Dr. Victoria Maizes

Hi, Andy.

Dr. Andrew Weil

Hi, Victoria.

Dr. Victoria Maizes

We have Scott. Shannon, who is an integrative psychiatrist whom you have known for a very long time.

Dr. Andrew Weil

I knew him as a medical student here at the University of Arizona. And I've followed his career with great interest.

Dr. Victoria Maizes

Yeah. And he's really been a leader in integrative psychiatry and always, complements you for your mentorship.

Dr. Andrew Weil

And psychedelic therapy as well. And I'm looking forward to hearing from.

Dr. Victoria Maizes

Well, let's get him on.

Dr. Andrew Weil

Okay.

Dr. Victoria Maizes

Dr. Scott Shannon is a pioneer in the field of integrative psychiatry. He founded the Wholeness Center, an integrative mental health center, and served as the site principal investigator for the phase three trial of MDMA assisted psychotherapy for PTSD. He published the first integrative psychiatry textbooks for both adults and children, as well as two books for parents, including Parenting the Whole Child.

Scott has been a mentor to numerous physicians who believe in a more holistic approach to enhancing mental health and well-being. Welcome, Scott.

Dr. Scott Shannon

Well, thanks, Victoria. So happy to be here. It's an important conversation and happy to have it with both of you.

Dr. Victoria Maizes

Wonderful. I would really love to have a dual conversation. One is what has caused this crisis in mental health in young people. And two, maybe more importantly, what can we do to alter it?

Dr. Scott Shannon

Well, you know, it's been brewing for a while. Ever since I've entered the field, we've seen declining rates of, mental health indicators, and we've seen this sort of multifactorial, sort of perfect storm, almost kind of thing, where we've seen declining sleep, declining exercise, declining outside time, poor nutrition, less time with parents and increasingly stressed, adult population.

And then in the last ten years, really this onset of, smartphones and social media, which has really escalated all these trends to an unbelievable degree. And, and this all reached crisis proportions before Covid. So we've got to be clear about that.

Dr. Victoria Maizes

Yeah. I have seen many experts, point to the last point, not all the earlier vectors, but smartphones and social media, as you know, the evils that have really, harmed our children. And, I'm curious, whether that was just from your perspective, the tip of the iceberg or something more fundamental.

Dr. Scott Shannon

I do think there's some fundamental things going on, and and one of them is that I think our science and our society has become so denuded of spirituality and depth. And, I'm just fascinated by how we've just lost sort of a spiritual sense of our existence. And given that over to things and it's become increasingly, I think, desiccated, empty, desert out there.

Not for those of you in Tucson, but the desert in other ways. yeah. So I think it's a lot of things, but I think at its core, it's a spiritual issue.

Dr. Andrew Weil

And, Scott, I assume you share my concern about the incredible overuse of psychiatric medication in children and adolescents. I think we have no idea what the effects are on the developing brain alone or in combination.

Dr. Scott Shannon

Oh, I wholeheartedly agree, I just want to take a minute out to thank you, Andy, for your sort of mentorship and inspiration for me in my career, because I've tracked along with many of the things that, you inspired me with integrative health and psychedelics both. So thank you. Yeah. And, you know, all my career, I think I've been in ambivalent prescriber.

And so it allowed me to kind of keep a little bit of a jaded eye to this thing that most psychiatrists lose sight of. But like you, I'm very concerned because we just don't have the data that it's safe. And I think, like in the case of ADHD, we're now medicating probably over 10% of our pediatric population. And I think we're going to see increasingly that, once we get away from this ideal that the chemical imbalance theory actually works for treating people.

I think we're going to really see the detriment and the sort of flotsam and jetsam that this has created for kids, huge issues, I think.

Dr. Victoria Maizes

So for a moment, be the czar of mental health for, our society in the United States. What would you do differently? What would you do? in families, in schools, in communities, if you're a policymaker, like, how do we get to a much, much better place in terms of how we care for our kids?

