MedEvidence! Truth Behind the Data · Dr. Michael Koren

Schizophrenia, Psychadelics, and Seeing the Future

January 7, 2026·48 min·4 clips

Three traumas before age 18 raises psychosis risk 13-fold; five traumas raises it 172-fold.

1. MedEvidence host Dr. Michael Koren interviews Professor Paul William Miller on psychedelics, EMDR, and their application to schizophrenia and PTSD. 2. Dr. Miller is a consultant psychiatrist specializing in general adult and late-life psychiatry in Northern Ireland, with a background in surgery before transitioning to psychiatry. 3. The episode's core thesis is that schizophrenia and PTSD are substantially trauma-driven conditions, and that EMDR and certain psychedelic compounds offer evidence-based treatments beyond conventional pharmacology. 4. Miller describes his involvement in the Irish schizophrenia triad study led by Professor Kenneth Candler, which identified the first gene of risk for schizophrenia. 5. He argues that while genetic risk for schizophrenia exists, genes alone are neither necessary nor sufficient—environmental trauma is a critical driver. 6. Northern Ireland research found that three traumas before age 18 increases pathology-level psychosis risk by 13 times, and five traumas by 172 times, a dose-response relationship replicated globally. 7. Miller uses the term 'small t trauma' to describe events that don't meet DSM-5 Criterion A but still overwhelm the mind's processing capacity, citing colleague Katie Shea's definition: 'any threat the mind is not adequately prepared for.' 8. He introduces EMDR—Eye Movement Desensitization and Reprocessing—created by the late Dr. Francine Shapiro, which Miller trained in during 1997. 9. EMDR's adaptive information processing model holds that trauma derails normal memory formation, causing events to be relived rather than remembered, as shown in functional imaging work by Russ Latinus on road traffic collision survivors. 10. Miller explains the eight phases of EMDR: assessment, preparation, and phases three through seven for reprocessing past events, present triggers, and future catastrophizations. 11. He uses a water-bottle time capsule analogy: unprocessed trauma from age eight retains the emotional 'software' of an eight-year-old, which can override an adult's competence when the network is triggered. 12. Dutch research and Bob Stickgold's REM sleep work suggest that bilateral stimulation taxes working memory, replicating the descending cortical-thalamic signal that trauma disrupts and allowing the brain to process at a higher cognitive level. 13. Miller explains that EMDR is recognized as a gold standard treatment for PTSD, with evidence showing reduced vividness and emotionality of traumatic memories after BLS sessions. 14. He describes the anterior cingulate cortex seesaw effect: ventral activation reduces emotional charge while dorsal activation increases cognitive distancing—both observed during EMDR. 15. The IMPACT-1 trial by Transcend Therapeutics enrolled 14 participants with moderate-to-severe, treatment-resistant PTSD to test TSN-D201, a compound related to MDMA but described as gentler and non-hallucinogenic. 16. Miller reports substantial improvement on the CAPS-5 scale in IMPACT-1 participants, most of whom had carried a PTSD diagnosis for years and failed at least two prior treatments. 17. He distinguishes TSN-D201 from classical psychedelics like LSD and psilocybin, noting it works differently in the brain and does not induce a hallucinatory state, making it more amenable to placebo-controlled research design. 18. Dr. Koren and Miller discuss the challenge of placebo-controlled psychedelic trials, noting that IMPACT-1 progressed from open-label to a randomized double-blind design in its IMPACT-2 extension. 19. The episode is suited for clinicians, researchers, and people with personal experience of trauma or PTSD who want to understand emerging treatments beyond standard pharmacology. 20. Listeners seeking a broad overview of mental health treatment without clinical detail or those averse to discussions of childhood trauma and psychosis may find the episode demanding.

As heard by us

A steady, evidence-minded psychiatric conversation about trauma treatment and psychedelic medicine.

Dr. Michael Koren's conversation with psychiatrist Paul William Miller follows Miller's path from surgery to psychiatry, then into EMDR and psychedelic research. The strongest stretch is the one that turns a dense clinical subject into plain language.

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You want a grounded look at psychedelics, trauma, and EMDR from a consultant psychiatrist.

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