In this episode of Vital Psychedelic Conversations, we do something a little different: instead of interviewing a teacher and student to hear their different perspectives, Kyle (Vital’s main creator/developer) has a conversation with Johanna Hilla (our Coordinator of Education and Training), with the two basically interviewing each other.
Johanna is originally from Finland but now lives in the UK, where she is pursuing a Ph.D. in philosophy at the University of Exeter. She has worked with us before, but became a full-time part of PT right around the time we launched Vital, so we thought it’d be interesting to hear a talk between two of the main figureheads behind this year’s cohort as it comes to an end.
They discuss the beginnings of Vital and how the pandemic actually helped; how it’s been for Johanna to experience powerful group work for the first time; and what it’s been like to see virtual connections turn into real friendships as groups came together at retreats (this was recorded at Altman Retreat in Jamaica). And they analyze Vital and look to the future: What worked? What didn’t? What were the biggest takeaways from this year? How can we add more somatic work (and maybe even have a retreat centered around getting into flow state and hiking or snowboarding)? How can we incorporate state-specific models as more states legalize? And most importantly: Can we become a new gold standard in the training/education world? We hope so!
“The whole curriculum, the way in which it’s structured with the five elements, the way in which it emphasizes experiential learning and process-oriented thinking and incorporates all of these transpersonal elements but also has a really sufficient amount of clinical backing: I just thought that it was really brilliantly structured (which I think you did most of that work) and I thought that this is exactly what we need right now.” -Johanna
“The emotional density and the charge that happens in a room when people are either doing some kind of plant medicine ceremoniously or doing breathwork: I think it’s always really something tangible, and it’s a great privilege to witness people going into these deep psychological processes. But obviously, it also takes something from you. You really have to be very present, there for many hours, and you go through the experience with the people as a witness. Even though you don’t know what they’re going through, you’re still going through it with them in a way.” -Johanna
“I think breathwork really honors the idea that we all come from a certain baseline and that people have different levels of intensity that they’d like, and different comfort zones. And I think that’s also fine. Not everybody is going to go for the five grams in silent darkness, and I don’t think everybody has to either. If there’s people who are feeling a bit more anxious about going into new experiences, I think breathwork is a really great gateway into the psychedelic world. And then maybe some people will really fall in love with the method and actually want to continue with it. I think it offers something for everyone.” -Johanna
In this episode, David once again interviews a teacher and student from Vital, speaking with Grof-certified Holotropic Breathwork® practitioner, author, and developer of InnerEthics®: Kylea Taylor: M.S., LMFT; and therapist and Lead Consultant of psychological therapists at NEU: Shabina Hale.
This Vital Psychedelic Conversation is largely centered around ethics: how practitioners and facilitators define ethics; how InnerEthics® is involved; power dynamics; accountability; how the energy in a session is transferable and can bring up shadow elements for both parties; the need to be honest about one’s own scope of competence; the need for facilitators to have more experience both as a sitter and experiencer; and the very simple but most vital aspect of facilitation: considering how any decision made will affect the person on the psychedelic.
They also discuss having a code of ethics inspired by Indigenous culture and decades of underground use; how the psychedelic experience is affected by the ways it’s treated by its surrounding culture; how the practitioner becomes a protector; defining what is normal in a psychedelic experience (can you?); informed consent and the importance of explaining how roles will change throughout the process; and what the world would be like if everyone followed the same set of ethics.
Have you seen our commercial for Vital yet? We’re pretty thrilled with how it came out.
Notable Quotes
“We’re doing psychedelics in a different culture and a different community. I come from an Asian community that is often more tight knit and more tribal in its way of being, and mental health is seen differently within that community, care for elders is seen differently in that community. And so immediately, you’ve got these different rules and different structures that happen. And psychedelics obviously have come from some of those communities, but we don’t have the same communities anymore. We’re in the West. People will take them [and] they don’t go back to communities. They’re on their own. And that’s really isolating. …How do you keep people safe in some form of community when they go back into a society which is much more individualistic?” -Shabina
“I think it helps to just consider it all normal and not abnormal, because it’s only abnormal in the context of our society and our culture. What happened to Indigenous people in their psychedelic experiences was held; whatever it was was held by the culture, so it was not abnormal. It was normal in the extraordinary state of consciousness, and they assumed that it was healing and worked with it.” -Kylea
“You can see things that may not make sense on the outside, but to that person, on the inside, they really do make sense. And they make sense of it in a way that is far more profound than you could ever interpret or analyze or try and take apart.” -Shabina
“I think if people really find out what is theirs to do and do it, that is so satisfying that all these other things that cause problems for other people disappear.” -Kylea
In this episode, Joe interviews Portland, OR-based licensed marriage and family therapist, ketamine-assisted therapist at Rainfall Medicine, lead educator at InnerTrek, and speaker at our upcoming Convergence conference: Gina Gratza, MS, LMFT.
She talks about how she decided she wanted to become a therapist and when she knew psychedelics were the next step; meeting Rick Doblin at Burning Man; the efficacy of MDMA being used in conjunction with traditional therapy; how the self-compassion of MDMA gives her tremendous hope for its use in treating eating disorders; how non-ordinary states of consciousness teach us the wiseness (and uniqueness) of our inner healer; and her healthy concerns for how Oregon handles psilocybin legality: InnerTrek will be graduating some of the first licensed facilitators in Oregon and they should be certified by summer, but with OHA-approved service centers and manufacturers still up in the air, what happens next?
She and Joe also discuss how non-ordinary states of consciousness teach us the wiseness (and uniqueness) of our inner healers; the need for therapists to continuously do their own work; the idea of a psilocybin-licensed facility doubling as a music venue; David Nutt’s drug harm scale; Kylea Taylor; “The Trialogues”; archetypes of Burning Man; and how in psilocybin-assisted therapy, we can only do so much before the spirit of the mushroom ultimately takes over.
Notable Quotes
“There’s a strength in the empathic attunement that’s happening in the heart space that’s coming forward, so it’s not just talk therapy. There’s a connection happening. And we are creatures of love and belonging and connection, and when we feel that with another human being [and it’s] authentic – that is a very powerful force. We don’t have to compare it, but it’s just as powerful as medicine.”
“I hope to never be a master of any domain. I know that the juiciness of this life and this existence is continuing to stay open to learning and growing and evolving, and for me, that’s coming back to humility: I’ll never know everything, especially when it comes to the realm of altered states of consciousness. We’re trying to understand life in this state of consciousness, let alone bringing in altered states and the many different dimensions at which things can come through to you, and the uniqueness of everyone’s experience.”
“This is what we humans are able to do: Here are the measures, here are the ways in which we’re training. And then there’s the spirit of the mushroom. There’s what we are going to bring and then there is going to be what the mushroom brings: …the mycelium network, the earth, the nature; like a total other force that is beyond our ability to really know or read what will move through that.”
In this episode, David interviews two people from different sides of Vital: clinical psychologist, adjunct professor, Co-Founder of the Psychedelics R2R nonprofit, and Vital instructor, Dr. Dominique Morisano, CPsych (the teacher); and writer, psychedelic-assisted medicine facilitator, integration coach, and Women On Psychedelics Co-Founder, Jessika Lagarde (the student).
With the 2023-24 edition of Vital set to begin in April and applications closing at the end of March, we thought it would be interesting to relaunch Vital Psychedelic Conversations, but with the spin of speaking to both instructors and students to hear their different perspectives on retreats, facilitation, psychedelic education, the quickly advancing psychedelic space, and of course, Vital itself.
Morisano and Lagarde mostly discuss experience: how it’s gained, how it changes perspectives and methodologies, how one decides they’ve experienced enough to be able to know the terrain enough to help others, the importance of knowing when a patient needs a facilitator/therapist who has had the same life experience, and knowing when one’s own skills and limitations means a patient would be better off seeing someone else. And they discuss safety, the importance of being trauma-informed (and what does that mean, really?), and the puzzling cases when facilitators haven’t had their own psychedelic experience but feel the need to use psychedelics to help others.
And of course, they talk about Vital: the joy in joining together in community with people they’ve only known virtually; how interesting these retreats are compared to others due to the level of the participants’ experience; how partnering up and taking turns as the sitter and experiencer shows how little of a difference there is between student and teacher; and how many people have reported the most impactful part of the retreats was not their own experience, but being there for someone else.
