Dale Johnson: You're listening to Truth in Love, a podcast of ACBC. You know, I love engaging the various topics that we discuss on this podcast with so many faithful brothers and sisters who are involved in the biblical counseling movement. You know, these conversations really help me consider current issues and how we should always seek to discern them from a biblical lens. And if you've enjoyed or learned from the subjects that we address, would you consider leaving us a review or rating? whatever platform you use to help our visibility so that others may be helped as well. Thank you to all who join us in listening weekly. I pray that this resource has been practical and an encouragement to each of you as we try to provide biblical wisdom to the problems that people face. So, to find out more about our resources, the other podcasts that we do, or the other forms of resources that we provide, please visit us at biblicalcounseling.com. Psychedelics in Presidential Orders on this edition of Truth in Love. I'm Dale Johnson, and you're listening to Truth in Love, a podcast of the Association of Certified Biblical Counselors where we seek to provide biblical solutions to the problems that people face. This week on the podcast, I'm delighted to have with me Dr. Matt Rehrer. He's an emergency medicine physician in the Bay Area. He graduated from Baylor College of Medicine in Texas, and he moved to the Bay Area for residency in 2008 where he and his wife, Kara, have lived ever since. Matt and Kara have been married for 21 years and they have three children. Matt serves on staff at North Creek Church in Walnut Creek, California. He's the author of Redeeming Memory and contributed a chapter on dementia for the Christian Counselor's Medical Desk Reference. We are continuing our discussion this month on ⁓ issues related to mental health and Mental Health Awareness Month. And, Matt, welcome to the podcast. I'm grateful for your time today.

Matt Rehrer: Yeah, thanks for having me on, Dale.

Dale Johnson: Now, it wasn't too long ago, Matt, that we had a discussion about psychedelics. We talked about the concepts and the uses that are being proposed in lots of different places. At that time when we recorded, I had no idea that there would be some sort of presidential action related to the concept of psychedelics. But it proves the point that we were trying to make that this is a growing phenomenon. And ⁓ the president has recently put out an order related to psychedelics. And so, I want to give you a chance to you know, maybe do a quick review, catch people up on what in the world we're talking about, and then we'll get into discussing a little bit about the president and what the president ordered based on some recommendations from HHS. So ⁓ I'm going to let you give a quick review of these psychedelics and what we're talking about here.

Matt Rehrer: Yeah, I think for some, could definitely go back and listen to the first podcast where we got into microdosing. But for some, when they hear psychedelics, think they think tie dye shirts in Berkeley or a seventies like Springsteen concert. You know, those are the things that come to mind. but psychedelics include things like LSD, mushrooms. we're going to talk more about Ibogaine and the interest really started to mount. in the past few years over the idea of taking micro doses, smaller amounts to treat different conditions like depression, PTS, drug addiction, things like that. The growing number of applications are happening about as fast as this has hit the public sphere. So ⁓ we're just bringing this back up because I think a lot of people ⁓ are wondering how is this relevant? And frankly, it's starting to pop up in the counseling room. So just I helpful and now the news has hit with President Trump's order. helpful to just bring this back up.

Dale Johnson: Yeah, little did we know when we were recording that. We were seeing, you see it certainly as a physician, but I'm seeing it in lot of the literature, ⁓ you know, the increase of ⁓ interest in the concept of psychedelics. And ⁓ it is interesting to me, though, that we see the president ⁓ talking about this particular subject. And so talk a little bit about not just for the presidential order, but some other things, I think, that were going on. Why is this now in the news so heavily? and what prompted the president to describe this recommendation to him.

