The healing powers of illegal drugs like MDMA and psilocybin are finally living up to the hype – and they are already transforming our view of mental illness, says Sam Wong.
He wasn’t the first person to say it, and he probably won’t be the last, but Tom Insel’s accusation carried extra weight thanks to his job title: director of the US National Institute of Mental Health. Towards the end of his 13-year tenure, Insel began publicly criticising his own organisation, and psychiatry in general, for its failure to help people with mental illness. ‘There are great examples in other areas of medicine where we’ve seen innovation really make a difference,’ says Insel. ‘Not so much for patients with schizophrenia, post-traumatic stress disorder or depression.’
It’s hard to argue. Mental illness has reached crisis proportions, yet we still have no clear links between psychiatric diagnoses and what’s going on in the brain – and no effective new classes of drugs. There is one group of compounds that shows promise. They seem to be capable of alleviating symptoms for long periods, in some cases with just a single dose. The catch is that these substances, known as psychedelics, have been outlawed for decades.
A psychedelic renaissance has been feted many times, without ever delivering on the high hopes. But this time feels different. Now there is a growing band of respected scientists whose rigorous work is finally bearing fruit – not only in terms of benefits for patients, but also unprecedented insights into how psychedelics reset the brain. If the latest results stand up to closer scrutiny, they will transform the way we understand and treat mental illnesses.
The idea that they might be used to treat mental illness emerged in the 1950s, a decade or so after Swiss chemist Albert Hofmann first described his experiences of taking LSD. By the mid-1960s, roughly 40,000 people had been given LSD as part of treatments for all manner of mental illnesses, from obsessive compulsive disorder to addiction, depression and schizophrenia.
It looked like we were onto something. Then psychedelics escaped the lab and took off among the counterculture. The backlash meant that by 1970, they had been banned in the US, Canada and Europe. Research ground to a halt.
In the meantime, treatment for depression, the most common mental illness, came to be dominated by drugs called selective serotonin reuptake inhibitors (SSRIs), which boost levels of the neurotransmitter serotonin in synapses by blocking its reabsorption by neurons. Their success in early trials fuelled the idea that depression is caused by a deficiency in serotonin. But recently, this idea has been called into question, as more and more studies suggest SSRIs aren’t as effective as we thought.
That comes as no surprise to many psychiatrists. Despite their ubiquity – 8.5 per cent of people in the US take them – SSRIs work for just 1 in 5 people. Even when they do work, there are problems, not least that coming off the drugs brings severe side effects. The picture is no less grim for other mental illnesses: there is a chronic shortage of new treatments and precious few ideas about where fresh options might come from.
That’s part of the reason why a psychedelic revival has always been so tantalising. The first push came in the late 1990s, driven primarily by a US non-profit called the Multidisciplinary Association for Psychedelic Studies (MAPS). After a few individuals were determined enough to go through the arduous process of getting approval to work with psychedelics, the US Food and Drug Administration (FDA) decided to treat psychedelics like other drugs, meaning researchers were not banned from working with them.
Two decades later, those efforts are finally paying off. The psychedelic renaissance is entering a new stage, with a series of startling insights gracing the pages of leading journals and clinical trials making progress.
MDMA, better known as the party drug ecstasy, is the furthest along. Although not a classic psychedelic in that it doesn’t induce hallucinations, MDMA works by flooding the brain with serotonin, which makes users feel euphoric. These mood-altering effects are the reason researchers became interested in using it as a tool to assist psychotherapy for people with post-traumatic stress disorder (PTSD).
PTSD will affect roughly 7 per cent of people in the US at some point in their lives. The most effective treatment involves memory reconsolidation. People are asked to recall traumatic events so that their memories of them can be stripped of fearful associations by processing them in a new way. The problem is that recall can sometimes be so terrifying that they have to stop receiving this form of therapy. MDMA appears to help, not only because it extinguishes anxiety and stress, but also because it triggers the release of oxytocin, a pro-social hormone that strengthens feelings of trust towards therapists.
At the Psychedelic Science 2017 conference in Oakland, California, a group led by Michael Mithoefer at the Medical University of South Carolina presented results from trials in which 107 people with PTSD underwent a psychotherapy while under the influence of MDMA. A year or so after having the therapy, roughly 67 per cent of them no longer had PTSD, according to a measure based on symptoms such as anxiety levels and frequency of nightmares. About 23 per cent of the control group, which had psychotherapy and a placebo drug, got the same benefit.
That convinced the FDA to give the nod for Mithoefer’s group to carry out further trials involving more participants, the last hurdle to clear before the drug can be approved. In fact, the FDA was so impressed that it granted MDMA ‘breakthrough therapy’ status, which will accelerate the path towards approval. If all goes well, it could be in use as soon as 2021.
If recent results are anything to go by, however, true psychedelics – those that induce hallucinations – might end up having the biggest impact on mental health. That’s because psilocybin, the active ingredient in magic mushrooms, is beginning to look like the real deal: a genuinely effective, long-lasting treatment for depression.
It started in 2006, when Roland Griffiths, a psychiatrist and neuroscientist at Johns Hopkins University in Baltimore, replicated the results of a notorious study from 1962. He showed that a large dose of psilocybin can induce mystical experiences in volunteers without any mental health problems, including feelings of ego dissolution, a sense of revelation, ineffability and transcendence of time and space. Fourteen months after taking the drug at Griffiths’s lab, 22 of the 36 participants said the experience improved their well-being or life satisfaction, and rated it as one of the top five most meaningful experiences of their lives.
It was a landmark study. As Solomon Snyder, also at Johns Hopkins, wrote at the time: ‘The ability of these researchers to conduct a double-blind, well-controlled study tells us that clinical research with psychedelic drugs need not be so risky as to be off-limits to most investigators.’
In a double-blind study, neither the researchers nor the participants know who is receiving the experimental treatment. It is tricky to do with drugs like psilocybin because the hallucinations they induce mean volunteers know they aren’t taking a placebo. But Griffiths and his colleagues got around the problem by using a placebo that induces a slight stimulating effect to trick recipients into thinking they got the active drug.
Figuring that psychedelic experiences would be particularly valuable to people confronting a terminal illness, Griffiths and others began trials designed to assess the safety and efficacy of psilocybin to treat anxiety in people with advanced cancer. In the largest of those, Griffiths recruited 51 volunteers. Half of them were given a small placebo-like dose during one session, then a high dose five weeks later. For the other half, the sequence was reversed.
The results were published in 2016. There was a marked reduction in depression and anxiety symptoms compared with placebo after the high-dose session, and for 80 per cent of them those benefits continued to be felt six months later. An associated study at New York University reported similar results.
Meanwhile, Robin Carhart-Harris, a neuroscientist at Imperial College London, has been working with people with depression that has resisted all available treatments. In a trial involving 20 people, participants had two sessions – one on a single low dose of psilocybin (10 mg), one on a single high dose (25 mg) – during which they each separately lay listening to specially chosen music, accompanied by therapists.
The findings, also reported in 2016, were impressive. Those two doses, combined with the psychological support, were sufficient to lift depression in all 20 participants for three weeks, and to keep it at bay for five of them for three months.