Notable Quotes
“Do you know the terrain? Let’s say you’ve taken ketamine once, and you’re doing six sessions of ketamine with a client. Do you really know what they’re going to be experiencing, and can you have had the full range of experience? …How do we define this? I can tell you: You have a hundred psychedelic experiences; most likely you’re going to have a different experience each time, and a different connection to inner/outer terrain or different realms or different ways of thinking and being. So when is enough enough? When did you learn your lesson? When did you gain the experience necessary to navigate someone [else’s experience]?” -Dominique “You learn a lot about yourself as well, I find at the end of a day. Every journey is also a journey for the facilitator, and we are constantly mirrors to each other, so it’s very interesting work to do in that sense as well, because your own inner work is continuously being done.” -Jessika “It’s never the same. Two sessions are never the same, and even how you show up on that day for that session, or set and setting; all of that influences [the experience], so we have to constantly be placing ourselves between being a student [and being] a teacher sometimes, but never put ourselves in the spot that we think, ‘Okay, now I know everything. Yeah, I’m done.’” -Jessika
“How do you develop wisdom? The way to develop wisdom is through experience, and often, pain.” -Dominique
In this episode, Kyle interviews researcher, speaker, writer, competitive freediver, and one of the world’s leading experts on 5-MeO-DMT: Dr. Malin Vedøy Uthaug.
As a society, we mostly live in our minds, emotionally constipated while surprisingly disconnected from our bodies, with basic human needs that are all too often not met. Uthaug and Kyle talk about what manifests when those needs aren’t fulfilled, the strength of one’s inner mind state to change perspective, and how powerful true catharsis and embracing grief can be. And they talk about somatics: why we don’t focus on the body more, and how we could embody experiences with non-ordinary states of consciousness to better connect to our inner world.
She discusses the impact (or non-impact) of following a strict dieta before a big experience; preparing for an experience with physical exercise (even right before the ceremony); freediving; the challenge of therapists/facilitators sitting with someone through strong catharsis; the popcorn theory; the guilt people feel from experiencing love and bliss; and the paralysis-by-analysis problem of not making the connection between insight and action.
Notable Quotes
“What I’ve seen throughout all these years working in the field is that there is at least very commonly this notion that the psychedelic is going to heal them; they don’t have to do any other work – just popping that tab of psilocybin or smoking that pipe of 5-MeO is going to result in change. And that expectation is a bit dangerous, I think. They might not get the help that they are seeking because they’re placing that help externally to them. …Healing is actually hard work. It’s not something that happens overnight. It’s the tiny little steps of change accumulated that creates a bigger change. It’s changing your tiny, tiny habits until it changes your life.” “You can realize a bunch of things, but if you’re not doing anything, nothing is actually going to change. It might feel like it changes because you have felt it in your brain or you’ve seen it or have this insight, but that needs to be translated actively into your life.” “I think putting the body back into the equation is the way forward, however that might look.”
In this episode, Kyle interviews C.J. Spotswood, PMHNP-BC: author and board-certified psychiatric-mental health nurse practitioner currently enrolled in CIIS’ Psychedelic-Assisted Therapies and Research certificate program.
He talks about his introduction to psychedelics and his first patient immediately asking him about microdosing; why he changed his mind on microdosing and why he wrote his book; microdosing studies he’s most excited about; the terms: treatment-resistant depression, risk reduction, and flight nurses; Irving Kirsch’s work uncovering the bad science of research studies; the need for physicians to know enough about psychedelics to be able to meet their patients where they are; the importance of group work; and how, while they’re already so well-versed in caring for patients, using nurses to their full licensure could be the answer to the quickly growing psychedelics and scalability problem.
Notable Quotes
“When you look at the early research into the 50s in the 60s; they were doing microdosing research, they just didn’t have a title for it. They thought they were using placebo levels but they were actually looking for threshold levels; things like that. Really, it was what by today’s standards [would be an] amount that we would consider as a microdose.”
“I don’t like the term [treatment-resistant depression] when we use that because if you’re using [it] when you’re looking at the standard medications like SSRIs [or] SNRIs, they’re basically all the same. …So when you say that someone’s ‘treatment-resistant’ for three medications, four medications that are all basically working the same pathways and in the same amount; is that truly treatment-resistant, or are we just trying the same thing with just different medications, whereas doing microdosing is a different pathway [and] is a different approach?”
“My first patient I ever saw as a new clinician, like, literally my first patient: I come in and I’m starting to talk to them for the first interview and I got to the point and I’m asking them: ‘Where are we going, what do you need?’ and they said to me, ‘Do you know anything about microdosing?’ …I said to them, I go, ‘Yeah, I know a little bit.’ …So I asked her what she knew, and she knew quite a bit. And she goes, ‘What do you know?’ and I kind of just said to her: ‘I don’t really know how to put this, [but I] wrote a book on it and it’s going to be coming out next year.’ …It reinforced my feeling [that] I’m doing the right thing: this career suicide I’ve thought of, going into working with psychedelics and being open and talking about it, hearing my first patients talking about it – it’s got to be serendipity.”
In this week’s episode, Kyle is back on the podcast, joining Joe to discuss three recent articles; two of which pose a lot of questions.
They first look at Colorado’s Proposition 122, which, now that it has passed, enters into the long and arduous process of being figured out – all while existing in the complicated paradigm of state vs. federal legality. One of the biggest concerns revolves around data collection and privacy: Is the collected data truly anonymous? Since psychedelics will still be federally illegal, how can we trust that the DEA isn’t going to abuse their power?
Next, they discuss Attorney General Merrick Garland making moves to end the sentencing disparity between offenses involving powder cocaine and crack cocaine: while essentially the same substance, being caught with 28 grams of crack cocaine currently carries the same sentencing as having 500 grams of powder!
And lastly, they touch on a very interesting article from Lucid News about the value of psychedelic therapy, which gives some staggering data points showing why the black market will always exist: MDMA-assisted therapy sessions likely costing $11,500 (with the MDMA itself costing between $480 and $9,600), Esketamine treatments costing as much as $32,400 a year, and more – all with results that don’t seem to be as long-lasting as many believed they would be. This one deserves more analysis, but Joe and Kyle had limited time for recording this week, so stay tuned for more. For now, enjoy this episode, and Happy Holidays from the Psychedelics Today team!
As the psychedelic movement expands, with surmounting research serving to change the tide of public opinion, more people are seeking out psychedelics as modalities for healing and self-exploration. Whether in the context of psychedelic-assisted therapy, plant medicine ceremonies, or recreational use, the modern Western psychedelic discourse has long been interwoven with the concept of “set and setting.”
But in contemporary psychedelic culture, the term is no longer sufficient as a harm reduction mantra. How can it be updated to better serve today’s journeyers?
A Brief History of Set and Setting
“Set and setting” refer to many factors which extend beyond the psychoactive effects of a given substance, playing a vital role in shaping psychedelic experiences. Typically, “set” refers to the mindset of a psychedelic explorer and “setting” refers to the context in which a substance is taken.
However, there has been little development of which variables fall under the umbrella of set and setting since its conception in the 1960s. There are significant factors that shape a psychedelic experience – both acutely and in the long term – which aren’t fully captured by set and setting alone.
The concept of set and setting has become something of a harm reduction mantra interwoven with the emergent field of psychedelic-assisted therapy and psychedelic research at large, used to describe the ways in which factors that extend beyond the substance itself can impact and shape its effects. Accordingly, it’s been an impactful linguistic tool that therapists, researchers and explorers have looked to for guidance on curating a container for an experience with medicine.
“Set” commonly refers to an individual’s mindset, including both immediate and long-range states of mind. A person’s immediate set is related to their state of mind before a psychedelic session, including everything from intentions, fears, hopes, and expectations about the session. However, their long-range set might include enduring personality traits, personal history and formative life experiences, social identities, and mental health history.
“Setting” commonly refers to the container of the experience, which includes the physical and social environment within which a substance is ingested, factoring into account when and where it will take place. Thus, setting may include aspects such as music, whether it takes place outdoors or indoors, the decor/props in the session room, as well as the relationships between others present.
The concept of set and setting does not exist independently of culture, with the sociocultural context of set including, but not limited to, race, economic status, strength of relationships with others, and the individual’s access to and relationship with nature.
Timothy Leary, 1960s counterculture icon and ex-Harvard lecturer in clinical psychology, is generally given credit for popularizing the concept of set and setting through his emphasis on the importance of both in shaping psychedelic experiences.