Matt Rehrer: Yeah, for those who are interested, you could actually pull this ⁓ order up, this executive order that President Trump made on April 18th. And the order is very interesting because first he frames why this is such an issue, why he's interested in this area of research with psychedelics. And he mentions the continued rise and burden of suicide and mental illness rates in America and starts quoting different statistics that are very alarming. as suicide rates continue to rise, ⁓ serious mental health illnesses continue to affect a majority, like a large portion of the population. And the answer then he goes after bringing this to bear, including the veteran suicide rate, which I think is why it got the president's attention as well as veterans were saying we need a solution as well. They were being impacted and he says, And I quote, despite massive federal investment into researching potential advancements in mental health care and treatment, our research system has yet to produce approved therapies that promote enduring improvements in the mental health condition of these most complex patients. Innovative methods are needed to find long-term solutions for these Americans beyond existing prescription medicines. So, wow, what a statement. mean, he's acknowledging the, I'd say failure really of addressing these significant mental health issues. that are being defined. what this order does is particularly targets and mentions a drug that we'll get into called Ibogaine, but it accelerates research and tries to remove any barriers ⁓ from medical research addressing and ⁓ looking into the effects specifically of Ibogaine and maybe some others. What's fascinating is you're like, well, how did this happen? And there's there's rumors out there that this possibly was inspired by a Joe Rogan text message to the president, which Wall Street Journal gave a pretty detailed account of. So that's where the origins are of this, which is kind of amazing, ⁓ truly, that this is where we're going for advancement is to look to psychedelics as a solution.

Dale Johnson: Now, I have more questions about what prompted this because it does seem interesting to me. You mentioned the Joe Rogan text potentially. And, you know, I think about this in terms of the HHS, right, ⁓ and the secretary, ⁓ Mr. Kennedy, as it seems is what they've been trying to accomplish is look at science, what's happening at the FDA, question some of the regulations that have been happening. They've opened the door even to have a more full-on discussion about some of the things being reported relative to things like antidepressants and the usefulness of it, the side effects that come along with that or the ⁓ addictive nature properties of such medication. And they're raising the alarm on things like that in a way that, okay, they're looking at some science, they're concerned about it. And this seemed to be just a very different perspective, right? Where we're looking at psychedelics where... As you just mentioned, the president acknowledges the weakness of our approach with the issues of trauma and treating veterans and so on and so forth. And really the large failure of some of the mental health complex that people are recognizing. And yet all of sudden, we bring in this concept of psychedelics, which really doesn't have the scientific basis ⁓ that seems consistent with the way they've scrutinized some of the other medications. And I just found it very interesting. any ideas in your thoughts on what prompted this, ⁓ especially when it seems a little bit inconsistent with the current health secretary ⁓ and most of his recommendations and some of the views of the FDA, regardless of what people think about that, it just seems a little inconsistent. So I'm just curious. This is ⁓ your opinion on this as we sort of think through it ⁓ and consider what the president said here.

Matt Rehrer: Yeah, we don't have all the background of why they shifted to psychedelics specifically. One thing I would say that came out in the executive order, if you read it, is desperation. I think that the world is looking for a solution. They're acknowledging the continued massive and really tragic sadness to the failure of these prescription medications. that it's leading to these continued rise in suicide rates that are alarming, especially with veterans. ⁓ The statistics they were quoting in there are just stunning. And I think we all know this, if we're living in the United States and even globally, that there is a continued outcry. And so it comes off as inconsistent to then switch to a solution like psychedelics that have such little, and we're gonna go into this, such little backing. from the scientific community and actually have serious side effects ⁓ while condemning the current prescription medications where at least you could argue there's a lot more double-blinded controlled randomized trials out there. I have my own thoughts on those, but at least it's out there, the information's out there. So this seems like quite a dramatic pivot and one that has wits of desperation to it, ⁓ to me.

Dale Johnson: Mm-hmm. Yeah, and that's helpful. Now, let's talk specifically about the drug because, you know, he refers to psychedelics broadly, but it seems as though he narrows it to a specific psychedelic. I want to talk a little bit about that particular drug Ibogaine that he mentioned.

Matt Rehrer: Yeah, so in the order, you as we mentioned, there's a number of psychedelics, but the one that gets highlighted specifically in the order is Ibogaine. And the origins of that, comes from an extract from a plant in West Africa called an Iboga shrub. So that's where the name comes from. It makes sense. But the shrub has psychoactive compound to it and is used in spiritual practices by a group of people, the Witi people in their spiritual ⁓ and religious practices. So that's where this came from. Nobody knows how it works. There's a lot of different neurotransmitters that seem to get scooped up in how it works. ⁓ Cited that I can find again with very poor research includes serotonin, dopamine, and glutamate, maybe even opiate receptors are involved. It's kind of like ⁓ a big buckshot across your neurotransmitters and that's some of the reason it's getting promoted. The idea is it's a full reset, which is because you're like, well, and look at all the things that it's interacting with. I don't necessarily think that's a positive that there's so many neurotransmitters being interacted with. It shows a lack of targeting and frankly is concerning. And then if you try to look up like, well, what's the dosing?