That is in stark contrast to the best available antidepressants. ‘What’s weird and so different about these [psychedelics] is that we’re talking about a single dose having long-term effects,’ says Insel, now at a start-up called Mindstrong. ‘That’s a remarkably different approach to what we’ve been doing, with drugs that people take chronically.’
Hints as to why psychedelics work so quickly and so enduringly have come from brain scans. Since 2010, Carhart-Harris has used functional magnetic resonance imaging (fMRI) to scan the brains of people without mental illness while they are experiencing the effects of different psychedelic drugs. He has found that LSD and psilocybin both cause activity in parts of the brain that normally work separately to become more synchronous, meaning the neurons fire at the same time. In addition, connectivity across a collection of brain regions called the ‘default mode network’, which is linked to our sense of self, or ego, is drastically reduced. The more this network disintegrates, the more volunteers report a dissolving of the boundaries between themselves and the world around them.
Carhart-Harris thinks psilocybin therapy interrupts the spirals of rumination and negative thoughts that depressed people get caught up in. In that sense, it seemed telling that people in his psilocybin-for-depression trial who experienced aspects of a spiritual or mystical experience saw a bigger decrease in their depression scores than those who didn’t.
To see what effect the drug had, however, Carhart-Harris and his colleagues scanned the brains of their participants before and after they received psilocybin-assisted therapy. Contrary to expectations, the integrity of the default mode network, meaning the extent to which neurons across its separate brain regions fire together, had increased one day after therapy. What’s more, the magnitude of this effect correlated with the extent to which the volunteers’ depression had lifted.
Since the volunteers weren’t scanned during the acute drug experience, interpreting this result requires a bit of speculation, but Carhart-Harris sees this as a ‘reset process’. ‘You take something that’s ordered, but pathologically ordered perhaps; you shock it and scramble it and then it returns, but it returns to a healthier mode,’ he says.
For Carhart-Harris, this trick of unlocking the brain’s ability to remodel itself, known as plasticity, is what makes psychedelics so unique and valuable. The effect isn’t intrinsically therapeutic, he says, but when combined with psychotherapy it appears to have an unparalleled capacity to alleviate mental illness or behavioural problems.
The insights gleaned by peering into the brains of the people who volunteered for his psilocybin trial don’t end there. Participants were shown pictures of happy and frightened faces as they lay in the fMRI machine. The amygdala, a part of the brain that deals with emotions, including fear, typically lights up in response to such stimuli. SSRIs dampen those responses. But after the combined psilocybin-psychotherapy session, the amygdala lit up. And again, this effect correlated with how well people did: the greater the response in the amygdala, the more their symptoms improved.
This suggests a profound change in the processing of emotions, which fits with what participants reported in interviews. While SSRIs blunt both positive and negative feelings, it seems psilocybin does the opposite, helping people reconnect with their emotions. Those may not always be positive, but the idea is that connection with emotions is better than numbness.
The usual caveats apply, of course: all of these studies are relatively small and Carhart-Harris’s recent trial lacked a control group to directly contrast with those taking psilocybin. ‘One needs to be cautious,’ says Paul Summergrad at Tufts University in Boston, who is a former president of the American Psychiatric Association. ‘The history of psychiatry and medicine is full of things people get excited about that don’t play out.’
If larger studies produce similarly compelling outcomes, however, the implications would be profound. ‘The conversation now with psilocybin and MDMA is very different than what we’ve had with the development of other antidepressants and anti-anxiety drugs,’ says Insel. ‘We’re now talking about psilocybin-assisted therapy, meaning that it’s not just about the chemical but the role the chemical can have in a psychotherapeutic experience,’ he says.
For Insel, the fact that they are psychedelics is irrelevant. ‘I’m excited to think that there might be compounds that could be used in a new way to give us something that will make a difference for people who haven’t received much assistance from the drugs we have.’
So what now? The short answer is more trials. UK firm Compass Pathways plans to conduct a placebo-controlled psilocybin trial in 400 people with depression across eight European countries. Griffiths is also preparing for a placebo-controlled trial, and Carhart-Harris is planning one to compare psilocybin with a leading SSRI.
One problem is that drug development is an eye-wateringly expensive business. In preparation for MDMA being licensed for PTSD, however, MAPS has set up a public benefit corporation that will market the drug and use the profits to push through other promising psychedelics.
The biggest danger now might be that history repeats itself. The first wave of psychedelics research was to a great extent doomed by excessive enthusiasm. Today, as the revival has gathered steam, some doctors have likewise grown impatient and gone rogue, offering their patients underground psychedelic treatments. Hence the current crop of researchers are at pains to preach patience and rigour.
Insel put it more bluntly at the 2017 Psychedelic Science conference: ‘Don’t screw this up.’
Can you really set a mental alarm clock by hitting your head on the pillow before you go to bed? That’s not so far from the truth, says Simon Makin.
Some people swear that if they want to wake up at 6 a.m., they just bang their head on the pillow six times before going to sleep. Crazy? Maybe not. A study from 1999 shows that it all comes down to some nifty unconscious processing.
For three nights, a team at the University of Lübeck in Germany put 15 volunteers to bed at midnight. The team either told the participants they would wake them at 9 a.m. and did, or told them they would wake them at 9 a.m., but actually woke them at 6 a.m., or said they would wake them at 6 a.m. and did.
This last group had a measurable rise in the stress hormone adrenocorticotropin from 4.30 a.m., peaking around 6 a.m.. People woken unexpectedly at 6 a.m. had no such spike. The unconscious mind, the researchers concluded, can not only keep track of time while we sleep but also set a biological alarm to jump-start the waking process. The pillow ritual might help set that alarm.
The sleeping brain can also process language. In a 2014 study, Sid Kouider of the École Normale Supérieure in Paris and his colleagues trained volunteers to push a button with their left or right hand to indicate whether they heard the name of an animal or object as they fell asleep. The team monitored the brain’s electrical activity during training and when the people heard the same words when asleep. Even when asleep, activity continued in the brain’s motor regions, indicating that the sleepers were preparing to push the correct button. The people could also correctly categorise new words, first heard after they had dropped off, showing that they were genuinely analysing the meaning of the words while asleep.
It’s an ability that makes good evolutionary sense, says Kouider. ‘If you stop monitoring your environment, you become very vulnerable during sleep … It makes sense that you don’t simply shut down, but continue tracking in a kind of standby mode.’ This might explain why some sounds, like our names, wake us more easily than others.
This protective monitoring may not last all night, however. A study published in 2016 found that while language processing continues in REM sleep for words heard just before bed, once in deep sleep all responses disappear as the brain goes ‘offline’ to allow the day’s memories to be processed. ‘Your cognition about things in the environment declines progressively towards deep sleep,’ Kouider says. ‘Sleep is not all-or-none in terms of cognition, it’s all-or-none in terms of consciousness.’
You may have taken a break, but your brain hasn’t. Caroline Williams reveals how the unconscious carries on mulling things over long after you quit.