In the cult classic, The Psychedelic Experience, Leary together with his colleagues Ralph Metzner and Richard Alpert reflected, “Of course, the drug dose does not produce the transcendent experience. It merely acts as a chemical key – it opens the mind, frees the nervous system of its ordinary patterns and structures. The nature of the experience depends almost entirely on set and setting.”
To a large extent, the notion of set and setting within Western culture has been shaped and inspired by the ways in which Indigenous cultures around the world ingest psychoactive plant medicines in contexts bound by ritual, ceremonial objects, music, relationship with the land, and cosmological interpretive frameworks.
Compared with Indigenous cultures, Western culture has a bias against the use of psychoactive substances, and despite evidence that the peoples of Europe once used psychoactive plants ritualistically, such traditions have been long forgotten. Cultural frameworks determine the lens through which psychedelic experience is interpreted, and the lack of a cultural context, beyond that of prohibition, within which to make sense of psychedelics in the global North has produced a need for the ongoing formulation of set and setting.
More recently, Ido Hartogsohn, assistant professor at the program for Science, Technology & Society at Bar-llan University, has been conducting research on set and setting, exploring the ways in which psychedelic experiences are shaped by society and culture. In 2017, Hartogsohn published a paper outlining the history of set and setting, pointing out that although the term is often credited to Leary, its roots extend further back.
He explains how members of the Club des Hashischins, translated as “Club of the Hashish Eaters,” a Parisian group dedicated to exploring psychoactive-induced experiences in the 1840s, gave emphasis to what he calls factors beyond the substance itself. When Timothy Leary began his research with psilocybin in 1960, he exchanged letters with English author Aldous Huxley, who shared an excerpt written by one of the club’s members, Théophile Gautier, in which Gautier explores the necessity of preparation and going into a hashish experience with a “tranquil frame of mind and body.”
In addition, Hartogsohn suggests that having a better understanding of set and setting could serve as a form of harm reduction as well as benefit enhancement, highlighting that “the discourse on set and setting had remained largely underdeveloped over the years.”
An Expanded Vision: Set, Setting, and Support
Considering the growing mainstream emergence of psychedelics, set and setting alone is no longer sufficient as a harm reduction mantra, nor is it sufficient as a guidepost for the benefit maximization of psychedelic therapy and research. We argue that as a matter of public health, this mantra must evolve into “set, setting and support.”
No doubt that the proliferation of positive results from clinical studies being conducted on psychedelics, alongside countless mainstream articles detailing their healing benefits with promising headlines like “The Psychedelic Revolution Is Coming. Psychiatry May Never Be the Same,” are driving increasing numbers of people experimenting with psychedelic substances.
Despite the undeniable healing benefits of psychedelics, media discourse around them is sometimes dressed in sensationalist language, serving to construct psychedelics as miracle cures for all mental health problems. This premise is misleading and does not highlight the innumerable challenges that present themselves around the psychedelic experience.
One evident challenge that may emerge, is that of the psychedelic experience itself. Even when set and setting are controlled, there is no guarantee that challenging content and situations will not present themselves.
“Sometimes active journeyers can find themselves in unsound decision-making states. Having the support of a peer, trip sitter, or facilitator, during an experience can help the explorer navigate their inner state and make adjustments to the setting for maximum comfort and safety,” says Hanifa Nayo Washington, co-founder and Chief of Strategy at Fireside Project, a psychedelic peer support line that provides free, live phone support to individuals actively tripping or looking to process past experiences.
As psychedelic researcher and transpersonal psychologist Stanislav Grof says, psychedelics can be “non-specific amplifiers of mental or psychic processes.” That is, they have the ability to amplify content which is latent in the psyche, bringing up thoughts, emotions, and sense impressions that we were previously unconscious of.
Another challenge that may emerge after the experience relates to the fact that healing is often a messy, non-linear process in which things sometimes get worse before they get better. Anecdotally, there appears a common point of contention around individuals’ expectations going into an experience versus the actual outcome. No doubt, having forms of support already integrated into the process can make such moments of difficulty easier.
This self-guided class investigates the history, science, and best practices for safe and effective microdosing; hosted by Adam Bramlage, founder of Flow State Micro, Dr. James Fadiman, the “father of modern microdosing,” and a dozen expert guest faculty. Enroll today!
Beyond this, the aftermath of a psychedelic experience can also be destabilizing, as the non-ordinary states of consciousness they elicit serve to catapult us beyond the bounds of our everyday perceptions. In part, it is this very disruption in our normative flow of consciousness that enables psychedelics to be so healing, however, it can also be a simultaneously scary process as we find the foundations of our worldviews and belief systems turned on their heads.
“Psychedelic experiences can invite tremendous dysregulation in the body, mind, and spirit system,” Washington says. “Enlisting post-journey support in the immediate days, weeks, and months that follow a psychedelic experience can significantly ease the process of self-regulating to a ‘new normal’.”
What Can You Do To Seek Support?
Seeking avenues of support is a way to enhance psychedelic preparation, journeys, and integration, with support taking many different forms. One type of support, which may seem more self-evident, is that of socially-based, community support at the interpersonal level.
Despite the fact that psychedelics can elicit feelings of connection and oneness, some who use psychedelics may find themselves feeling alienated and misunderstood. For years, prohibitionist, zero-tolerance policies served to demonize psychedelic substances and those who used them, resulting in a lingering stigma and sense of shame associated with their use. This is especially true for individuals from communities of color who have long faced the impact of the discriminatory enforcement of drug laws, with the war on drugs producing profoundly unequal outcomes across racial groups.
Additionally, spiritual and mystical-type experiences have long been ridiculed and pathologized in Western culture, as they often include elements that are not culturally accepted as objectively real, sometimes resulting in those who have profound transpersonal experiences being dismissed or labeled as “crazy.”
Following a deep spiritual or transpersonal experience in which an individual disconnects from their ego, once they begin folding back into themselves there are layers of their identity or their lives that they may leave behind. This letting go of behaviors and parts of the psyche that are no longer of service can be conceived of as a type of “psychedelic shedding.” Omar Thomas, Founder of Jamaica’s Diaspora Psychedelic Society, CEO of Jamaican Organics and Psychedelics Today Advisory Board member, first formulated the notion of “shedding” in the context of psychedelic integration.
This might relate to one’s job, relationship, identification with a certain religion, sexual identity, or even their gender. When one goes through this shedding process without adequate support, there’s the risk that rather than finding relief from their mental and psychospiritual afflictions, they deepen, due to the many associated implications and consequences of the shedding process.
For example, what happens when someone realizes that the reason for their stress is rooted in their work, but they can’t quit because they won’t be able to support their family otherwise? Or what happens when someone sheds a cis-gendered identity but they’re in a marriage that would fall apart, opening a flurry of difficult, albeit potentially necessary effects?
This shedding process isn’t necessarily a bad one, but it certainly can be without having adequate support present to facilitate and ease the process. Like a butterfly going through its metamorphosis, it needs to be held in a safe container while fragile to emerge on the other side as its fullest and most beautiful expression.
Even today, as psychedelics become increasingly accepted in the mainstream, there is still a residue of stigma that remains. Thus, it is important, when looking for someone to support your journey, to find a non-judgemental, trustworthy person to share the experiences with. For some, this person may materialize in the form of a therapist, counselor, coach, or shamanic guide, while for others it may be a trusted friend or family member.
If support in an individual’s immediate circle is scarce, finding community support could come from connection online or in person with a psychedelic community, many of which offer courses and integration circles. One benefit of finding community online is around connecting with people from a particular social identity group that may not be accessible otherwise. For example, there are now integration circles that cater to individuals who identify as BIPOC, neurodivergent, or queer.
“In preparation for a psychedelic journey, support can look like gathering with a trusted friend, psychedelic facilitator, or support circle, to explore intentions, apprehensions, impressions, and beyond,” Washington says. “This support can increase awareness of one’s inner weather or set. With greater awareness comes the possibility for increased understanding of one’s own needs and knowing.”
Other forms of support include tools and techniques that a psychedelic voyager can draw upon as resources for grounding before, during, and after psychedelic experiences.
No matter the quality of the experience, beyond an intention to reduce the risk of harm, certain practices can be adopted as a way of supporting oneself through moments of discomfort or difficulty, to add a deepened sense of meaning and lasting benefit to the experience. For example, a 2019 study that observed the effects of psychedelics on long-term meditators suggested that the effects of a mindfulness practice may help patients sustain treatment outcomes in the long-term.