Dr. Scott Shannon

Well, I think we have to regulate social media, and I think we should probably make 16 the age that kids can sign on to social media. I think we can instruct and educate parents about the need to keep kids off smartphones until the age of 13. I think we need to build more family. We need to build more community.

I think we need to emphasize outside time, nature, exercise. one of the biggest issues with smartphones is the opportunity cost for kids to develop relationships, to be outside, to have free play. And I think we have to empower schools to take some actions and really have home free schools. And it's not just encouraging kids to turn them off, but actually taking them away from, you know, the 9 to 4 or 9 to 3 kind of block when they're in school.

I think we need to probably get a little more strident about kids nutrition, whether it's in schools or the labeling we have I think there's a lot of things we could do. But ultimately in our society, most of it falls to parents. So I think we have to educate parents, inspire parents to take action, you know, and we can ask for legislators to take action. But that's that seems to be a, a difficult task these days.

Dr. Andrew Weil

Well, good advice.

Dr. Victoria Maizes

Are you aware of any communities or schools that are taking this step? I did hear about a school in Europe which did, a kind of social experiment. They, restricted use of cell phone in one of three ways. One was, that the kids could have it at school, but it had to be turned off. The second was that they were collected at the door of the school, essentially, and the third was they had to leave them at home. I'm guessing that both of you could predict which one created the most distress in the kids.

Dr. Scott Shannon

Oh my God. yeah, it's things like that that we need to realize that it's like we require a license to drive a car. And, you know, we should have some regulation because it's clear when you look at the data that around 2012, in a synchronized way across the world, pediatric mental health accelerated its deterioration. And we can look at, you know, 20% cell phone penetration in 2012.

But by 2016, it was almost 80%. And so that is the piece that really changed their trajectory. So I think I think we need to get more assertive both as parents, a school administrators and even legislators just taking on this issue.

Dr. Victoria Maizes

One of the things I think is interesting is there appears to be a bit of a different impact on girls and boys. Do you want to talk about that?

Dr. Scott Shannon

Yeah, it's really clear this has affected girls much more because in that sort of critical social learning, cultural indoctrination era, from like 10 to 14 girls are much more focused on communion and connecting to a community. And for boys, it's about building agency and action. And so boys are drawn to video games that are action oriented when lose sports, you know, kind of has that metaphor.

But that's been much less detrimental because girls, what happens on social media, they get bullied, they get into comparison, they get obsessive about how their social standing is impacted. And girls have the ability to devastate one another with comments on social media. Oh my god, you know, talk about mean girls. It's it's a thing.

Dr. Victoria Maizes

And so on some level, the boys are actually still playing together, even if they're using a device.

Dr. Scott Shannon

Yeah. And they're often playing together remotely. So there is a cost to what's interesting is one on one friend time has cratered during this same ten year period, whereas 50% of kids used to be with each other after school, it's now like 20 or 25%. So that's fallen off. And so the relational component here is really critical for both boys and girls.

Dr. Victoria Maizes

One of the former guests, on our program is someone I know, you know well, Dr. Bonnie Kaplan, and she really focuses on the importance of micronutrients for brain health. And I'm interested in knowing your experience with supplementing micronutrients in kids.

Dr. Scott Shannon

You know, I think this is an area where, they these interventions win, hands down, compared to psychiatric medication. For the last, I stopped seeing people routinely last summer. But in the 20 some years before that, I found that working with broad spectrum micronutrients, was just a game changer for me in dealing with pediatric mood disorders, particularly bipolar disorder, when it's just head and shoulders above toxic things like lithium and Depakote. So yeah, I think the world of these agents, I, you know, I try to teach and train about them as much as I can. There's so much less toxic. And I think we now have 40 peer reviewed studies supporting their use, not only in mood disorders, but in ADHD and in other areas where they can be a support for people and help them to feel more well and alive, as opposed to, medicated and dulled.

Dr. Andrew Weil

We've been hearing a lot about the dangers of ultra-processed foods on health. And, certainly kids are great consumers of these, and I wonder what the impact of that is on mental emotional health.