Wouldn’t it be great if you could leave difficult decisions to your subconscious, secure in the knowledge that it would do a better job than conscious deliberation? Ap Dijksterhuis of Radboud University Nijmegen in the Netherlands proposed this counter-intuitive idea in 2004. No wonder it was instantly popular.
Dijksterhuis had found that volunteers asked to make a complex decision – such as choosing between different apartments based on a baffling array of specifications – made better choices after being distracted from the problem before deciding. He reasoned that this is because unconscious thought can move beyond the limited capacity of working memory, so it can process more information at once.
The idea has been influential, but it may be too good to be true. Many subsequent studies have failed to replicate Dijksterhuis’s results. And a recent analysis concluded that there is little reason to think the unconscious is the best tool for making complex decisions. Still, Dijksterhuis remains confident that the effect is real and is an important part of our mental toolkit.
Others think the unconscious mind’s way of processing information is more important for creativity than for decision-making. It brings together disparate information from all over the brain without interference from the brain’s goal-directed frontal lobes. This allows it to generate novel ideas that burst through to consciousness in a moment of insight. John Kounios of Drexel University in Philadelphia believes an idea can only be truly creative if it appears in this way.
Some people seem to be better wired for this kind of thinking. Kounios has found that people who tend to solve problems in ‘aha’ moments of insight have different resting state brain activity – with less frontal control – than more logical thinkers.
While there is no known way to change your brain into a more creative one, Kounios suggests thinking about a problem until you get stuck, then taking a break and hoping that something useful bubbles up before your deadline.
Your unconscious mind is seriously judgemental. But our snap decisions often turn out to be spot on. Simon Makin explains how.
Ever felt love at first sight? Or an irrational distrust of a stranger on a bus? It could be because our unconscious is constantly making fast judgements. And they are often pretty accurate.
In the early 1990s, Nalini Ambady and Robert Rosenthal, both then at Stanford University in California, asked volunteers to rate teachers on traits including competence, confidence and honesty after watching 2-, 5- or 10-second silent clips of their performance. The scores successfully predicted the teachers’ end of semester evaluations and 2-second judgements were as accurate as those given more time. Further experiments showed similar accuracy for judgements about sexuality, economic success and political affiliation. For anyone hoping to use this to their advantage, the bad news is that no one has worked out what to do to pass yourself off as a winner. It seems to be an overall body signal that is both given out and picked up unconsciously, and is greater than the sum of its parts. This makes it very difficult if not impossible to fake.
In some cases, all we need to make these judgements is a glimpse of a face. In a separate study, people saw the faces of US election candidates for 1 second and were then asked to rate their competence – these ratings not only predicted the winning candidates, but also their margin of victory. A follow-up study found that people could make such judgements given only a tenth of a second. Again, the magic ingredients of what makes a face you can trust haven’t been identified, so this is one area of the unconscious where we have little choice in the conclusions we draw. While the skill is undoubtedly useful, it can also make unfounded prejudices feel like intuition when they are actually the result of our unconsciously held biases towards specific social groups.
Although we can’t easily change our facial features, our unconscious mind has a trick for making us likeable: mimicry. Jo Hale, a psychologist at University College London, is using virtual avatars to study the popular idea that we like people who mimic our body language. While it takes a lot of effort to consciously mimic someone’s body language, we do it effortlessly, without thinking, all the time. In a recent study, Hale programmed virtual avatars to mimic volunteers with a 1- or 3-second delay in their mimicry and found that 3 seconds may be close to a natural delay, because it rendered people both unaware they were being mimicked and more likely to rate the avatar as likeable. A delay of 1 second seemed to raise a flag to the consciousness, making volunteers more likely to notice the mimicry. So despite what body language coaches might have you believe, mimicry may only work if you get the timing right.
Your unconscious has a sixth sense of the space your body takes up, and the invisible area around it. Anil Ananthaswamy discovers that getting to know it better could improve your memory.
Thanks to unconscious processing, most of us instinctively know where our limbs are and what they are doing. This ability, called proprioception, results from a constant conversation between the body and brain. This adds up to an unerring sense of a unified, physical ‘me’.
This much-underrated ability is thought to be the result of the brain predicting the causes of the various sensory inputs it receives – from nerves and muscles inside the body, and from the senses detecting what’s going on outside the body. ‘What we become aware of is the brain’s “best guess” of where the body ends and where the external environment begins,’ says Arvid Guterstam of the Karolinska Institute in Stockholm.
The famous rubber-hand illusion is a good example of this. In this experiment, a volunteer puts one hand on the table in front of them. Their hand is hidden, and a rubber hand is put in front of the participant. A second person then strokes the real and rubber hands simultaneously with a paintbrush. Within minutes, many people start to feel the strokes on the rubber hand, and even claim it as part of their body. The brain is making its best guess as to where the sensation is coming from and the most obvious option is the rubber hand.
Recent research suggests this sixth sense extends to the space immediately surrounding the body. Guterstam and his colleagues repeated the experiment, stroking the real hand but keeping the brush 30 centimetres above the rubber hand. Participants still sensed the brush strokes above the rubber hand, implying that as well as unconsciously monitoring our body, we keep track of an invisible ‘force field’ around us. Guterstam suggests this might have evolved to help us pick up objects and move through the environment without injury.
A lack of proprioception is rare but can happen with nerve or brain damage. The case of Ian Waterman, who lost proprioception after nerve damage caused by a flu-like virus in 1971, demonstrates just how much we rely on this ability. After being told he would never walk again, he slowly learned to consciously control his muscles to move his body. Decades later, it is still far from easy and he only has full control over his movements if he is looking at the relevant body part and concentrating. ‘Because his proprioceptive system is shot, these things are not automatic for him. It requires constant conscious effort,’ says Anil Seth, a neuroscientist at the University of Sussex in Brighton.
Even if the system is working fine, there is some evidence that it might be worth consciously trying to improve it. A recent study in which volunteers trained in MovNat exercise – a programme designed to tax the body’s natural balancing, jumping and vaulting abilities – improved more on measures of working memory than a control group who did yoga or no exercise.
Matching what your brain predicts to what actually happens gives you a jump-start on how to react, writes Diana Kwon, but what happens when your expectations go awry?
Every moment, the brain takes in far more information than it can process on the fly. In order to make sense of it all, the brain constantly makes predictions that it tests by comparing incoming data against stored information. All without us noticing a thing.
Simply imagining the future is enough to set the brain in motion. Imaging studies have shown that when people expect a sound abstract or image to appear, the brain generates an anticipatory signal in the sensory cortices.
This ability to be one step ahead of the senses has an important role in helping us understand speech. ‘The brain is continuously predicting the sounds, words and meanings that people are trying to produce or communicate,’ says Matt Davis at the MRC Cognition and Brain Sciences Unit in Cambridge.
Studies have also shown that the brain can use one sense to inform another. When you hear a recording of speech that is so degraded it is nearly unintelligible, the words sound clearer if you have previously read the same words in subtitles. ‘The sensory parts of the brain are comparing the speech you’ve heard to the speech you predicted,’ says Davis.