One might consider adopting a type of embodiment practice, engaging different aspects of the body in creating deeper self-awareness, balance, and connection. Whether it be a practice rooted somatics or mindfulness, or a more dynamic movement-based practice like yoga or dance, finding ways to become embodied helps to cultivate a deeper relationship with oneself and inner support to fortify your whole being.
Exploring the value of somatic practice, Lauren Taus, therapist practicing Ketamine-assisted Psychotherapy and Founder of Inbodied Psychedelic-Assisted Therapy and Integration Training shares, “Every emotion has a somatic counterpart, a felt sense in the body, which means that developing a daily practice of being in your body and listening to somatic wisdom is essential for healing.”
Support can also manifest by tending to your connection with nature. It can be easy to feel isolated after the depth and intensity of a psychedelic experience, however, the earth and the manifold beings that permeate it can serve as a source of community, providing consistent support through the embodied, knowing you were never alone to begin with.
In our vernacular, we tend to say that we are using psychedelics, but it’s certainly possible that psychedelics are actually using us. When one considers the predictable shift in values developed out of their use, expanding them to the global scale, we can see that not only are psychedelics healing us at the individual level, but are collectively helping to change the course of humanity’s place on earth by allowing us to care more about ourselves, one another, and the earth itself.
As this continues, there will be a never-ending need to increase layers of support for the broader community. Where might you be able to add that missing piece in your community, in your work, or in your personal life? What does it mean for you to evolve beyond set and setting?
In this week’s episode, Joe and David team up again to discuss what news interested them the most this week: the DA dropping a felony drug charge against a mushroom rabbi in Denver due to the passing of Proposition 122; Numinus Submitting a Clinical Trial Application to Health Canada that would give in-training practitioners the ability to experience psychedelics with their psilocybe-containing EnfiniTea; and a University of Exeter-led trial moving forward with the next step in a study using ketamine for alcohol use disorder (with 2/3 of the money coming from the National Institute for Health and Care Research).
They also review a paper that analyzed the economics of psychedelic-assisted therapies and how insurers come into play; as well as The Journal of the American Medical Association stating that, based on current trajectories compared to cannabis legalization, they believe the majority of states will legalize psychedelics by 2037. So nice to see these continued steps in the right direction!
And if you missed it, we just announced that applications are open for the next edition of Vital. There are incentives to paying in-full by certain dates, so if you missed out on last year’s edition or have been curious, attend one of our upcoming Q+As!
In this episode, David interviews Sherry Rais: Executive Director of the Boston Psychedelic Research Group, Grants Manager for CIIS, and CEO/Co-Founder of Enthea.
Enthea is a benefit plan administrator that provides health plan benefit riders and single case agreement services for psychedelic healthcare with a provider network including certified and credentialed Ketamine-Assisted Therapy (KAT) and Psychedelic-Assisted Therapy (PAT) practitioners. In other words, if a company wants to offer psychedelic-assisted therapy as a benefit for their employees, Enthea makes this possible (and affordable). Their first client was the very psychedelically-minded Dr. Bronner’s Magic Soaps, and they’ve just announced the signings of three new clients that you may not expect to provide KAP to their employees: Daybreaker, Tushy, and Guinn Partners. Their goal is to have 100,000 covered lives in 40 cities by the end of 2023, and, alongside the guidance of MAPS, hopefully roll out MDMA-assisted therapy in Q2 of 2024.
Rais talks about Enthea’s process, costs, and goals; her Ismaili religion; her nomadic, marathon-running life; her experience sleeping on the streets of Toronto at 16 and her need to help the less-fortunate; how her most powerful psychedelic experience was watching someone else transform; and why companies are suddenly interested in these emerging therapies.
Notable Quotes
“For me, the most powerful psychedelic experience I had was actually in a situation where I was sitting with someone else and saw this person transform in front of me. That was two years ago and that person; I still see the effects of that experience on that person’s life and how much he’s changed from this one experience, and I’ve never seen anything like it. It was the most beautiful thing I’ve ever witnessed.”
“I think you and I know that these medicines work, and we also know that they cost way more than $500, and immediately, that tells me there’s an equity crisis in the ecosystem; that we’ve finally found medicines that may be able to help millions of people that are suffering from a variety of issues, and there’s this huge barrier and its cost. So the goal of Enthea is to solve that problem by making these medicines affordable.”
“The fact that you have a plan that doesn’t cover mental health is very telling of the landscape and the culture in America today and why you’ve made the case for me on why Enthea is needed. Because if this doesn’t happen, when will people get access? They’ll continue waiting and waiting and waiting that their primary insurance provider covers this.”
In this episode, Kyle interviews psychologist, psychotherapist, author, and certified Holotropic Breathwork® facilitator: Marc Aixalà.
Aixalà is part of the International Center for Ethnobotanical Education, Research and Service (ICEERS), offering integration psychotherapy sessions, developing theoretical models of intervention, and training and supervising therapists. He is also the writer of the recently released, Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness, of which you can win a copy by entering our giveaway here!
Aixalà wrote the book after receiving more and more emails from people asking for guidance on how they were supposed to process a recent experience, and he realized that so much was unknown around the concept of integration: What exactly does it entail? Has the psychedelic space created a narrative that you need integration when maybe you don’t? When is the work considered integration and when is it psychotherapy?
He talks about some of the metaphors he uses to explain integration; the seven scenarios he typically sees in people seeking integration (and how to respond to each); philosophical constructivism and the importance of working with someone within their preferred cosmology; how the psychedelic hype has created a marketplace full of competition (and why that could be bad); and why he thinks being trained in Holotropic Breathwork is perhaps more important than being trained in facilitating a psychedelic experience.
Notable Quotes
“One of the things that psychedelics show us (or for me, the main thing) is that somehow, healing is inside of us and growth is inside of us, and they teach us accountability, they teach responsibility, and they teach us that we are the expert of ourselves – that our journey does not depend on an external person. So in my way of practicing integration, I also want to honor that, and do integration when it’s needed, but not create an additional need for people that don’t have it.”
“I think that that’s the richness and the beauty of psychedelics and the psychedelic experience, is that it cannot be understood from just one prism. No, it’s a trans-disciplinary approach that will give us a more subtle understanding of different dimensions included. I don’t think that there’s one way that is better than the other of using psychedelics, [just] as I don’t think that there’s one Shamanic tradition that is better than another Shamanic tradition. Things are there for a reason and we find what resonates more with us.”
“I believe that breathwork can be more effective than psychedelics to deal with certain emotions; things like anger, rage. The body and the somatic part of a traumatic event; that has worked very well with breathwork in my opinion – better than with other substances because it provides some sort of mental clarity that is not distorted by the archetypal aspects of psychedelics.”
An NYU psilocybin depression study participant discovers an unforeseen application for psychedelics: the treatment of chronic pain. Part 1 of the series: Psychedelics and Chronic Pain.
Everything Worked, but Nothing Lasted
In the fall of 2020, I was living a pretty successful and happy life – on paper. I had co-founded a very popular, leading-edge CrossFit gym in NYC; one of the first in the world. I held multiple advanced certifications in applied neurophysiology through Z-Health, helping clients with challenging pain and performance issues. As an early adopter of kettlebell training, I became a nationally top-reviewed instructor and trained Team 6 Navy SEALs, astronauts, pro athletes, wounded veterans, and members of the FBI, NYPD, NYFD, and ROTC. I was featured in Men’s Fitness, the NY Times Sunday Routine, and USA Today. I had 30 years in the pain & performance field, training and teaching at a high level, and was becoming widely known for helping people with difficult mobility problems or chronic pain, using unique methods from the leading edge of neurological rehabilitation. On top of all of that, I was 17 years sober.
However, not all that glitters is gold. A now ex-business partner was committing a Ponzi scheme to the tune of millions, and his case followed him like a shadow, turning my life’s passion into an emotionally and financially toxic nightmare that economically devastated my family. My best friend, Kirk MacLeod, who I had completely rehabbed from chemo & cancer surgery, died six months after being declared in remission. My first son had developed undiagnosed GERD and couldn’t sleep more than an hour and half at a time, which meant my wife and I slept even less.