Dr. Scott Shannon

You know, it's got to be profound. And certainly we're seeing just the rates of, type two diabetes and blood sugar issues becoming very critical for kids. You know, they're now predicting that, you know, within 50 years, maybe of over a third of Americans will have diabetes, may be approaching 50%. And that starts in the pediatric, too, when we've seen, weight gain in kids, obesity.

We used to have the least obese state in the country. And we're now the same place that Mississippi was 20 years ago. It's horrific. And it's because kids aren't moving. They're sitting still and they're eating the wrong kind of foods, like ultra processed foods. So, yeah, I have grave concerns about that.

Dr. Victoria Maizes

Scott, I think you are the first physician that I ever heard present on the research for psychedelic medicines. And, you know, at that time you were mostly talking about ketamine, which of course, isn't a true psychedelic, as Andy likes to remind us. But it was, what was legal and available. And I know you've also, been a leader in medical cannabis and, you were a PI, primary investigator in the, maps MDMA trial.

How do you see these, I would say revolutionary medicines, being integrated into integrative mental health. And will they have a role in kids?

Dr. Scott Shannon

You know, I think they will have a role in kids. In fact, now that MDMA is about to have approval from the FDA, then we'll have mandated pediatric trials. So that's going to begin. But backing up a bit, I think these are a pivotal moment not only in mental health, but for our society at large. And one of the things I've been thinking about a lot is how we've moved so far from an understanding of our reality that's relational based, or makes room for spirit and human experience.

And I think that, the pivot and what we see, it's what's interesting with psychedelics is it's a contagion. This is one of the few things that Republicans and Democrats agree on. It's really fascinating. But we're getting bills across the aisle, legislative changes. It's now legalized in Colorado and Oregon and other states will soon follow. But I think it's a draw inside there's some spiritual hunger in our country, in our society, and not just in mental health care, not in health care, but much more broadly. And I think psychedelics, as they shifted consciousness in the 60s, I think they're going to do it in a broader, more comprehensive way. We learned a lot of lessons from those experiences in the 1960s.

And, hopefully we are paying attention. But I think it's pivotal, and I think because we're moving from a suppressive model of the psyche, where we try to reduce symptoms by managing misery and sedating people basically to an evocative model of the psyche, where we're trying to honor the healing power. And I think this is really going to be psychedelics are going to move us from a very conventional allopathic model of pathology, of the self to a model that's just very, progressive, much more integrative, holistic that makes room for the inner healer.

So I think it's a beautiful moment of transition, and I'm so happy to be a part of it.

Dr. Andrew Weil

And I, I couldn't agree with you more. I think one of the questions that, frequently comes up is about the age appropriateness of using psychedelics in cannabis. The question is, are these dangerous for the developing brain? What advice would you give to parents, to kids? You know, there are very powerful cannabis preparations that are now you can buy them in convenience stores so I assume that these are easily available to young people. Now, what advice would you have about young people experimenting with these?

Dr. Scott Shannon

You know, we're seeing vaping, tar, wax, dabs that are getting, over 50% THC content. And what we have is pretty clear data that this increases the risk for psychosis and likely decreases a lot of developmental tasks for people in mid to late adolescence and early adulthood. I've actually never been sort of a pro cannabis guy. I've been to cannabidiol, a CBD guy, hemp based. I think that's wonderful. So, you know, my feeling is it's recreational. And like I learned from my mentor, it's all about the relationship with the substance that you have. And so there are some people, teenagers that can have a decent relationship with cannabis that's not abusive. but many can't. And so I have real caution there. I think the difference with other psychedelics is that they're used occasionally and they seem to be more anti addictive, whereas cannabis can clearly have an addictive pattern that teens.

I worked at a residential program in Boulder for a while for young adults, kind of failure to launch territory. And one of the biggest things we saw was, these late teens who got into smoking a lot of cannabis and then lost all drive and motivation. Smart kids, capable a lot of parental resources, but they ended up sitting in their parents’ basement playing video games.