Not only do we make hypotheses about external information, our brains also make predictions on the basis of emotional signals coming from the body. Moshe Bar, a neuroscientist at Bar-Ilan University in Israel, goes so far as to suggest that we consciously recognise an object only once our unconscious mind has calculated its importance based on what our senses and emotional reaction are saying. The conscious fear of a snake on a hiking trail comes after the brain has processed the shape and initiated jumping out of the way, for example.
Making predictions does have its downsides, however. Incorrect inferences reinforced by repetition can be hard to reverse, which is why when you learn the wrong lyrics to a song, it can be difficult to stop hearing them. Stereotyping is a more troublesome example of the same thing. While it can be useful to recognise that the dangers of things like snakes and fires are relatively constant, when it comes to human interactions, it can lead to negative biases and discrimination. ‘Stereotypes and prejudices are predictions working as they do with everything else, but [in a way] that is not desirable,’ says Bar.
Some neuroscientists also believe that the hallucinations experienced in psychosis are the result of expectations gone awry. In one recent study, people who were more prone to psychotic experiences were better at seeing hidden shapes in images that had been digitally degraded. The researchers speculate that this could mean their brains jump to conclusions faster and rely less on evidence coming in from the senses.
Despite its flaws, prediction is hugely beneficial. ‘Imagine that our brain didn’t work like that,’ says Bar. ‘Every snake you see you’d have to learn afresh. Every fire you’d have to touch and burn yourself.’
Do something enough times and your brain can automate the process, making good habits and bad. Anil Ananthaswamy reveals the ways you can get back some conscious control.
So much of what we do in our day-to-day lives, whether it be driving, making coffee or touch-typing, happens without the need for conscious thought. Unlike many of the brain’s other unconscious talents, these are skills that have had to be learned before the brain can automate them. How it does this might provide a method for us to think our way out of bad habits.
Ann Graybiel of the Massachusetts Institute of Technology and her colleagues have shown that a region deep inside the brain called the striatum is key to habit forming. When you undertake an action, the prefrontal cortex, which is involved in planning complex tasks, communicates with the striatum, which sends the necessary signals to enact the movement. Over time, input from the prefrontal circuits fades, to be replaced by loops linking the striatum to the sensorimotor cortex. The loops, together with the memory circuits, allow us to carry out the behaviour without having to think about it. Or, to put it another way, practise makes perfect. No thinking required.
The upside of this two-part system is that once we no longer need to focus our attention on a frequent task, the spare processing power can be used for other things. It comes with a downside, however. Similar circuitry is involved in turning all kinds of behaviours into habits, including thought patterns, and once any kind of behaviour becomes habit, it becomes less flexible and harder to interrupt. ‘If it’s a good habit, that’s absolutely fine,’ says neuroscientist Anil Seth at the University of Sussex. ‘But if you ingrain a bad habit, that’s equally difficult to get rid of. You lose that moment of choice when you can decide not to do something.’
Crucially, though, Graybiel’s team has shown that, even with the most ingrained habits, a small area of the prefrontal cortex is kept online, in case we need to take alternative action. If the brake pedal in our car stops working, for instance, our entire focus of attention shifts to the physical act of driving the car. This offers hope to anyone looking to break a bad habit, and to those suffering from habit-related problems such as obsessive–compulsive disorder and Tourette’s syndrome – both of which are associated with abnormal activity in the striatum and its connections to other parts of the brain. These circuits could prove fruitful targets for future drug treatments. For now, though, the best way to get a handle on bad habits is to become aware of them. Then, focus all your attention on them and hope that it’s enough to help the frontal regions resist the call of the autopilot. Or you could teach yourself a new habit that counters the bad one.
Understanding what is happening in the brain during hallucinations reveals how we’re having them all the time, and how they shape our perception of reality, says Helen Thomson.
Avinash Aujayeb was alone, trekking across a vast white glacier in the Karakoram, a mountain range on the edge of the Himalayan plateau known as the roof of the world. Although he had been walking for hours, his silent surroundings gave little hint that he was making progress. Then suddenly, his world was atilt. A massive icy boulder loomed close one moment, but was desperately far away the next. As the world continued to pulse around him, he began to wonder if he could believe his eyes. He wasn’t entirely sure he was still alive.
A doctor, Aujayeb checked his vitals. Everything seemed fine: he wasn’t dehydrated, nor did he have altitude sickness. Yet the icy expanse continued to warp and shift. Until he came upon a companion, he couldn’t shake the notion that he was dead.
In recent years it has become clear that hallucinations are much more than a rare symptom of mental illness or the result of mind-altering drugs. Their appearance in those of sound mind has led to a better understanding of how the brain can create a world that doesn’t really exist. More surprising, perhaps, is the role they may play in our perceptions of the real world. As researchers explore what is happening in the brain, they are beginning to wonder: do hallucinations make up the very fabric of our reality?
Hallucinations are sensations that appear real but are not elicited by anything in our external environment. They aren’t only visual – they can be sounds, smells, even experiences of touch. It’s difficult to imagine just how real they seem unless you’ve experienced one. As Sylvia, a woman who has had musical hallucinations for years, explains, it’s not like imagining a tune in your head – more like ‘listening to the radio’.
There is evidence to support the sensation that these experiences are authentic. In 1998, researchers at King’s College London scanned the brains of people having visual hallucinations. They found that brain areas that were active are also active while viewing a real version of the hallucinated image. Those who hallucinated faces, for example, activated areas of the fusiform gyrus, known to contain specialised cells active when we look at real faces. The same was true with hallucinations of colour and written words. It was the first objective evidence that hallucinations are less like imagination and more like real perception.
Their convincing nature helps explain why hallucinations have been given such meaning – even considered messages from gods. But as it became clear that they can be symptoms of mental illnesses such as schizophrenia, they were viewed with increasing suspicion.
We now know that hallucinations occur in people with perfectly sound mental health. The likelihood of experiencing them increases in your sixties; 5 per cent of us will experience one or more hallucinations in our life.
Many people hallucinate sounds or shapes before they drift off to sleep, or just on waking. People experiencing extreme grief have also been known to hallucinate in the weeks after their loss – often visions of their loved one. But the hallucinations that may reveal the most about how our brain works are those that crop up in people who have recently lost a sense.
I have personal experience of this. At 87, my grandmother began to hallucinate after her already poor sight got worse due to cataracts. Her first visitors were women in Victorian dress, then young children. She was experiencing what is known as Charles Bonnet syndrome. Bonnet, a Swiss scientist who lived in the early 1700s, first described the condition in his grandfather, who had begun to lose his vision. One day the older man was sitting talking to his granddaughters when two men appeared, wearing majestic cloaks of red and grey. When he asked why no one had told him they would be coming, the elder Bonnet discovered only he could see them.
It’s a similar story with Sylvia. After an ear infection caused severe hearing loss, she began to hallucinate a sound that was like a cross between a wooden flute and a bell. At first it was a couple of notes that repeated over and over. Later, there were whole tunes. ‘You’d expect to hear a sound that you recognise, maybe a piano or a trumpet, but it’s not like anything I know in real life,’ she says.