Unsurprisingly, my episodic depression returned after more than a decade and a half, and I was now increasingly treatment-resistant; unresponsive to psychiatric drugs that had previously worked. All my pain neuromodulation interventions that worked on my clients no longer worked for me, and I had developed chronic pain myself.
I share all my background here to demonstrate that I was not under-resourced in either knowledge, networks, or diversity of approaches, practice, or experiences. I poured over all my certification materials looking for anything I had missed, but had fallen into an increasingly deeper recovery hole; everything worked, but nothing lasted. I was hitting a new bottom in my life, deeply sinking into the midst of an increasingly treatment-resistant depression episode that had likely been ongoing for five years.
But then I became aware of ongoing studies on psilocybin for depression happening locally in NYC. I had experienced a few high-dose psychedelic sessions nearly a quarter century ago and had been an avid Terence McKenna fan (even speaking with him directly after a lecture in Seattle), but I had never taken psychedelics therapeutically, and my recreational interest had effectively vanished once I became sober from alcohol. Intrigued, I connected with the local clinical research coordinator, Leila Ghazhal, at the NYU for the clinical trial of Psilocybin for Major Depressive Disorder study (sponsored by the Usona Institute), and took all the online and over-the-phone assessments, passing them easily. The primary investigator (PI) on my study was Dr. Stephen Ross, who had been leading psychedelic research at NYU for more than a decade. Amazingly, I made it into the trial within a month and a half, learning that I’d actually beat out 8500 other applicants for just 100 spots nationwide.
Trying Not to Hope
When I first entered the trial, I was in a state of denial about how severe my depression was, but once I took the MADRS assessment, there was no avoiding that I had moderate to severe depression with suicidal ideation.
I remember a specific moment very well during this process, when I was finally cleared to enter the study and the study coordinator was speaking with me about the results of my assessment and my upcoming participation. I asked what would happen if I didn’t receive psilocybin during my session, and he reassured me that they would not just drop me off in the middle of the ocean to dog paddle – that there were other interventions and studies available and they would be sure to find me something, but there was a good chance I would receive psilocybin and hopefully get some good results. At this point, my mask cracked a little bit and some protective cynicism came out, and I quipped with a bit of a shrug: “Well, we’ll see.” I hadn’t meant it to be dismissive or sarcastic but it came out that way, and the conversational atmosphere rapidly shifted. He looked right at me and suddenly he wasn’t the primary investigator anymore, lost in the myriad details and logistics of a very involved study. Now he was the deeply experienced clinician and therapist, and, having heard something within the tone of my voice, dropped all the way in and asked softly: “What’s going on behind that, Court?” Suddenly, all the masking dropped and there was no more place to hide because I was so, so tired at this point, and had been waiting for this moment. In and out of therapy for years, dozens if not 100 self-help books, so many modalities, so many somatic systems, and here I was with a chance for something new to help me. When I realized why there was cynicism behind my statement, my voice cracked, I started crying, and I answered him: “Trying not to hope.”
The one glimmer of hope I did have was reading a 2018 paper by lead author Calvin Ly describing psychedelics’ neuroplastic activity in the prefrontal cortex. As someone who had studied the neurology of pain for years, this was revelatory. Many pain conditions are, in fact, nociplastic or noxious conditions arising out of the central nervous system (CNS); there’s no more injury or damage if there ever was, but your CNS is still continuing to put out a maladaptive alarm signal that is perceived as pain. So learning that psilocybin was creating actual structural change within my cortex – not “just” psychological change – was completely astonishing.
Applications close on March 26 for this year’s edition of Vital.
My dosing date was on March 5, 2020, and I remember looking down at the capsule sitting in the cup, saying to it: “I really hope that’s you.” I was terrified inwardly that I would receive the placebo, that I wouldn’t respond to the psilocybin, or that it would only work just a little bit, only for its effects to slowly fade. But within half an hour, there was no denying that I had received psilocybin, and I earnestly pursued all the procedures everyone on my care team at NYU had worked with me on for weeks in preparation for this day.
I was genuinely shocked at the sheer volume of psychological material from my childhood and early adulthood that came up. I had profound transpersonal experiences and healing, revisiting instances that were pivotal in my childhood. I had an encounter with the first woman I had ever loved, who had committed suicide three years after we had broken up. Her death had caused a profound grief in me that drove my drinking for a decade after. I thought I had released the majority of my grief around her once I got sober, but clearly, there was so much more to heal that had been deeply suppressed as I tried to move forward with my life.
Reset, Renewed, and Reborn
The biggest shock of all, though, was waiting for me at the end of the day when one of my facilitators casually pitched a seemingly routine question while closely watching me out of the corner of his eye: “So, how do you feel?” Without thinking, I reflexively replied, “Good,” but then, just as reflexively, scanned more deeply inward, and in a sudden rush, realized my depression was completely gone – not just better, but vanquished, exclaiming: “Good! That fast? Are you fucking kidding me, that fast? Is it gone already?”
It felt as if a huge mass had been surgically removed from me or as if an entire continent within my interior was now suddenly revealed. No matter how many times you read the word “remission” and the percentages behind it in scientific studies, very little will prepare you for the shocking reality of it. The contrast between before and after was profound. All of the iterative rumination was gone, and it took no effort for that to happen. And it only seemed to strengthen as the days passed. Miraculously, all suicidal thoughts ceased on that day and never returned.
Shockingly, only ten days after my dosing session, NYC went into a complete pandemic lockdown, my entire industry closed, and my two young boys were now at home with me 24/7, tele-learning. I cannot imagine what 2020 would have been like for me if I had received the placebo. It’s almost unimaginable.
For more on this topic, make sure to check out episode 369, where Court and Joe interview Timothy Furnish, MD & Joel Castellanos, MD of UC San Diego’s Psychedelics and Health Research Initiative (PHRI).
But here is where the story takes an even more profound and impactful turn. During the session, my leg started intensely tremoring/spasming. I had been evaluated for musculoskeletal pain and dysfunction that I had acquired through a host of injuries over the years of my performance career, and in fact, had just been in the doctor’s office a few months earlier trying to determine if I had arthritis or something worse. But right there in the session room, I started having a neurological revision, with my muscles and nerves in my right inner thigh firing in an effort to recalibrate the sensory and motor inputs and outputs in that part of my kinetic chain. It was almost like a self-generated TENS unit (Transdermal Electromagnetic Nerve Stimulation, used to generate muscle contractions and neuromodulate pain signals with micro-electric pulses) getting my leg back online by creating intense motor activity in the muscles of my thigh.
I’ve since spoken with spinal injury survivor Jim Harris and read a case series from UC San Diego’s Psychedelics and Health Research Initiative (PHRI) published in PAIN Journal where the exact same thing occurred to them under the effect of psilocybin with the same positive results, but at the time, the facilitators were concerned enough to ask the primary investigator to come and evaluate me during the session. I had to explain to him, somewhat hilariously as I was going into my peak, that, in fact, the tremors felt intensely good. I’m grateful that he let them continue because it has made all the difference.
While I partially understood what had happened, I was understandably beyond eager to learn more, and to see where else this realization could take me: Why did this work so well? Has our understanding of chronic pain been wrong? And if psychedelics are the answer, what does treating chronic pain with psychedelics actually look like?
This is part 1 of a 2-part piece and part of a larger series on chronic pain and psychedelics. In part 2, I will dive into the research around remapping and mirror box therapy, and why my psychedelic experience seemed to be so effective.
Future articles will focus on:What is pain and what causes chronic pain, old assumptions vs. new science, the suspected mechanisms of action behind the interaction between psychedelics and pain, and best practices and safety concerns for working with psychedelics to alleviate chronic pain.
In this episode, David interviews Dr. Ben Medrano: Co-Medical Director with Nue Life, board-certified psychiatrist specializing in integrative psychiatry, and former Senior Vice President and US Medical Director of Field Trip Health.
He discusses his path to Nue Life; from growing up around mental illness, to the rave scene, to Buddhism, to his years working for the underserved in an East Harlem Assertive Community Treatment, and his biggest takeaway from that time: that the healthcare system he knew was not truly helping people. He talks about stigmatization (of some modalities like electro-shock treatment, of psychedelics, and of ketamine – which seems to be stigmatized even within the psychedelic space); his concerns that the at-home ketamine model is at risk as we make our way out of the pandemic; and how at-home ketamine can drastically reduce the cost of treatment.