And, you know, one of the key things is how do we get them off cannabis and what cannabis does to the frontal lobes we've seen on our, scans is it really increases frontal alpha and just puts the clutch in. And so they spin and they don't have the ability to engage in the world. And so, they end up in their parents basement, not not everyone, obviously, but this can be an issue. So I, I share your concerns about some of the high, high potency cannabis agents.

Dr. Victoria Maizes

I realize the cultural context is very different, but, Andy, I believe that I've heard you talk about, in, you know, some of the indigenous societies, children are exposed to psychedelics at a pretty young age.

Dr. Andrew Weil

Well, particularly it's used in, an adolescent coming of age rituals. And, you know, under the supervision of shamans who are very experienced and, and are good guides and it seems to be quite stable usage.

Dr. Scott Shannon

Yeah. You know, my sense is, is I see a role for them and I think if it's managed very well and thoughtfully, you know, think about the exposure someone has using a psychedelic 2 or 3 times maybe just once in mid to late adolescence versus everyday use of psychiatric medications. I don't even think there's a close comparison to risk.

I think it's orders of magnitude different because with psychiatric medications you're constantly putting it in the brain and forcing the brain to make changes. And a good portion of people that do that can't get off the medications. We now have millions of people in the US who are locked on antidepressants because they can't tolerate the withdrawal symptoms. So I think psychedelics pose less risk.

But I think it's a little bit of a a challenging territory to think about how we move down that age spectrum. We do ketamine treatments, ketamine assisted psychotherapy for some teenagers. And it found it can be helpful mostly as a way to help them engage in therapy and open them up to the therapeutic process. But, I think society's not quite ready for that milestone yet, but we're coming, and I think we're going to have the opportunity, I think, to work with MAPS like those in the, phase four trials with pediatric, you know, it'll be adolescent 12 to 18 use of MDMA.

Dr. Victoria Maizes

And do you have less MDMA concerns because it isn't a true psychedelic?

Dr. Scott Shannon

I think all these agents and not have to differ a little bit with Andy on this.

Okay.

I think all of these agents, what they share in common is the ability to change consciousness and the flow of information in the brain. And so we can have classic psychedelics like psilocybin, five methoxy DMT. And we can have things like MDMA, which is an amphetamine compound, and we can have ketamine.

They can all change the inner experience, even though they're not all classic psychedelics. So when I talk to people about it, I talk to them as catalysts, inner catalysts for change in perspective. I think ketamine, you know, it's not as good as the other agents. I will readily admit that it doesn't have durability. And what the classic psychedelics have is durability.

And once someone has a profound experience, it seems to stick to their ribs and lasts.

Dr. Victoria Maizes

Yeah, it's just so interesting. I would like you to say a little bit more about this distinction that you made earlier between, what you call suppressive, medication and evocative treatment because, I don't know, it seems to me that most people would choose door number two.

Well, I think, you know that we developed this, aura of intimidation around the psyches, that people can become psychotic. They can have hysterical reactions, they can cry, and what we, the agents that we began to use in psychiatry 70, 80 years ago, all had this ability to mute responsiveness. And so antidepressants muted people's ability to care not only about their own depression, but also about relationships and other things in their life.

And then we have the antipsychotics, which are obviously very dulling, very sedating. And they can effectively hide psychosis for a period of time. But all these agents, require daily dosing to suppress these symptoms. And like with benzos, I mean, the same thing that we got into with narcotics, we can see with benzos, is that they take away fear, but they also sensitize to fear.

And, people have great difficulty getting off benzos once they've been on it. So, and these are benzodiazepines like Valium, Xanax, librium, pretty common out there the challenge is, how do we move from an era where we've been fearful about the psyche, trying to suppress symptoms and pretending that we don't have the ability to heal ourselves to a model where we can embrace healing, trust in the psyche, and allow altered states to begin to shift the stuckedness that people, you know, the biggest reason people come to see me is because they're stuck.

And I think what psychedelics do better than any. And clearly the classic psychedelic looks do this best of all is they shake up somebody's snow globe and give them an opportunity to change the patterns that they've been stuck in, increases neuroplasticity, which is that brain's ability to change and learn. that's the goal that we want in mind when we're working with people in mental health.