Max Livesey was in his seventies when Parkinson’s disease destroyed the nerves that send information from the nose to the brain. Despite his olfactory loss, one day he suddenly noticed the smell of burning leaves. The odours intensified over time, ranging from burnt wood to a horrible onion-like stench. ‘When they’re at their most intense they can smell like excrement,’ he says. They were so powerful they made his eyes water.
Sensory loss doesn’t have to be permanent to bring on such hallucinations. Aujayeb was in fine health, trekking across the glacier. ‘I felt very tall – the ground appeared far from my eyes. It was like I was seeing the world from over my shoulder,’ he explained. His hallucinations continued for 9 hours, but after a good night’s sleep, they were gone.
When our senses are diminished, all of us have the potential to hallucinate. It can take just 30 to 45 minutes for people to experience hallucinations if they try a simple visual deprivation technique. In a study run by Jiří Wackermann at the Institute for Frontier Areas of Psychology and Mental Health in Freiburg, one volunteer saw a jumping horse. Another saw an eerily detailed mannequin. ‘It was all in black … had a long narrow head, fairly broad shoulders, very long arms.’
Yet why should a diminished sense trigger a sight, sound or smell that doesn’t really exist? ‘The brain doesn’t seem to tolerate inactivity,’ said the late neurologist Oliver Sacks when I spoke to him about this in 2014. ‘The brain seems to respond to diminished sensory input by creating autonomous sensations of its own choosing.’ This was noted soon after the Second World War, he said, when it was discovered that high-flying aviators in featureless skies and truck drivers on long, empty roads were prone to hallucinations.
Now researchers believe these unreal experiences provide a glimpse into the way our brains stitch together our perception of reality. Although bombarded by thousands of sensations every second, the brain rarely stops providing you with a steady stream of consciousness. When you blink, your world doesn’t disappear. Nor do you notice the hum of traffic outside or the tightness of your socks. Well, you didn’t until they were mentioned. Processing all of those things all the time would be a very inefficient way to run a brain. Instead, it takes a few shortcuts.
Let’s use sound as an example. Sound waves enter the ear and are transmitted to the brain’s primary auditory cortex, which processes the rawest elements, such as patterns and pitch. From here, signals get passed on to higher brain regions that process more complex features, such as melody and key changes.
Instead of relaying every detail up the chain, the brain combines the noisy signals coming in with prior experiences to generate a prediction of what’s happening. If you hear the opening notes of a familiar tune, you expect the rest of the song to follow. That prediction passes back to lower regions, where it is compared to the actual input, and to the frontal lobes, which perform a kind of reality check, before it pops up into our consciousness. Only if a prediction is wrong does a signal get passed back to higher areas, which adjust subsequent predictions.
This idea is consistent with what was happening to Sylvia. Although she was mostly deaf, she could still make out some sound – and she discovered that listening to familiar Bach concertos suppressed her hallucinations. Timothy Griffiths, a cognitive neurologist at Newcastle University, scanned Sylvia’s brain before, after and while listening to Bach, and had her rate the intensity of her hallucinations throughout. They were at their quietest just after the real music was played, gradually increasing in volume until the next excerpt.
The brain scans showed that during her hallucinations, the higher regions that process melodies and sequences of tones were talking to one another. Yet, because Sylvia is severely deaf, they were not constrained by the real sounds entering her ears. Her hallucinations are her brain’s best guess at what is out there.
The notion of hallucinations as errant predictions has also been put to the test in completely silent rooms known as anechoic chambers. The quietest place on earth is one such chamber at Orfield Laboratories in Minneapolis, Minnesota. Once inside, you can hear your eyeballs moving. People generally start to hallucinate within 20 minutes of the door closing. But what’s the trigger?
There are two possibilities. One is that sensory regions of the brain sometimes show spontaneous activity that is usually suppressed and corrected by real sensory data coming in from the world. In the deathly silence of an anechoic chamber, the brain may make predictions based on this spontaneous activity. The second possibility is that the brain misinterprets internally generated sounds, says Oliver Mason at University College London. The sound of blood flowing through your ears isn’t familiar, so it could be misattributed as coming from outside you. ‘Once a sound is given significance, you’ve got a seed,’ says Mason, ‘a starting point on which a hallucination can be built.’
Not everyone reacts the same way inside an anechoic chamber. Some people don’t hallucinate at all. Others do, but realise it was their mind playing tricks. ‘Some people come out and say “I’m convinced you were playing noises in there”,’ says Mason.
Understanding why people react differently to a diminished sensory environment could reveal why some are more prone to the delusions and hallucinations associated with mental illness. We know that electrical messages passed across the brain are either excitatory or inhibitory – meaning they either promote or impede activity in neighbouring neurons. In recent experiments, Mason’s team scanned the brains of volunteers as they sat in an anechoic chamber for 25 minutes. Those who had more hallucinatory sensations had lower levels of inhibitory activity across their brain. Perhaps, says Mason, weaker inhibition makes it more likely that irrelevant signals suddenly become meaningful.
People with schizophrenia often have overactivity in their sensory cortices, but poor connectivity from these areas to their frontal lobes. So the brain makes lots of predictions that are not given a reality check before they pass into conscious awareness, says Flavie Waters, a clinical neuroscientist at the University of Western Australia in Perth. In conditions like Charles Bonnet syndrome, it is underactivity in the sensory cortices that triggers the brain to start filling in the gaps, and there is no actual sensory input to help it correct course. In both cases, says Waters, the brain starts listening in on itself, instead of tuning into the outside world. Something similar seems to be true of hallucinations associated with some recreational drug use.
As these insights help us to solve the puzzle of perception, they are also providing strategies for treating hallucinations. People with drug-resistant schizophrenia can sometimes reduce their hallucinatory symptoms by learning how to monitor their thoughts, understand the triggers and reframe their hallucinations so that they see them in a more positive and less distressing light. ‘You’re increasing their insight and their ability to follow their thoughts through to more logical conclusions,’ says Waters. This seems to give them more control over the influence of their internal world.
This kind of research is also helping people like Livesey reconnect with the external world. If his phantosmia, or smell hallucinations, are driven by a lack of reliable information, then real smells should help him to suppress the hallucinations. He has been trialling sniffing three different scents, three times a day. ‘Maybe it’s just wishful thinking,’ he says, ‘but it seems to be helping.’
The knowledge that hallucinations can be a by-product of how we construct reality might change how we experience them. In his later years, Sacks experienced hallucinations after his eyesight began to fail. When he played the piano, he would occasionally see showers of flat symbols when he was looking carefully at musical scores. ‘I have long since learned to ignore my hallucinations, and occasionally enjoy them,’ said Sacks. ‘I like seeing what my brain is up to when it is at play.’
Our ancestors used to drill holes in the skull to expel demons – and the technique has made a comeback as a cure for dementia. Arran Frood drills down.
In the early 1960s, a young Russian neurophysiologist called Yuri Moskalenko travelled from the Soviet Union to the UK on a Royal Society exchange programme. During his stay, he co-authored a paper published in Nature. ‘Variation in blood volume and oxygen availability in the human brain’ may not sound subversive, but it was the start of a radical idea.