Medrano tells a great story of a patient who saw incredible improvements through ketamine, and discusses some Nue Life highlights: their just-released 664 participant-study in Frontiers Psychiatry showing the safety of at-home ketamine (and that at-home is just as effective as other routes of administration); Nue Care, their model for aftercare using digital phenotyping, goals, and a scoring system (which he believes could be the new model for integrative psychiatry); and their Nue Network, which could be a solution for better education on ketamine and for granting access for patients through prescribers who typically don’t understand much about its efficacy.
Notable Quotes
“All the different interests, personalities, visions, [and] goals that are in this sort of circus of psychedelic commercialism is very necessary to understand. And for me, I think the biggest takeaway is that there is one thing that binds everybody who’s involved, and that is hope, really. I think there’s a lot of hope in this sphere.”
“The hazards of a benzodiazepine are well known, and to some extent, one might even argue that with some of these DEA-regulated substances that we do ship at home; that if we’re going to say that we need to subject ketamine to a higher standard, then we need to do it for the rest of these DEA-regulated substances, because they have very hazardous risk profiles. …I can’t help but think that there’s a little bit of …stigma [around] what it is that we’re doing.” [On an at-home ketamine patient’s success]: “He is able to get out of the house every day and enjoy the sunshine, and the way he views his trauma is at a level that I think all of us would aspire to: really, as something that has sort of made him into the man that he is today, with something really unique and powerful to offer as a human to others – rather than as a wound.”
In this Veteran’s Day episode, Joe checks in with two members of the Heroic Hearts Project: Founder and President, Jesse Gould, and Chief of Operations, Zach Riggle.
Heroic Hearts’ mission is to create a healing community that helps veterans suffering from military trauma recover and thrive through helping them gain access to psychedelic treatments, professional coaching, and ongoing peer support – and we’re always happy to have them on the podcast to remind listeners about the extremely important work they do.
Among other projects, they are currently running several studies: psilocybin for gold star wives (spouses of fallen soldiers), ayahuasca for combat veterans, and ibogaine for special operations veterans through the University of Texas at Austin Dell Medical School’s Center for Psychedelic Research & Therapy; a study with the University of Georgia on personality change through psychedelics; a gut microbiome study with University of Colorado Boulder; and a psilocybin for head trauma study through Imperial College London. And today, they released the short film, “It’s Time – A Documentary of Veterans and Pro Athletes Seeking Healing Through Psychedelics.”
Gould and Riggle discuss the growth in interest and acceptance in psychedelics they’ve seen over the last few years; the importance of people telling their stories; relative trauma and how people too often wait to seek help; how trauma isn’t always due to a single event; Colorado’s Proposition 122 (which passed!); the need to have standard measurements in psychedelic studies; and how people who go through trauma together can heal together.
Notable Quotes
“At what point do we ask for help? I think, just as a society, we feel like things have to be in full-on crisis before we need to seek some sort of assistance. And we want to put [it] out there that that doesn’t have to be the case – that if you’re able to look at your life and realize that there may be some areas where things could improve and you might need some help in improving them, then don’t be afraid to reach out, because we’re not going to turn you away.” -Zach
“In the standard medical world, the physicians [or] the psychologists are looking at that qualifying incident and trying to heal that, trying to address that. And there’s some things that are pretty effective …but they’re working largely on that single incident, and ignoring all the other things that may have happened over time. And that’s where psychedelics can be so beneficial, is that they address that whole issue with a full system reset.” -Zach
“You take a population that largely (due to their illness) has been isolating, pushing everyone away, and just sitting back and looking at how amazing everyone else’s life is while theirs continues to deteriorate. Well, we plug them back into a community, bring them in, and help them to heal together. That’s a powerful thing to realize: that communities that were traumatized together; they heal better together.” -Zach
In this episode, Kyle interviews Dr. Steven Radowitz: Medical Director at Nushama, a wellness center in New York City primarily offering IV ketamine, with a strong focus on letting the experiencer explore their journey undisturbed.
Recorded in-person at Nushama’s flagship location just over a year after opening, Radowitz talks about his past and why he became interested in ketamine, the look and feel of Nushama, their process, and why they favor IV ketamine. He highlights his biggest takeaways from the year: the surprise in just how effective ketamine has been; the role of integration and what aftercare truly looks like; and the importance of learning to hold space and be a compassionate listener – that the doctor isn’t the healer and the psychedelic isn’t the magic bullet cure; instead, they are just tools that allow the patients to heal themselves.
He discusses how he sees psychedelics as a dimmer switch for the ego; how disorders are tools to deal with trauma; why he is reframing trauma as a learning experience; why he thinks ketamine will survive once psilocybin and MDMA are legal; why group work is so effective and powerful (and likely the new model for psychedelic therapy); and the importance of staying humble through all of this – humble to the power of the medicine and humble to the amazing capacity for people to heal and grow, simply by being allowed to explore their journey and be heard.
Notable Quotes
“I’m not a healer, and I often tell people [that] during their preparation, when I do my medical intake. I talk to them about that. I say, ‘I’m not here [to heal you], I’m here just giving you a tool. You’re the healer. All this stuff does is [that it] just takes away what’s blocking you from realizing that. It’s like a dimmer switch on the ego [and] on the mind.” “I’m trying to move away from the word ‘trauma.’ It’s a difficult life event that’s there to teach us. It’s there for something. And with every one of those events; there’s a little jewel within it, but you have to go in there and go through it. And it’s just a cloud, just a myst, almost, that’s preventing you. Just push [through it] and hold space. As long as people are in a safe place to go there and journey there, then they’ll realize that it’s just an event. It’s just an experience, and you move on. That wisdom is: a memory without the emotion.”
“I think any type of journey work, any type of psychedelic work, I almost think you have to be called to it in a way. You shouldn’t be coerced, ever, into this. …I find that the ones that are really ready to do the work are finding us on our own.”
In this episode, Kyle interviews Dr. Jennifer Montjoy: Tucson, Arizona-based psychiatric nurse practitioner with a private practice specializing in ketamine-assisted psychotherapy, and Medical & Research Director at TRIPP (Transpersonal Research Institute of Psychotherapeutic Psychedelics); a 501(c)(3) organization that provides psychedelic training and research opportunities largely for female and BIPOC scientists.
A Vital student introduced Kyle to Montjoy’s research on ketamine and PTSD and presented with her at the recent ICPR conference in Amsterdam, where this was recorded in-person (as Kyle and Johanna were there, representing Psychedelics Today). Montjoy talks about her protocol, the self-transcendent scale she’s using with clients pre- and post- induction, how ketamine can help people get over past trauma through shifts in emotional memory, and what she sees most in successful cases: a gradual shift toward self-agency.
She discusses how integral titration is to her process; how ACE (adverse childhood experience) scores work; how dissociation can help with childhood trauma; how clients often naturally fall into using Internal Family Systems to describe their process; and how physicians and therapists shouldn’t be afraid of the concept of ceremony and opening sessions with intention – and, as she likes to say, giving one’s mind coordinates on where it can end up.
Notable Quotes
“I do think it’s helpful to have a skillset and general understanding of that so you know what’s happening in real time, but for the most part, I subscribe to the philosophy that we all have an inner healer. We all have that inner wisdom, but most of us don’t have access to it because we have these managing protectors from our trauma.”
“Often [for the] opening, I’ll ask the higher self to step into the light, to take the reins and let all those parts know that the goal here is not to annihilate or bypass them. That’s the language I consistently use in opening, because as the facilitator, we want to align with those parts too. We’re not the enemy.”
“Don’t be afraid to incorporate ‘ceremony.’ …I think that makes a lot of physicians maybe uncomfortable; that idea. [But] opening and closing [the ceremony] can be very helpful tools, [and] making sure we’re asking about intention before each session. I call that the coordinates, because we want to give the unconscious mind the coordinates.”
In this episode, Joe interviews Christopher Dawson & Andrew Galloway: Co-Founders and CEO and COO, respectively, of Dimensions; a Canadian-based company creating retreats that blend traditional plant ceremonies with neuroscience and a luxurious, five-star environment.