Dr. Andrew Weil

How do you feel about some of these new, non-pharmacological interventions like transcranial magnetic stimulation and, various forms of light therapy? What do you see as the potential of these?

Dr. Scott Shannon

I think they may have some, some big potential, but I see TMS and, transcranial direct stimulation and other things being, I mean, we could call them ECT lite, if you will. but they're really an external something that we're doing to the brain. And, I much would prefer a transformational process like we could have with psychedelics that really encourages the body's process to grow and change.

But, I think what we see with TMS and other things and clearly, I think there may be a role for it because certainly psychedelics are not yet broadly accepted. They're not reimbursable. and TMS is probably less, I'm sure it is less traumatic and invasive than ECT, but I think it still has that model of we're doing something to people and they're a passive recipient.

Whereas in the psychedelic framework, we're encouraging people to have an active process of growth and transformation. Sometimes we can't get that, but I think if we can reach for that. I think that has to be our ideal.

Dr. Victoria Maizes

[Audio #4: Getting “Unstuck” in Mental Health Challenges] It seems to me that some of the earlier, things that you mentioned were absent in our society also unstick people. So like when people go on a wilderness experience and connect deeply to nature, they get unstuck from their life in one way, when they become very spiritually connected, they often get unstuck from their life in another way. I'm just curious what else you think besides, psychedelics, which, as you said, you know, are not so easy for most people to access at this time, unsticks the brain.

Dr. Scott Shannon

I have this whole category of things like spiritual catalysts. So one of them is like world pilgrimage. World travel. I mean, spend a month in India and not come back a changed human being. but, we can have religious conversion, you know, Saint Paul on the road to Damascus kind of thing. We can have meditation.

We can have, you know, sometimes, a disaster for all of its negative implications, creates massive change. And then we have these sort of life events that are pivotal, like the birth of a child, the death of a parent, divorce. These can be stimulations that really shake someone's snow globe up. Psychedelics can do it. Near-Death experiences. Although I'm loathe to prescribe them because about 25 to 50% of people die, you know?

But, yeah, there's this whole category of spiritual catalysts, and it's really fascinating. Takes me back to the work of Jerome Frank and how he looked at all these different things that could support healing.

Dr. Victoria Maizes

And he could you add to that list?

Dr. Andrew Weil

No, that's a pretty good list. I like travel for me has been a big one. I think just experiencing other cultures, being around different kinds of people, that has tremendous potential.

Dr. Scott Shannon

Yeah, yeah, I agree.

Dr. Victoria Maizes

You said disaster. I have to say, in my clinical practice, where I've taken care of a lot of women with breast cancer, a breast cancer diagnosis often completely unstick someone.

Dr. Scott Shannon

Yeah. And they've done surveys and said some significant portion of women would not go back and do it over because they felt that it was such a catalyst for change. And, personal evolution. So, yeah, sometimes we need to get hit over the head with a two by four.

Dr. Scott Shannon

I listen to you at Psychedelic Science last year, and I loved what you were saying about five methoxy, why you think it can be the future for psychedelic medicine.

Dr. Andrew Weil

five methoxy dimethyltryptamine, as you know, is the main constituent of toad venom. Our toad here in the Sonoran Desert, and when inhaled, vaporized and inhaled, it produces a very intense, altered state that's quite short lasting, you know, maybe five minutes with some period of comedown. It's not visual. it's an experience of total ego dissolution. I think it has tremendous potential for preparing people, for dying, for really discovering that you or not, your body, that you're not in your mind. you know, I it's a great catalyst to transformation. so I think there's, I just see great potential for it that many people have experimented with. and NM dimethyltryptamine, you know, that's intensely visual. You see cartoons and entities. I mean, that's all fun, but I think five methoxy is much more serious.

Dr. Scott Shannon

We're in the middle of a study right now with Beckly, basically with five methoxy for.

Dr. Andrew Weil

Oh great.

