs, how drugs affect the brain and mind. |
| And I got interested in it, really, almost from my very first day at university. |
| I actually went to university. |
| I thought I was going to do physiology, and I was going to work out new ways of treating pain, using improvements on electrical stimulation. |
| But my mentor at the university at Cambridge was a guy, he was the guy that discovered GABA in the brain. |
| Right. |
| And it was at the time when we were rewriting the whole science of the brain, from essentially being a telephone exchange, where everything was electrical, to being some sort of soup of chemicals, which somehow pulled things together. |
| He discovered GABA, and the concept of synaptic transmission and neurotransmitters was just developing. |
| And then, of course, if you, given the fact that the brain works through utilizing maybe up to 80 different neurotransmitters, to understand those, you have to use small molecules we call drugs. |
| So then I got interested in drugs, and, you know, I haven't solved it all yet, so I can't take a look. |
| You know, I've been doing it. |
| It's a massive, massive task. |
| But obviously, mental illness, it affects addiction. |
| And it affects other areas, you know, like enhancement and well-being, et cetera. |
| The brain and the mind, it's just so ludicrous, isn't it? |
| You know, I've been thinking about it since I was 18, as you have. |
| And the analogies that are used are often those of the technology of the day. |
| So sometimes it's a telephone exchange, then it became a digital computer. |
| Then it became some quantum machine or other. |
| But it's just utterly unbelievable, the sheer complexity of it. |
| I don't know, 100,000 million nerve cells with hundreds of interconnections each. |
| Well, yes, it's actually, yeah, it's so it's, I think the current estimate is about 80 billion. |
| Yeah. |
| And each one's like a little computer. |
| But it's, the analogy of the brain really is not a computer analogy. |
| Its analogy is with humankind. |
| Yeah, it's, the brain is so powerful because, in the same way as humans, you are powerful because we work, if we work together, we can be extraordinarily powerful. |
| And we have the analogy. |
| If we could. |
| And in a sense, many aspects of humanity emerge from the brain. |
| This emergent consciousness that comes from the. |
| Oh, yes. |
| Presumably comes from the brain. |
| I don't think there's any doubt about that. |
| We don't understand. |
| I'm sure. |
| Yeah. |
| I think, I mean, obviously, there are people who think it comes elsewhere. |
| And there's no way you could ever say no. |
| But I think it's quite likely, unless we're part of some very sophisticated game that some, someone beyond the universe is playing. |
| I think it's probably coming from the brain. |
| Well, one thing I'm pretty sure about having worked with an ethetist is we can switch it off for a period of time. |
| That's. |
| Yeah. |
| That seems pretty convincing evidence, actually. |
| Well, that is also true. |
| Yeah. |
| But what's interesting, of course, John, is that that's we'll come on to this later, is that until recently, the theory of consciousness was you can switch it on or off. |
| It's whether you are awake or asleep. |
| Now, of course, you know, we've got these wonderful new drugs called psychedelics, which just change the direction of consciousness as opposed to whether there's a lot of it or not. |
| Not so much of it. |
| On the topic, I have just finished reading your book. |
| Fantastic. |
| Eminently readable, I must say. |
| If you're whatever you're, you know, for nurses and doctors, fine for bricklayers, painters and decorators. |
| Also fine. |
| Eminently readable and in clear English. |
| Thank you. |
| And I must say, I've been looking forward to this because my understanding of psychedelics is is very primitive. |
| And I'm hoping you're going to clarify that. |
| But just before we go on to that, what common psychiatric disorders do you come across as a psychiatrist? |
| What causes this mental distress that seems so prevalent in our world at the moment? |
| Well, yeah, I think it's important, John, as you when you were doing psychiatry, you were you are presuming hospital, were you? |
| Yeah. |
| Yeah. |
| It was it was a proper old fashioned asylum. |
| It was the end of the asylum days. |
| Where was that? |
| It was Garland's in Carlisle, Cumbria. |
| Oh, OK. |
| I suspect I strongly suspect you've never heard of it. |
| I've not heard of it. |
| You're quite right. |
| I've not heard. |
| But there were I've been in many like that, of course. |
| Yeah, for sure. |
| Mostly gone. |
| But there, you know, you were seeing people with within, you know, often very enduring and very complex and very distressing, serious mental disorders. |
| And for which, you know, we had little in the way of treatments. |
| And today we still have limited treatments. |
| But then there's the much bigger. |
| That's like the tip of the iceberg underneath. |
| There's this, as you point out, this distress and misery and unhappiness, which is, you know, becoming some ways more pervasive. |
| And as whether that whether, you know, whether it's useful to talk about it as mental illness or whether we should talk about it in some other way, I think is a bit of an open question. |
| It's certainly something we need to think about and try to help people with. |
| But I don't I'm not sure labelling it mentally on this is necessarily going to help us because then it kind of constrains a little bit. |
| If it's illness, you've got to have a treatment. |
| Whereas, you know, you and I, of course, we definitely want prevention if we could. |