Dawson realized what so many people were starting to learn about psychedelics after attending a 2015 conference in Peru that mixed neuroscientists with traditional healers, but for Galloway, it was direct experience, as he gives credit to plant medicines for helping him to heal from a 6-year addiction to crack cocaine. They each tell their story and how it led to the beginnings of Dimensions, where they worked for a year with a “Dreamlab” team of MDs, psychiatrists, practitioners from different fields, and even a design agency to create different programs for different substances – all with a focus on true set and setting and integrating perfectly with nature. They’re in the middle of a soft launch right now, offering cannabis in a ceremonial, group setting context to friends and families at their Algonquin Highlands location; perfecting everything before opening up to the general public. And once the law catches up with them, they hope to offer psilocybin and other psychedelic-assisted therapy across several new retreat locations.
They talk about Health Canada and the country’s trajectory towards legal psychedelics; critiques of traditional addiction treatment and the efficacy of 12-step programs; the tension between the psychedelic space and traditional healing space; investing in biotech; the polyvagal theory; how animals deal with trauma (and how we don’t); and the concept of integration: If you’re just taking a pill and not doing the work, are you missing the point entirely?
Notable Quotes
“We’re biased (we’re in the retreat business), but I don’t think that psilocybin, as an example, should be reduced to a pill that you take with your juice in the morning and you no longer take your SSRI because this is your new pill. For us, it’s the psychedelic-assisted therapy that actually maximizes the potential of the psychedelic experience, and that’s the mechanisms through which fundamental, behavioral change can take place. I think the idea that a pill can replace all of that means that you’re kind of missing the point about the whole experience.” -Chris “I don’t want to slam traditional treatment because it actually did work for me to some degree. …I had a crack-cocaine addiction for six-seven years and ended up in rehab for six months and came back and participated in 12-step programs and remained abstinent. That part worked. The difference for me when I got involved with plant medicine was something else: I got healed. Instead of just abstaining and not using to cope or to manage with whatever I was dealing with, I actually healed through plant medicine.” -Andrew “Is it a pill or is it the therapeutic process? If you don’t engage in integration, then you’re just taking a pill.” -Chris
“We talked about stigma earlier; it’s changing, and [for] the general public, the stigma around the war on drugs is changing too. I think people have finally figured out that it doesn’t work. No war works. We only declare war on things that we can make money from.” -Andrew
Christopher Dawson is the Co-Founder and CEO of Dimensions, a growing collection of retreat destinations combining neuroscientific research with plant ceremony in immersive natural environments. Prior to co-founding Dimensions, Christopher was the founder and CEO of Edgewood Health Network, where he oversaw the largest private network of residential/outpatient treatment providers in Canada and led the merger and acquisition of Canada’s top three treatment centers to create that network.
About Andrew Galloway
Andrew Galloway is the Co-Founder and COO of Dimensions, a new paradigm for healing, combining ancient ceremonial plant medicines with modern science in safe, legal, and nurturing natural environments. He leads the organization’s clinical teams and operations for Dimensions Retreats, a new collection of immersive, transformational healing retreats combining neuroscientific research with plant ceremony and luxurious hospitality. Prior to co-founding Dimensions, he was a National Director of Edgewood Health Network; leading 10 outpatient centers. Andrew was the former VP at GreeneStone Muskoka, an international certified alcohol and drug counsellor, and has 14 years of experience working directly for the NHL/NHLPA substance abuse program.
Shannon feels that the majority of people who are interested in (and could benefit from) psychedelics would prefer that their experience be as close to a conventional medical setting as possible. And especially with the risks of rogue practitioners, licensing boards want to see predictability, uniformity, regulation, and (perhaps most importantly) that we as a psychedelic culture are placing importance on being accountable and self-governing. He wants to establish a certification process that’s standard enough that which medicine the patient is using will become secondary.
He discusses what the certification process will likely look like; why uniformity is so important; the challenges of respecting and integrating Indigenous traditions into a medical model that’s drastically different; what people should look for in psychedelic education; and the importance of breaking from a siloed and hierarchical model into one that’s cross-disciplinary, where professionals of all types can work together for the betterment of the patient.
Notable Quotes
“The premise of the certification board is that we’re trying to certify a process …of medication-assisted, psychedelic-assisted psychotherapy that looks at integration [and] prep, that looks at set and setting, that looks at the sacred container of this relationship; and that we build that, and that is the core of it, and the medications become a little bit secondary. We can bring ketamine in, we can bring DMT in, we can bring psilocybin [in], [and] we can bring MDMA in; because these medications, frankly, they’re not really chemically-related or that similar, but what’s similar is the process that patients go through with them.” “There’s always the question of: ‘How do I get training?’ …The Psychedelic Science Funders Collaborative just did a survey of the field of education and found that there are now over 50 providers of psychedelic education, and four years ago, there might have been a handful. But someone coming [up]: What do they do? ‘How much do I need to study?’ These things are expensive. It’s confusing. So we want to create a clear, professional path [where] someone says: ‘I’m going to step into this and do this as a career. Here’s what I need to do? Good. I can do that.’”
Scott has been a student of consciousness since his honor’s thesis on that topic at the University of Arizona in the 1970s. Following medical school, MDMA-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a Psychiatry residency at a Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico. Scott has published four books on holistic and integrative mental health including the first textbook for this field in 2001. He founded Wholeness Center in 2010 with a group of aligned professionals to create innovation in collaborative mental health care.
Scott is a past President of the American Holistic Medical Association and a past President of the American Board of Integrative Holistic Medicine. He serves as a site Principal Investigator and therapist for the Phase III trial of MDMA assisted psychotherapy for PTSD sponsored by Multidisciplinary Association for Psychedelic Studies. He has also published numerous articles about his research on cannabidiol (CBD) in mental health. Scott founded the Psychedelic Research and Training Institute (PRATI) to train professionals in ketamine-assisted psychotherapy and deliver clinically relevant studies. Scott co-founded the Board of Psychedelic Medicine and Therapies in 2021 and currently serves as the CEO for this non-profit public benefit corporation. He lectures all over the world to professional groups interested in a deeper look at mental health issues and a paradigm shifting perspective about transformative care.
In this episode, Joe interviews Licensed Marriage & Family Therapist and certified sex therapist, Courtney Watson. In just two years’ time, Watson grew from “Psychedelics are white people drugs” to opening a ketamine clinic to serve the marginalized communities she comes from. She shares the work she is doing through Access To Doorways; her Oakland-based non-profit whose mission is to bring psychedelic-assisted therapy to queer, trans, non-binary, gender non-conforming, Black, Indigenous, people of color, and two spirit communities.
This discussion is all over the map, from the platform of African traditional religion through the prospect of trauma healing for white supremacists, across BIPOC erasure in psychedelic research studies, and down into the realms of connecting to the spirit of entheogens from our pasts. Watson waxes on Black resilience; Hoodoo; how ALL plants are entheogenic; how conceptualization and talk in the psychedelic space often falls short of real action; ancestral veneration and ways to connect with one’s ancestral past; andthe concept of “spirit-devoid” synthesized compounds actually being the evolution of those plants’ spirits. She breaks down thoughtful considerations for queer and trans people in the psychedelic space, pointing out that while our society places too much emphasis on gender and sex, the acknowledgement of gender diversity and tearing down of the myths of hetero- and cisnormativity is hugely important. She believes that true access to these medicines can lead to true healing, which leads to love, justice, and actual equality. You can support Access to Doorways by making a donation here.
Notable Quotes
“Our people will talk to us. They will guide us. They will direct us. Especially for folks that don’t have ancestral practices in their day to day and haven’t had for generations; ancestors are starving for attention. They’re like, ‘Thank God you see us!’ Give them some light, give them some love, give them some attention, and they will open roads for you in all sorts of ways that you never knew were possible.“
“I think we also place way too much emphasis on gender and sex in this culture in this way that ends up stigmatizing the fact that there is gender diversity. …Holding all of this knowledge that heteronormativity is a thing and cisnormativity is a thing, and that these are not the default when we’re working with trans folks and folks that do not identify as heterosexual – that is really important.” “Healing could actually help shift what’s happening. It can help turn things in the ways that they need to be turned; in the ways towards love, towards justice, towards actual equality. It’s only when we are healed that we can actually do that; 1) because we have enough energy to be able to do that, but also because we have enough vision and foresight to be able to do that. The clarity of what it means to actually love only comes when we are healed.“
“There’s a lot of conversations, there’s a lot of talk, there’s a lot of conceptualizations, there’s a lot of dreams. But there’s not a lot of action. …So many people get stuck in the conceptualizing piece of it and the philosophizing piece of it that action gets missed. Access to Doorways is action. With $7000, we have given 4 subsidies. I know people that have raised ten times more than us and have not done that much. It is completely about doing what we say that we’re doing. It is completely about action towards healing.”