Dale Johnson: Mm-hmm.

Matt Rehrer: Well, here we are. We're in research land where no dosing has been established. Nobody knows what the proper amount is, which is what we talked about in microdosing. There's been no standardization. So the indications have already been alluded to, particularly with depression, PTS, and addiction. And it's just starting to expand out into other spaces where people think this can be applied. But one thing I want to make sure that the listeners are aware of is that

Dale Johnson: Yeah. Mm-hmm.

Matt Rehrer: there's serious side effects for Ibogaine. That's why it's not been researched is because there was observed sudden cardiac deaths from something called prolonged QT. What that means is as your heart beats and you can look at an EKG, you see as your electrical impulses go, you have set things frankly that the Lord has put in your heart, little nodes that fire off. Nobody can explain why they fire, but that's what it gives you the beat at your SA and AV node. And the problem is, with this particular medication, it's known to prolong the intervals in between those firings and can lead to your heart stopping. So unfortunately, with Ibogaine, that's a known issue. And there's a number of medications that prolong this QT that people would probably be taking as well. Simple things like ⁓ some of the medications you would take for depression already are known to cause this problem.

Dale Johnson: Mmm.

Matt Rehrer: as well as anti-emetics like Zofran and others, you have to be very careful when you give a nausea medication. So meaning you could be taking Ibogaine as well as other common medications and really doubling your tripling, whatever it would be, odds that you're going to have this pretty big side effect that you won't even know is happening until it happens. ⁓ the research, are no randomized double-blind studies on this medication. So this is, we are in infancy and part of, again, the reason that this hasn't been well researched is because of these very scary side effects that clinicians, physicians ⁓ usually steer clear of it becomes apparent because they don't want to get themselves into trouble in a study where they have to stop the study because somebody died. ⁓ So we'll see. ⁓

Dale Johnson: Yeah, mean, to your point, there are ethical issues in trying to pursue study with these known types of issues. So how will we ever cross that sort of regulatory barrier, if you will, ⁓ and get to a place where research is actually condoning or promoting something like this?

Matt Rehrer: Yeah, it's a schedule one drug too. Like Ibogaine is not, it can't just be prescribed by everyone. It's the same as getting an opiate prescription, et cetera. It's at the highest class it can be. One for its effects, but second, it's because it's got these serious side effects. They don't want anybody just prescribing or taking this without consulting a physician. So it's interesting they mentioned this particular psychedelic because it already has eyebrows raised in the medical community.

Dale Johnson: Yeah, that's interesting for sure. Now, I want to shift gears and get to what our focus would be as we think about Scripture, but even before we get there, I can't help but to let my mind race to the history of psychiatry. And what you see, if I were to describe broadly what you see in the history of psychiatry, is an ebb and flow, or what I might call a cycle, a cycle from what was termed in most of the literature between romantic psychiatry and biological psychiatry. just roughly speaking, romantic psychiatry was sort of your psychological approach, right? So this was sort of your Freudian talk therapeutic approach. We see these problems, we want to address these in broad moral therapeutic terms, which came out of France and so on. And then you see this movement with Emil Kraepelin towards biological explanations. Hey, we think we can discover this. we're going to reduce man down to this biological explanation. And throughout the history of psychiatry, you've seen sort of emphases change, right? People get weary with the lack of scientific vigor from one, so they sort of cycle back through, well, okay, maybe we should think about talk therapy. I see that happening right now, especially with some of the information that's been coming out about the chemical imbalance theory and so on, and to your point about the science behind some of the antidepressant, anti-alytic medication. So lots of questions have been raised. I'm seeing some people back off of the concept, the influence of Eastern mysticism, for example, ⁓ along with now the introduction of microdosing, to your point back to the hippie phase and Timothy Lirius, who I will think of. It's interesting to see, this seems to be one of the symptoms that ⁓ the approach to psychiatry is moving in some ways away from, you know, this biological basis. and framework, or reductionism, if you will, ⁓ to more of a romantic sort of variety. Now, that's just my speculation. I don't know what you think about that, but it just seems as though these are symptomatic of that sort of ⁓ ebb and flow or tug of war, if you will, between psychology and psychiatry. And as I'm watching this happen, we have to start answering the question about the Scriptures. How do we deal with these things from a biblical perspective? And I bring that up just to say, like, these approaches are philosophically based to a large degree, and we see that through history, and I think we're sort of living through one of those transitions even now. So, for our purposes and for most of our listeners as they think about this concept, what does the Bible actually say about something like psychedelics and ⁓ the way it affects us as a human being? Because, okay, the Bible doesn't have ibogaine. listed in there as some sort of warning, don't do this, don't take this. ⁓ But the Bible certainly gives broad expressions about how we should think in wisdom about these issues. Give us some insight on how we should think biblically about these types of mind-altering drugs.