Decades later, having worked in Soviet Russia and become president of the Sechenov Institute of Evolutionary Physiology and Biochemistry at the Russian Academy of Sciences in St Petersburg, Moskalenko returned to the UK. He began collaborating with researchers at the Beckley Foundation in Oxford, and in 2010 his work started to bear fruit.
And weird fruit it is. With funding from the foundation, he is exploring the idea that people with Alzheimer’s disease could be treated by drilling a hole in their skull. In fact, he is so convinced of the benefits of trepanation that he claims it may help anyone from their mid-forties onwards to slow or even reverse the process of age-related cognitive decline. Can he be serious?
For thousands of years, trepanation has been performed for quasi-medical reasons such as releasing evil spirits that were believed to cause schizophrenia or migraine. Today it is used to prevent brain injury by relieving intracranial pressure, particularly after accidents involving head trauma.
In the popular imagination, though, it is considered crude, if not downright barbaric. Yet such is the desperation for effective treatments for dementia that drilling a hole in the skull is not even the strangest game in town.
The problem is huge and growing. Alzheimer’s, the most common form of dementia, affects 700,000 people in the UK and nearly 5 million in the US. In addition, 1 in 5 Americans over the age of 75 have mild cognitive impairment, which often leads to Alzheimer’s. As people live longer, the numbers seem certain to grow. Yet we have few ideas about what causes dementia and even fewer about how to treat it. Most patients get a mixture of drugs and occupational therapy, which at best stalls the apparent progression of their illness by masking its symptoms.
The causes of dementia are many and poorly understood, but there is growing evidence that one factor is the flow of blood within the brain. As we age, cerebral blood flow decreases, and the earlier this happens the more likely someone is to develop early onset dementia. It remains unclear, however, whether declining cerebral blood flow is the cause, or an incidental effect of a more fundamental change. Moskalenko’s research indicates that cerebral blood flow is more closely correlated with age than with levels of dementia, so he decided to delve more deeply.
As well as delivering oxygen to the brain, cerebral blood flow has another vital role: the circulation and production of cerebrospinal fluid. This clear liquid surrounds the brain, carrying the nutrients that feed it and removing the waste it produces, including the tau and beta-amyloid proteins that have been implicated in the formation of plaques found in the brains of people with Alzheimer’s.
How blood flow influences cerebrospinal fluid flow can be gauged from something called ‘cranial compliance’, a measure of the elasticity of the brain’s vascular system. ‘The cranium is a bony cavity of fixed volume, with the brain taking up most of the space,’ says Robin Kennett, a neurophysiologist from the Oxford Radcliffe Hospitals in the UK. ‘Every time the heart beats and sends blood into the cranium, something else has to come out to prevent the pressure rising to levels that would damage the brain.’ So, as fresh blood flows into the brain’s blood vessels, cerebrospinal fluid flows out into the space around the spinal cord through a hole in the base of the skull called the foramen magnum.
As we age, the proteins in the brain harden, preventing this system from working as it should. As a result, the flow of both blood and cerebrospinal fluid is reduced, impairing the delivery of oxygen and nutrients as well as the removal of waste. Moskalenko’s research suggests that this normally begins between the ages of 40 and 50. Moreover, in a study of 42 elderly people with dementia, he found that the severity of their cognitive disorder was strongly correlated with cranial compliance: those with the severest dementia had the lowest compliance. ‘Cranial compliance is a significant component of the origin of certain cases of brain pathology,’ he says.
This view gets qualified agreement from Conrad Johanson, a clinical neuroscientist at Brown University in Providence, Rhode Island. Although the link between low compliance and dementia has yet to be comprehensively shown, he says, ‘there’s a gestalt that it’s broadly true’.
So where does trepanation come into all this? ‘A hole made in the bony cavity would act as a pressure-release valve,’ says Kennett, and this would alter the flow of fluids around the brain. This is exactly what Moskalenko observed when he carried out one of the first neurophysiological studies on trepanation.
Moskalenko studied 15 people who had undergone the procedure following head injuries. He found that their cranial compliance was around 20 per cent higher than the average for their age. Based on this, he calculates that a 4 cm2 hole increases cerebral blood flow by between 8 and 10 per cent, which is equivalent to 0.8 millilitres more blood per heartbeat. This, he says, shows that trepanation could be an effective treatment for Alzheimer’s, and he even goes so far as to suggest that it might provide a ‘significant’ improvement in the mental functions of anyone from their mid-forties, when cranial compliance starts to decline.
Surprisingly, his most vociferous critics do not challenge his support for trepanation. Instead they question his ideas about how it works. Gerald Silverberg at the Stanford School of Medicine in California points out that drilling a hole in the skull may temporarily drain the cranial cavity of cerebrospinal fluid together with any toxins that may have accumulated in it, effectively flushing out the system. ‘Metabolite clearance, or the lack of it, is felt to be an important factor in the development of age-related dementias,’ he says. A similar intervention, known as a lumbar shunt or ‘spinal tap’, in which a needle is inserted into the spinal column to remove cerebrospinal fluid, can dramatically improve the cognitive performance of people who undergo the procedure, Silverberg says. Spinal taps are normally used as a treatment for hydrocephalus – water on the brain – but Silverberg is now trying it out on people with Alzheimer’s, and early studies suggest it helps.
Olivier Baledent, a neurophysiologist based at the University Hospital of Amiens, France, also questions Moskalenko’s focus on cranial compliance. Like Silverberg, he believes cerebrospinal fluid itself is key. Baledent’s research shows that in people with mild cognitive impairment, there is reduced activity in a part of the brain called the choroid plexus, where cerebrospinal fluid is formed. He suspects this results in impaired fluid formation and reabsorption, leading to a build-up of toxins, and that a spinal tap may be able to stop or decrease dementia by improving fluid turnover. Trepanation could work in a similar way.
So will dementia patients and their families ever accept trepanation as a treatment for the condition? Johanson, who sees trepanation as no more alarming than a spinal tap, admits that it is always going to be a hard sell. ‘People think it’s witchcraft when you drill a hole in the skull and patients are improving.’
Harriet Millward, when deputy chief executive of UK-based charity Alzheimer’s Research Trust, was keeping an open mind. ‘The procedure has been understudied so far and, until further research has been undertaken, the possibility of beneficial effects remains open,’ she said. David Smith, a neuropharmacologist and head of the Oxford Project to Investigate Memory and Ageing, is more receptive. ‘I think the observations look pretty robust,’ he says. In the absence of drug treatments for dementia, ‘these rather drastic surgical ones are worth considering’, he says.
For some the year is a C stretching out in front of them, for others it’s a hula hoop. Caroline Williams discovers that the ways some people visualise calendars could shed light on memory itself.
For Emma, the end of the year has special significance, and not just because of all the gifts and food. It’s also the only time of year when the date in her mental calendar lines up perfectly with her body.
Emma is a calendar synaesthete, one of a handful of people who see time: not as a vague conceptual timeline, but as a vivid calendar that feels so real they could almost touch it. This is a little-known variation of synaesthesia, in which the brain links one kind of sensation to another. Some people associate shapes with certain sounds, or colours with numbers. Emma sees time as a hula hoop, which anchors 31 December to her chest and projects the rest of the year in a circle that extends about a metre in front of her.
