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Psychedelic medicine is exciting but all the hype makes it hard to evaluate the results of clinical trials. Ex-
pectations are so high, and the blind (whether or not the patient and the clinician know they are getting a
placebo or active drug) is often ineffective.

Boris hopes to deconstruct the contributions of set, setting, and drug at least in part by studying the effects
of ketamine and psilocybin on depressed persons undergoing anesthesia for routine surgery. It's as close to
the perfect blind as one can get for the patient and the rater.

Boris thinks a lot about the placebo effect and how it has been somewhat demeaned in our culture to imply
that patients experiencing it have been fooled in some way. He is fascinated with our ability to engender
hope in patients to effect healing—whether or not a drug is used.

As an example, Boris wanted to share this experience with us:

A woman was attacked by a family member with a knife. She had self-defense wounds. Her hand was very
badly injured. She went to the emergency room. They patched it up and referred her to Stanford but she had
to wait two weeks to get an appointment. In the intervening time, she had horrible nightmares. She was una-
ble to sleep, unable to function, and unable to talk about the event without bursting into tears. That's how
Boris’ colleague found her in the pre-op area at Stanford. The team gave the patient light sedation and a
regional anesthetic for the arm.

Then one of the team with experience inducing dreams decided to induce a dream with anesthesia while
monitoring her with an EEG. She woke up as they were finishing and she started crying—not tears of anxie-
ty—but of joy.

Upon awakening, she recalled the knife but the emotional weight of the narrative shifted. She remembered
going to the emergency room, and going back to the operating room—all in her dream—and then being at
home with her hand fully recovered, running errands like it was no big deal.

After that, her symptoms were gone. That's amazing, but you may be thinking, “did it stick?” After all, this
is a patient who you might expect would convert from an acute stress disorder to full-on PTSD.

We followed her for eight months, and from that day forward, she no longer met criteria for a stress disorder.
She was able to talk calmly when I asked her to recount the experience.

She reported no more nightmares and being able to sleep and function with family.

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NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 15 January / February 2023