Matt Rehrer: Yeah, I think the Bible definitely addresses this in a few different ways, especially when you get into some would try to claim like, hey, we're trying to do this without altering your mind. But this particular research, this particular drug, we're starting to back away from even microdosing here. And even if you were to try to microdose, as we mentioned before, you generally develop tolerance and eventually end up in mind altering spaces because you have to take more and more of it. So.

Dale Johnson: Mm.

Matt Rehrer: I would say the Bible is very specific about ⁓ being careful when you are going to do anything that's intoxicating or mind-altering because it's similar to drunkenness. The idea is that it controls you. You are no longer spirit-led. You're no longer self-controlled as the Christian is now being ⁓ controlled by what they've taken, by the substance they've taken. And so that where we would go there in the counseling room, I think is to Romans 12, one and two, to urge brethren by the mercy of God to present your bodies, a living and holy sacrifice acceptable to God, which is your spiritual service of worship. And then it's do not be conformed to this world, but be transformed how? By the renewing of your mind. Your mind in Christianity is fully engaged. Unlike mysticism, like you were alluding to, Dale, The mind is not, it's going to another level, right? The idea is to become, ⁓ to access a higher space. The Bible is very clear that to have a relationship with Jesus and God, it's not that you're in some different spiritual frame, it's that your mind is actively engaged in reality ⁓ and thinking about God. And that would come right out of 1 Corinthians 2.16, that the believer has such a hope that we have what Paul says is the mind of Christ. So you're fully engaged in that and Ephesians 5.18 would finally come to mind that we're called to be sober and self-controlled so that we're able to engage with the Holy Spirit. And when some start hearing that, maybe if they're not as well attuned to what Christians are talking about in the Holy Spirit, they'd be like, well, that sounds like psychedelics. Absolutely not. The Holy Spirit is engaging you in the way that you're made in your mind to be able to think clearly, not to be changed in in the way that you're able to process. And I'm afraid that some people are using psychedelics as a form of escapism, which I think is what mysticism promises. You can escape your problem, which is not a solution. And the Bible is saying that you don't need to run from your problems. You run to Christ who helps you walk through and face your problems. So healing comes from Christ, not through altering your chemicals. And I think that that's a truth to be held onto.

Dale Johnson: Yeah, that's such a helpful framework and really basis by how we measure ⁓ something like psychedelics. And I think that really leads to the next question because really in this realm, ⁓ as we think about various treatments for different types of problems that everybody knows, the secularist knows are issues, the increase of suicidal ideation or suicides themselves and ⁓ the problems well documented in the mental health sphere. How does a Christian view this concept of psychedelics, especially when there seem to be promises or pragmatic promises that, these are effective for some people, these are helpful in cases of depression to eliminate suicides or in cases of a PTS, you know, with the veteran who's struggling in some way. And there are appeals to pragmatism in, well, it seems to help this, you know, this many people or this percentage of people in the population. ⁓ How do Christians think about the use of something like this knowing it does alter the mind? It's not something that is overtly curative in that sense. Help us to think Christianly about this.