Heidi, another calendar synaesthete, sees the year as a backwards C hovering before her, with January at one end of the horseshoe and December at the other. When she thinks of a date she feels herself travel along the calendar to the right spot. She has a separate, hoop-shaped calendar for days of the week. Both have been part of her life for as long as she can remember.
The fact that certain people can vividly conjure number lines and calendars was first noted by Victorian polymath Francis Galton in 1880, but we have only recently begun to figure out how – and why. It’s not just a matter of idle curiosity. Understanding how calendar synaesthesia works may help unravel the way we all keep track of our memories as we move through space and time.
That’s because calendar synaesthetes experience a supercharged version of the way everyone else experiences time. Studies of different cultures around the world have shown that our perceptions vary slightly – most people in the West perceive time as a straight line running through their bodies, with the future ahead of them, while in parts of Papua New Guinea time flows uphill and for some Chinese people it flows downwards. But we all compute the abstract concept of time in the same way: in our brains, ‘time is always mapped onto space,’ says V. S. Ramachandran, a neuroscientist at the University of California, San Diego.
The mapping job falls largely to the hippocampus, a pair of curved structures towards the centre of the brain that contain specialised neurons. Some, called grid cells, plot locations, while others, known as place cells, become active when we arrive on the scene. The basic circuitry seems to have evolved about 300 million years ago in a fish-like common ancestor, and similar systems are found in most other animals, from lizards to birds. At some point in human evolution, though, the hippocampus gained a second role: storing autobiographical memories, each with a time stamp recorded by specialised time cells.
‘As you live your life, place cells keep track of your location in the world, and time cells keep track of stimuli receding into the past,’ says neuroscientist Marc Howard at Boston University. ‘When you vividly remember a specific event from your life – say lunch last Tuesday – the hippocampus recovers the activity of time cells and place cells that were active during that event.’
Whether any other animals have this kind of autobiographical memory is hotly debated, but we know for sure that no other species makes calendars. Around 10,000 years ago, we began to notice the natural cycles of the sun and moon and record them for future reference, first in stone circles, and today on paper and computer screens.
But calendar synaesthetes don’t need to. They can call up their mental versions at will, something most are surprised to learn is unusual. Heidi first realised in a psychology class in high school. ‘My teacher was talking about synaesthesia and how some people see calendars. I said, “Doesn’t everybody see a calendar? How can you not?”’
Ramachandran wanted to know how they do it, and if they were really seeing calendars or summoning something from memory. So he asked a 20-year-old synaesthete called ML to recite alternate months between January and December, first forwards and then backwards. For most people, it takes three times as long to go backwards, because we have to construct the calendar from memory as we go. But ML was equally fast in both directions. She also unconsciously moved her eyes and finger as she went, suggesting her calendar was always in front of her.
To find out more, Ramachandran also used visual illusions, including the ‘motion after-effect’. If you stare for 30 seconds at a contracting spiral and then look at another picture, it will appear to expand, because the brain’s prediction outpaces our perception. But the illusion doesn’t happen if you look at a blank wall or just imagine a scene. ‘The brain needs something to attribute it to,’ says Ramachandran.
When ML looked at her calendar after the spiral, it expanded in the same way as a real image. When asked to imagine an object in her mind’s eye, it stayed still. That means that, as far as her brain is concerned, the calendar isn’t a figment of her imagination, it is actually there.
What is going on? Ramachandran points to an area of the brain that we rely on to make sense of symbols and numbers and order events into sequences. The angular gyrus is found above and behind the ears on each side of the brain at the junction of several sensory areas, including the visual cortex. It also connects directly to the hippocampus. We all probably use this bit of circuitry to imagine the layout of time, but Ramachandran believes this is where calendar synaesthetes have the extra connections that make their visions so very real.
There are many open questions, not least whether this vivid calendar helps memory. There’s reason to think so. ‘If you ask them about a specific memory, then they’ll conjure up the calendar and put the memory in the appropriate slot,’ says Ramachandran.
That might be a trick worth learning. Daniel Bor at the University of Sussex has found that people can teach themselves to experience synaesthesia by repeatedly associating colours with certain letters. It might be possible to do something similar with calendars.
But they may not be a universal boon. One synaesthete Ramachandran met finds her calendar confusing, and another says hers is missing August, which can be frustrating – not least for making plans for a summer break.
For Heidi, it’s a mixed bag. ‘It helps me sometimes because I can picture things better, but I do get mixed up.’ Her horseshoe-shaped calendar has a big gap after December, which means January always comes sooner than she expects it to. ‘It feels really abrupt, like a whole month was in between them and it just went all of a sudden,’ she says. Returning to the office after Christmas, that’s probably something we can all relate to.
Awe is so powerful it alters your sense of self, connects you with humanity and boosts your mind and body, writes Jo Marchant. And there’s a surprising way to get more of it.
Have you ever been stopped in your tracks by a stunning view, or gobsmacked by the vastness of the night sky? Have you been transported by soaring music, a grand scientific theory or a charismatic person? If so, you will understand US novelist John Steinbeck’s response to California’s giant redwood trees, which can soar more than a hundred metres towards the sky. ‘[They] leave a mark or create a vision that stays with you always,’ he wrote. ‘From them comes silence and awe.’
Philosophers and writers have long been fascinated by our response to the sublime, but until a few years ago, scientists had barely studied it. Now they are fast realising that Steinbeck was right about its profound effects. Feeling awestruck can dissolve our very sense of self, bringing a host of benefits, from lowering stress and boosting creativity to making us nicer people.
Yet in the modern world, the value of the word awesome has plummeted – almost anything can now acquire the epithet. At the same time, we risk losing touch with the most potent sources of awe. The good news is that there are ways to inject more of it into our everyday lives. You needn’t be religious. All you need is an open mind – although a willingness to try psychedelic drugs may help.
But what exactly is awe and where does it come from? ‘It’s a subjective feeling rooted in the body,’ according to psychologist and pioneering awe researcher Dacher Keltner at the University of California, Berkeley. In 2003, he and Jonathan Haidt, now at New York University, published the first scientific definition. They described awe as the feeling we get when confronted with something vast, that transcends our frame of reference and that we struggle to understand. It’s an emotion that combines amazement with an edge of fear. Wonder, by contrast, is more intellectual – a cognitive state in which you are trying to understand the mysterious.
You might think that investigating such a profound experience would be a challenge, but Keltner insists it’s not so hard. ‘We can reliably produce awe,’ he says. ‘You can get people to go out to a beautiful scene in nature, or put them in a cathedral or in front of a dinosaur skeleton, and they’re going to be pretty amazed.’ Then, all you need is a numerical scale on which people can report how much awe they are feeling. Increasingly, studies are including a physiological measure too, such as the appearance of goosebumps – awe is the emotion most likely to cause them, and second only to cold as a source.