| Well, I don't think there's anyone watching this video who's not suffered periods of whatever we want to call it, mental suffering. |
| Exactly. |
| Psychological distress. |
| Yes. |
| Or close family members who've been through really difficult times. |
| And of course, we can't really separate in some respects different parts of the body. |
| You know, the mind and the body are so interrelated. |
| If you're suffering physically, you're going to be suffering mentally as well. |
| That's a component of the pain and of the suffering. |
| Well, you and I, unfortunately, sadly, a lot of doctors don't. |
| And that's one of the things, you know, there is they still make fun of us doctors. |
| They make fun of us psychiatrists. |
| They don't know what we do. |
| They think we're just a doctor who's scared of blood. |
| Well, sometimes we're the thought police. |
| Sometimes we're shrinks. |
| You know, I mean, yeah. |
| There's some. |
| But on a serious note, the point you're making is that a lot of doctors, either through ignorance or even sometimes even kind of malice, don't want to think about the psychological constructs. |
| They and that's actually. |
| Can we can I be honest with you? |
| That's why I started off being a neurologist. |
| Mm hmm. |
| Because I thought, you know, that a it was difficult and be, you know, it was a challenge. |
| Understand the brain. |
| And then I realized that I was I worked on the what we would call a tertiary third third level neurology unit in St. Mary's Hospital. |
| And there were people there with very serious neurological disorders, but they were all much very similar to each other. |
| You know, I mean, epilepsy. |
| We couldn't do much about it. |
| Multiple sclerosis. |
| We couldn't do anything about it. |
| But the people that we could do things about with me who came in who had psychological distress and that psychological distress had manifested itself in things like blindness or paralysis or other, you know, unsteadiness. |
| And then what would happen would be that the neurologist would say would work out. |
| This is not a neurological problem. |
| Leave the ward. |
| And I hang on, hang on, hang on. |
| This is not a problem. |
| But, you know, A, it's a problem and people need help. |
| But B, it's actually very interesting, isn't it? |
| Because if someone can be paralyzed from the waist down because their mind makes them. |
| Wow. |
| That tells you something way more about the brain than you guys can tell me about when you just have a lump in there. |
| You know, I mean, it was it made me realize that the brain's way more powerful than even neurologists give it credit for. |
| And I can really relate to what you're saying. |
| We get patients in. |
| I worked in intensive care for a period of time, patients in with overdoses. |
| And basically the aim was to get them out as soon as possible. |
| Yes. |
| There was no, no holism. |
| No, why did they come here in the first place? |
| And I think to the to the list of problematic doctors, we could probably add politicians. |
| But we might talk about that. |
| We might talk about that later if you'd like to. |
| Yeah. |
| Well, I'm just kidding. |
| And let's let's not ruin the conversation. |
| No, let's keep let's keep the mind the mind clear. |
| So I think what were you talking about conditions there that hysteria, historic hysterical conditions? |
| Yes, that's what we would understand. |
| But that's what we would call them. |
| Yeah. |
| But just to be absolutely clear, that's an utterly pejorative term. |
| Hysteria comes from, I think, the Greek word for the womb. |
| So hysteria was things that women had. |
| Well, how insulting is that? |
| I mean, how utterly insulting is that? |
| Well, it's caused by the floating uterus, wasn't it? |
| That's right. |
| Exactly. |
| Wandering womb. |
| Yeah. |
| And couldn't have it. |
| I mean, well, as well, utterly insulting to women. |
| But also. |
| Totally. |
| Now we call them conversion disorders. |
| And, you know, well, I suspect we've all had minor, minor elements of that. |
| Can I give you an example? |
| Please. |
| So I broke my ankle really quite badly seven weeks ago. |
| And it's still not healed. |
| Luckily, I'm sitting, not talking, not standing. |
| And it did several things to me. |
| The first is my blood pressure went up, 20 millimeters systolic. |
| My sleep disrupted by the pain. |
| But now, and I found this the other day when I was in a conference talking with people about pain syndromes. |
| When people talked about their pain, I got pain in my body, not just in my ankle. |
| I'm thinking, this is fascinating. |
| You know, I'm empathizing with their pain, but I'm more able to do it now because I'm in pain myself. |
| Which was, which to me, very, very, you know, I've been around. |
| I've been a doctor for 50 years. |
| That was the first time I personally experienced what it is like to have that body response to someone else's pain. |
| And it was, it made me feel quite humble and made me think a bit more about what we should be training doctors to be sympathetic about. |
| Because you could, if I went to a doctor, they'd say, well, you know, that's just in your mind. |
| But it is in my mind. |
| But it's come from the fact that I did have a physical problem in my leg and still do. |
| Well, it's the interaction of the mind and the body and the experience is real. |
| It's a genuine pain. |
| Yeah. |
| Dissociating them is, one of the big problems we have in this, in science and in medicine, is it so much of what, the way we think about everything is in terms of what the words mean. |
| We use language. |
| It's often a very imprecise language. |
| It often locks people into a way of thinking, which isn't, you know, is constrained and possibly wrong. |