Matt Rehrer: Yeah, I think it would go all the way back to what we said in the beginning about the executive order by the president first. It really highlights a profound need in our country for help and healing, that suffering from things that are real. mean, someone who's going through severe depression or PTSD, these are not things to be discarded. They require compassion. And there is in the executive order, I think, a thread running through it of a desperate cry for help. And for the Christian to hear this, it goes, actually, this is the perfect opportunity for the Bible to shine because the Bible does have solutions. There is a promise for treatment in the Bible that says that there is hope for you. So the Order actually acknowledged that psychiatric treatments are failing, medication is failing. And I think that gives a voice to the Christian to go, well, it's time to speak up to say there is a solution found only in Scripture, that we have a Savior who actually promised to bear our burdens and walk in our valleys. You don't need to escape your problems. God actually uses your suffering and problems to grow you, refine you, and make you more into his image. So we continue, I think, as believers to evaluate the evidence. I don't want to completely say there's nothing here, discard it, sound anti-science, but it's easy to get caught up, I think, in the fervor of this next new thing and these promises of healing, which frankly are unproven right now. So anybody saying that is doing it with no evidence. But we need to be discerning of these risks and be cautious of solutions that frankly are riding on the, I think the backs of mysticism really, and maintain a compassion for sufferers who are out there. What an opportunity right now for the church and the old counselors to say like, hey, we have a solution. It's called scriptures, not psychedelics.

Dale Johnson: That's really good and very, very helpful to think Christianly about this. One final question, and I want to get as practical as possible as we take this into the counseling room, especially for us as Christians. And what comes to mind, I'm asked to speak a lot on how do we engage the psychologized counselee. I'm thinking back to, you know, the JBC article that David Pallison wrote at one point. And in our therapeutic age, that's not uncommon. It's very common that the church is often the last resort. So, they've that the individual may have been to lots of different outlets to seek solution. And they have a therapeutic mindset in how they see and understand their problems, their experiences, and so on. I think some of our people are going to see this increasingly as it becomes more popular. And we might be sitting across the table from someone who, the narrative in their mind is that they're taking psychedelics. It's now something that... you know, it has some level of acceptance or approval or, you whatever language we want to call it. Maybe they've been given some sort of prescription by a physician, so it feels much more justifiable. ⁓ And so now this explains how they see themselves and how they understand the problems that they face. We're going to be faced with that in the counseling room. So how do we, you know, biblical counselors, approach someone ⁓ knowing this therapeutic framework that they have based on treatments that they're pursuing. Where do we begin? How do we help them? How do we start? Give us some wisdom and, you know, I guess warn us from some pitfalls as well because we're not physicians. We're not giving medical advice. So help us to think through that a little bit.

Matt Rehrer: Yeah, I think the first would be ⁓ caution because the sometimes and I've had folks do this ⁓ with me. It is very common to have somebody on medication that comes and speaks to me. First of all, I would say there's a caution. You want to jump in and say like ⁓ they'll ask like, should I just stop this right now? And you need to be really careful. A lot of these ⁓ therapies and medications should not be stopped cold turkey without consulting. whoever prescribed it. And the person should feel comfortable going back and saying, can you please help me taper off? So that would be one caution just right off the bat. The second is, depending on where the person's at, I usually tell them, I'm so thankful that you feel comfortable coming to me and trusting me with this serious problem, especially with what's been going on in your life. And then if they want to address how does therapy and counseling go together, then we start talking about that because usually, I think it's best to be careful to not address it right up front and work it through because usually it becomes evident as you open scripture, you walk through counseling that they start to see the differences that this is coming from a different place, a different worldview, and help them get there on their own. If you just tell them that, it's very hard for people, especially in the world we live in, to differentiate.

Dale Johnson: Yeah. Yep.

Matt Rehrer: So walking patiently through with somebody might not even be the first session. Maybe it is, depends on how the conversation goes, but showing them the value of scripture and how change can be made and how this is actually coming from worldview, just like what you're hearing in the therapy session you were just in or from the psychiatrist that prescribed you medication. think those would just be a handful of very quick principles to just, ⁓ I think, add to the conversation ⁓ and what Pallison already kind of laid out for us.

Dale Johnson: So helpful, Matt. I really appreciate your help here in taking something that is bombarding our culture presently, even to the highest level where the president's giving an order, and really teaching us how to assess what's actually being said in the secular culture, and then making that transition to say, okay, as Christians, we have to think about this biblically. I think you did that for us today in such a helpful way. And then taking it full circle to the practical. How do we... sit across from table from somebody who's hurting, broken, and how do we gently and kindly really help them to see the value of Scripture in explaining what they're experiencing. Brother, thanks so much for taking time to use your expertise to help us to understand these things and to apply them well. So, thanks for your time.

Matt Rehrer: Yeah, thanks for having me on, Dale.