Dr. Scott Shannon

Depression. Yeah. We've created a couple people so far. Impressive. We hope to roll it out at our clinic under proposition 122.

Dr. Andrew Weil

I will be very interested to hear the results of that. I just think it has you know, both the duration of action and the quality of effect. I think I just see much greater usefulness for it than some of these much longer acting psychedelics.

Dr. Scott Shannon

I’m curious now, Andy, what you're interested in, what's the rock you're looking under right now?

Dr. Andrew Weil

Well, I really want to see, materialistic psychiatry go away. You know, I think the whole biomedical model of mental illness is just wrong. You know, I think we need a whole different way of thinking about the brain and the mind, and it's not all biochemistry, and it's not all, you know, not all emotional disorders are rooted in in brain biochemical dysfunction and therefore only treatable with medication.

You know, I really want to see that disappear. I was absolutely horrified when I began to see antipsychotics recommended to make your SSRI work better. I mean, unbelievable, these are very powerful drugs for major mental illness and on television advertising. You know, your antidepressant not working. Ask your doctor to prescribe, you know, one antipsychotic unbelievable.

Dr. Scott Shannon

I know, and it's sad in that, you know, that 80% of the antipsychotics that are used in children are used for non-psychotic indications. It's just for behavioral control. Right. And they sedate the kids. I mean they they do work but at what cost. You may be interested to know that one of your early pieces of advice that I listened to was always consider history and philosophy when you're trying to understand what you're doing and, you'll be interested to know that I'm, I'm rolling out a program on metaphysics that we need to go back to understanding metaphysics, to really properly discuss and understand mental states and where psychedelic experiences take people because we're now finding that a psychedelic experience can shift your metaphysical perspective from a materialistic perspective to a sickest perspective or something else. And so I think we need a language to talk about, and I'm really hopeful that this inward arc that we're beginning with psychedelics can take us to, you know, honoring the the depth of thought and understanding that comes with metaphysics.

Dr. Victoria Maizes

I'm so excited to hear that you're doing that, Scott. And it seems to me that you continue to be a pioneer. And, I know you've influenced the career of so many psychiatrists, many of whom are in despair really about, the way in which they practice medicine in our country.

Dr. Scott Shannon

And, you know, I see that, too. And what I see is that the ability to do psychedelic medicine, where you sit with someone and honor their psychic process and honor their inner healer, has been transformative. And a lot of people can, can, really move away from that place of despair when they start working with this different model that honors people's ability to heal.

And we get away from that medication suppressive model because, you know, I think it's in many ways toxic for the providers as well as the patients. And it it really is deadening that there's a sort of a vacuum that happens with it that many people burn out with, frankly.

Dr. Victoria Maizes

Yeah I want to honor the work that you have done and the contributions that you have made to integrative medicine, to integrative psychiatry, and just to the lives of so many people. Thank you.

Dr. Scott Shannon

Well, you know, it's my pleasure. And it's, I do still feel very passionate about all this. And, you know, I joke that, although I'm not getting younger, I still feel as passionate as I did. And probably close to 50 years ago when I met you Andy,.

Dr. Andrew Weil

Good. Keep it up. Keep it up.

Dr. Scott Shannon

I'm keeping it going. So we're trying to innovate with new ways of assessing brain function through colleagues, brain mapping and having that help us determine treatment direction, and ideally to direct us towards which psychedelics people are most responsive to, because I don't want us to get in the place ten years from now where we're trying to pick between five methoxy DMT, psilocybin, ketamine, and MDMA just based on a hunch. I don't think that's good science. I think we can do better than that. And, you know, right now psychiatry is so driven by personal opinion and observation that it would be nice to have some more science to guide us as we try to help people find find true healing.

Dr. Victoria Maizes

Well, that is a very, positive way, I think, to close this conversation, which has just been so rich and, you know, we're just so appreciative of you.

Dr. Scott Shannon

Thank you.

Dr. Andrew Weil

Yes. Thank you.

Dr. Scott Shannon

Pleasure. My pleasure.