| And yeah, and that's, that is really, you know, the idea, you know, there's a, there's a mind and not a body. |
| They're separate. |
| I mean, it's actually ridiculous. |
| We've got to be much more holistic. |
| Yeah. |
| So coming back to medications, what medications, what has been the main development in psycho, psychiatric medications, say, since the Second World War? |
| I mean, I seem to remember drugs like chlorpromazine, the major tranquilizers, came in probably about 1957, late 50s. |
| Yes, that's right. |
| And then tricyclic antidepressants. |
| Well, yeah, I mean, the sad truth is that in the 50s, modern psychopharm, modern therapeutic psychopharmacology, the modern medicines of psychiatry were discovered by accident. |
| Yeah. |
| And they were drugs like chlorpromazine, which were made to be sedatives, but did turn out to be, have some antipsychotic effects. |
| And then there was the first antidepressants, which amipramine was actually made to be a better chlorpromazine, but it had no antipsychotic effect. |
| But it did have an antidepressant effect. |
| And then alongside that came the benzodiazepines as sort of tranquilizers. |
| They're all discovered completely accidentally and then made available as medicines. |
| And then certainly for the antidepressants, significant side effects of toxicity emerged. |
| And so people began to refine them and get rid of the toxic elements. |
| But today, you know, I'm still, if I was still writing prescriptions, which I'm not anymore, but if I was, I would be writing prescriptions for the same class of drug. |
| I wrote my very first prescriptions back in when I first started prescribing in 1972. |
| And no other branch of medicine really are you relying on medicines which have got that old and have that, you know, not been improved in that time. |
| Yeah, it seems to me the changes are incremental. |
| So we went from the tricyclic sort of fairly non-specific drugs to the selective serotonin reuptake inhibitors. |
| So it's kind of a bit of a tweak, really. |
| Yes. |
| We went from venothiazine antipsychotics to slightly more refined antipsychotics. |
| But my understanding is they work in essentially the same way. |
| Is that correct? |
| They work the same. |
| In fact, in some ways, we went to less refined ones. |
| But we went through a cycle of refining and then de-refining because the refined ones had more side effects. |
| Yeah. |
| Of course, it's very important to keep drugs in patent so the pharmaceutical industry can make. |
| Well, that is... From patented drugs. |
| Yeah. |
| I mean, the Me Too concept has dominated, really dominated the whole psychiatric development field. |
| And it is partly that the system is very much... |
| It very much favors that because once one has got on the market, you know exactly what trials to do to replicate. |
| So, you know, you just basically just do handle turning, do the same thing. |
| But, I mean, to be fair, it's also been that even if you were to invent, these medicines currently are quite inexpensive. |
| So, there's very little incentive to come up with new treatments. |
| And, in fact, that's the point I've been making recently, that without any incentive, no one will. |
| So, if the model is that companies need to make money making drugs for mental illness and the companies are not going to make money because they're not investing, we've got to do something differently. |
| Which is why we've got to look to other lines of evidence, particularly in relation to things like psychedelics, where the evidence base is enormous. |
| But there isn't particularly a commercial way of developing it. |
| So, let's do it differently. |
| Let's society... We need a bit of a breakthrough, don't we? |
| I think that me too thing maybe has maybe got a few meanings these days. |
| I think what you mean in that context is you have a drug like SSRIs. |
| And you start off with Trozac and then you get citalopram and then you jiggle the molecule and you come up with sertraline and maybe tweak the molecule just a little bit and call it something new. |
| Yeah, but they all work in exactly the same way. |
| I mean, they have some differences. |
| But they're not very much, as you say, incremental advances. |
| And it's also, they've been very successful and companies have made quite a lot of money out of them. |
| So, it's been difficult to persuade investors to do something different. |
| Why? |
| I mean, to the absurd situation, this is kind of fascinating. |
| But there is one company now that is remaking a drug which is 50 years old. |
| Yeah. |
| It's a kind of benzodiazepine. |
| Yeah. |
| And obviously, it's been used in France for 50 years. |
| And it's pretty safe and quite well tolerated. |
| But obviously, they can't patent that. |
| So, they're making a, instead of putting, they're taking some of the hydrogen molecules out and putting a heavy hydrogen called deuterium. |
| So, they're making a deuterated version of this molecule. |
| Now, because they can get a patent. |
| And you think, well, guys, guys, we've got a powerful, if this drug is good, which it might be, I've never used it as a French drug. |
| Why don't we just make it available very cheaply for everyone rather than make a version just simply so you can sell it? |
| I mean, it just, medicine is, you know, the profiteering in medicine has distorted logic. |
| You know, surely, we should be putting our knowledge to making something new rather than a version of a 50-year-old drug. |
| Deuterium's heavy water, isn't it? |
| You remember the heroes of Telemark and all that. |
| So, stories from the Second World War of the heavy water. |
| It's not radioactive, just so we can reassure people. |
| I'm slightly reassured. |