In this way, Keltner and others have found that even mild awe can change our attitudes and behaviour. For example, people who watched a nature video that elicited awe – rather than other positive emotions such as happiness or pride – were subsequently more ethical, more generous and described themselves as feeling more connected to people in general. Gazing up at tall eucalyptus trees left others more likely to help someone who stumbled in front of them. And after standing in front of a Tyrannosaurus rex skeleton, people were more likely to describe themselves as part of a group. It might seem counter-intuitive that an emotion we often experience alone increases our focus on others. But Keltner thinks it’s because awe expands our attention to encompass a bigger picture, so reduces our sense of self.
‘The desert is so huge, and the horizons so distant, that they make a person feel small,’ wrote Paulo Coelho in The Alchemist. He was right. In a large study, Keltner found that after inspiring awe in people from the US and China, they signed their names smaller and drew themselves smaller, but with no drop in their sense of status or self-esteem. Similarly, neuroscientist Michiel van Elk at the University of Amsterdam found that people who watched awe-inducing videos estimated their bodies to be physically smaller than those who watched funny or neutral videos.
The cause of this effect might lie in the brain. In June 2017, at the annual meeting of the Organization for Human Brain Mapping in Vancouver, van Elk presented functional MRI scans showing that awe quiets activity in the default mode network, which includes parts of the frontal lobes and cortex, and is thought to relate to the sense of self. ‘Awe produces a vanishing self,’ says Keltner. ‘The voice in your head, self-interest, self-consciousness, disappears. Here’s an emotion that knocks out a really important part of our identity.’ As a result, he says, we feel more connected to bigger collectives and groups.
The notion of transcending the self has traditionally been associated with religious or mystical experiences. ‘Immenseness, infinitude, indescribability are some of the classical characteristics of mystical experiences that leave a person with a very powerful sense of awe,’ says neuroscientist Andrew Newberg at the University of Pennsylvania, who studies how religion affects the brain. For Keltner, this is one reason why awe was so little studied until recently. ‘People felt like awe is really about religion and psychologists were loath to study religion,’ he says. But after interviewing thousands of people around the world about their experiences, he believes it’s a mistake to see awe as inseparable from God. ‘Even in really religious countries, people are mainly feeling awe in response to other great people and nature,’ he says. ‘People have always felt awe about non-religious things. It’s available to atheists in full force.’ Newberg, who is studying the awe felt by astronauts, agrees. ‘You don’t have to have any given belief system in order to have these experiences,’ he says.
Instead, Keltner believes that awe predates religion by millions of years. Evolution-related ideas are tough to back up, but he argues that responding to powerful forces in nature and in society through group bonding would have had survival value. Chimps show signs of awe, such as goosebumps, during thunderstorms, he notes. ‘I think the central idea of awe is to quiet self-interest for a moment and to fold us into the social collective.’
It’s an instinct that has been co-opted for political ends throughout history, for example in grandiose structures, from the pyramids of Egypt to St Peter’s Basilica in Vatican City, or even Trump Tower. ‘Awesome art and architecture have long been part of the apparatus by which people have been controlled, both socially and psychologically, and kept in their place,’ says Benjamin Smith, an expert in rock art at the University of Western Australia. ‘The finding that awe diminishes our sense of self fits perfectly with this history.’
Despite these darker associations, there’s mounting evidence that feeling awe also has personal benefits. First, focusing on the bigger picture rather than our own concerns seems a powerful way to improve health and quality of life. Keltner’s team has found that feeling awe makes people happier and less stressed, even weeks later, and that it assists the immune system by cutting the production of cytokines, which promote inflammation. Meanwhile, a team from Arizona State University found that awe activates the parasympathetic nervous system, which works to calm the fight or flight response. Researchers at Stanford University discovered that experiencing awe made people feel as if they had more time – and made them more willing to give up their time to help others.
Awe also seems to help us break habitual patterns of thinking. The Arizona team discovered that after experiencing awe, people were better able to remember the details of a short story. Usually, our memories are coloured by our expectations and assumptions, but awe reduces this tendency, improving our focus on what’s actually happening. Researchers have also reported increases in curiosity and creativity. In one study, after viewing images of Earth, volunteers came up with more original examples in tests, found greater interest in abstract paintings and persisted longer on difficult puzzles, compared with controls.
In the modern world, though, we’re more likely to be gazing at our smartphones than at giant redwoods or a starry sky. And Keltner is concerned about the impact of our increasing disconnection from nature, one of the most potent sources of awe. ‘I’m struck by how awe makes us humble and charitable,’ he says. ‘Is that why we have so much incivility and hatred right now in the US? I think we should be asking these questions.’
Keltner warns of a lack of opportunities for awe in poor communities, as well as education, with its focus on test results rather than exploration. ‘We are taking that away from our kids and that is a very serious problem.’
Kenneth Tupper, a philosopher of education at the University of British Columbia, agrees. ‘The institution of modern schooling is very well designed to not evoke experiences of wonder and awe,’ he says. This can leave teenagers feeling ‘jaded and disenchanted’, without a sense of connection to anything larger than themselves. To counter such alienation, he suggests, self-obsessed Western societies might consider an unconventional way to rekindle awe, taking a lesson from traditional societies. Many of these use plant and fungus-based psychedelic drugs such as ayahuasca, peyote and psilocybin mushrooms to expand the mind and forge a connection to something bigger than the self, he notes. ‘These kinds of experiences are extremely highly valued.’ Tupper thinks we could all benefit from similar rituals.
That’s not as crazy as it might sound, according to Robin Carhart-Harris at Imperial College London. Through brain scanning, he and others have found that psychedelic drugs such as psilocybin and LSD reduce activity in the default mode network – just as awe does. In addition, boundaries between normally segregated bits of the brain temporarily break down, boosting creativity. Study participants who take psychedelics often describe being struck by vastness, and report an altered sense of self – to the point where it may disappear completely. ‘My feeling is that it’s the same thing,’ says Carhart-Harris. ‘Psychedelics are hijacking a natural system and fast-tracking people to these experiences of awe.’
There’s growing interest in using psychedelics to treat anxiety and depression, but Carhart-Harris argues that if taken in a safe and controlled environment, a dose of psychedelic awe could benefit healthy people too. ‘You can be more well,’ he says. ‘You can just feel calm and content and integrated and connected.’ This idea gains support from trials of more than 100 healthy volunteers. Roland Griffiths and his colleagues at Johns Hopkins University in Baltimore found that those who took a single dose of psilocybin rather than a placebo reported feeling happier and more altruistic afterwards. They still had higher well-being and life satisfaction more than a year later.
Keltner says this is important work. ‘Psilocybin should not be stigmatised,’ he says. It’s a potent source of awe, but there are plenty of other ways you can increase your awe quotient, he adds. First, you should raise your expectations. Put aside the myth that awe is rare, says Keltner. His surveys reveal that people feel low-level awe on average a couple of times a week. Then, think about what you find awe-inspiring. Everyone is different, but whatever does it for you, try to make it part of your everyday experience: when you’re choosing which route to walk to work, which book to read or what movie to see. ‘Don’t think it takes big bang conversions to get five minutes of awe,’ he says. ‘Find your sources and go get it.’