Courtney Watson is a Licensed Marriage and Family Therapist and AASECT Certified Sex therapist. She is the owner of Doorway Therapeutic Services, a group therapy practice in Oakland, CA focused on addressing the mental health needs of Black, Indigenous & People of Color, Queer folks, Trans, Gender Non-conforming, Non binary and Two Spirit individuals. Courtney has followed the direction of her ancestors to incorporate psychedelic-assisted therapy into her offerings for folks with multiple marginalized identities and stresses the importance of BIPOC and Queer providers offering these services. Courtney has received training from the Center for Psychedelic Therapies and Research at CIIS, MAPS, and Polaris Insight Center to provide psychedelic-assisted therapy with a variety of medicines. She is deeply interested in the impact of psychedelic medicines on folks with marginalized identities as well as how they can assist with the decolonization process for folks of the global majority. She believes this field is not yet ready to address the unique needs of Communities of Color and is prepared and enthusiastic about bridging the gap. She is currently blazing the trail as one of the only clinics of predominantly QTBIPOC providers offering ketamine -assisted therapy in 2021. She has founded a non-profit, Access to Doorways, to raise funds to subsidize the cost of ketamine/psychedelic-assisted therapy for QTBIPOC clients (now accepting donations!!!). When not in the office seeing clients or in meetings for the businesses she leads, she’s watching Nickelodeon with her kids, kinda working on her dissertation and more than likely taking a nap!
In this episode, David interviews one of the biggest names in psychedelics and someone we haven’t had on the show until now; Founder and Executive Director of the Multidisciplinary Association for Psychedelic Studies (MAPS), Rick Doblin, Ph.D.
MAPS has recently been at the center of media scrutiny, notably through the New York magazine‘s “Cover Story” podcast series, which chronicled instances of alleged sexual abuse within the MAPS clinical MDMA trials. Since reporting on this issue has largely called into question the design of MAPS’ clinical trials, data reporting, quality control, and claims around the efficacy of MDMA in the treatment of PTSD, we wanted to provide an opportunity for Doblin to respond to these very real concerns – and he does just that.
He discusses how MAPS reacted, what could have been done better, what it has all meant for the non-profit, and how it feels to now be considered the enemy by many in a space MAPS helped build. He addresses the concerns of sessions ending too soon (highlighting how that may suggest a desire for additional therapy) and asks anyone who has participated in a MAPS trial to complete a long-term follow-up survey so the organization can improve their process and ensure their data is as accurate and robust as possible.
He also discusses what the post-approval psychedelic landscape could look like; their goals for facilitator training and how they align with requirements in Oregon; their desire for a patient registry or “global trauma index”; and the importance of collecting and analyzing real-world evidence. And he talks about MAPS and their globalization goals: how exploring psychedelic therapy specifically in countries with little to no tradition of psychotherapy can lead to new therapeutic models. Rather than exploring areas where there is guaranteed revenue, they are seeking areas that are high in trauma instead – to bring these medicines where they are most needed.
Notable Quotes
“I think you can have solutions that go too far. The podcast people put out a solution, saying that there should be no touch in therapy. …They’ve also said that [our] studies should be shut down and that we need experts to think about this for years. I think that kind of thinking is out of balance with the amount of suffering that seems to actually be alleviated.”
“The more dangerous the drug, the more important it is that it be legal.”
“We’re really wanting to bring this to the police, [and] we’ve done a lot of work with veterans. The breakthrough that we’re still looking forward to one day would be to treat the first active duty soldier. So far, it’s only been veterans, but if we can treat active duty soldiers, I think that would be [great]. The closer you can treat people to the trauma, probably the better.”
“Even though we’re focused on MDMA and there’s all these other things for MDMA, really, what we’re doing is opening the door to psychedelic medicine. So what we want, ideally, is therapists to be cross-trained with MDMA, ketamine, psilocybin, ibogaine, 5-MeO-DMT, ayahuasca, whatever. And then the psychedelic clinics of the future will not be: ‘Here’s a ketamine clinic, here’s [an] MDMA clinic, here’s a psilocybin clinic.’ It will be psychedelic clinics, and the therapists will be cross-trained and they’ll customize a treatment program for each individual patient with any number of different kinds of psychedelics at different times in a sequence.”
Rick Doblin, Ph.D., is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He received his doctorate in Public Policy from Harvard’s Kennedy School of Government, where he wrote his dissertation on the regulation of the medical uses of psychedelics and marijuana and his Master’s thesis on a survey of oncologists about smoked marijuana vs. the oral THC pill in nausea control for cancer patients. His undergraduate thesis at New College of Florida was a 25-year follow-up to the classic Good Friday Experiment, which evaluated the potential of psychedelic drugs to catalyze religious experiences. He also conducted a 34-year follow-up study to Timothy Leary’s Concord Prison Experiment. Rick studied with Dr. Stanislav Grof and was among the first to be certified as a Holotropic Breathwork practitioner. His professional goal is to help develop legal contexts for the beneficial uses of psychedelics and marijuana, primarily as prescription medicines but also for personal growth for otherwise healthy people, and eventually to become a legally licensed psychedelic therapist. He founded MAPS in 1986, and currently resides in Boston with his wife, with three children who have all left the nest.
In this episode, David interviews Clinical Psychologist and Founder of the Psychedelic Society of Vermont, Dr. Rick Barnett, PsyD.
Barnett discusses the importance of building community in psychedelic spaces; psychedelic experiences as preventative medicine, and the differences between (and value within) the sanitized medical model and more ritualistic experiences. He talks about his own personal journey with addiction and recovery and looks at the interrelation between trauma, addiction, trust, and how psychedelics operate as disruptors – with a sense of meaning and purpose.
He discusses many of the current clinical trials happening around psychedelics and addiction; Alcoholics Anonymous and LSD; Vermont’s developing decriminalization bill (Measure H.644); the psychiatric workforce shortage and the potential solution of more prescribing psychologists; and, considering Oregon’s budding psilocybin therapy model, points out that one doesn’t need to be a licensed clinical practitioner with specific schooling to be a good psychedelic facilitator. Could we instead build models that are based largely on competency?
The Psychedelic Society of Vermont is putting on the Psychedelic Science & Spirituality Summit on the summer solstice (June 20-21) in Stowe, VT, with the goal of holding space for both the scientific and spiritual side of psychedelia. The conference is specifically for healthcare professionals, but all others are welcome to virtually attend or come to the summer solstice celebration after the conference. For more info, head to vermontpsychedelic.org.
Notable Quotes
“I had several profound experiences with LSD when I was a kid, and when I crashed and burned on alcohol and wound up in a 12-step rehab (the Hazelden Foundation), I quickly recognized that my experiences with LSD made me extremely receptive to the message that was being put forth to me in a 12-step-oriented rehab program. Concepts like surrender and a connection to spirituality, a connection to open-mindedness, willingness, being honest with oneself, taking one’s inventory – these kinds of concepts that are so common in 12-step programs – they resonated so strongly with me because of my experiences with LSD.”
“We have the ability to instill a sense of trust with our patients, and they can begin to trust themselves, and to trust the therapist, and to review some of these old hurts and really get into it over the course of therapy in a way that’s very healing. So it can happen with therapy, and I don’t think one is necessarily a substitute for the other. I think [psychedelics and therapy] work very well together. Psychedelics are yet another tool, just like therapy is a tool, just like AA is a tool, just like Suboxone and Methadone are tools. They’re all tools, and it’s really important to respect and honor that each one brings something positive, potentially, for an individual.”
“An AA program, a harm reduction program, a therapy program, a psychedelic program, [a] meditation retreat: All these things provide a nudge, and potentially a very transformative nudge in the direction of like, ‘Okay, and then what?’ What are you doing in your daily life? …That ‘assisted’ part is not just assisted by a therapist. It’s not just assisted by a drug. It’s not just assisted by a shaman or an integration coach. It’s assisted by everything.”
Dr. Rick Barnett, Psy.D., is the Co-Founder of the Psychedelic Society of Vermont, the Legislative Chair and Past-President of the Vermont Psychological Association, the founder of the non-profit organization, CARTER, Inc., and is a clinical psychologist and addiction specialist in private practice in Stowe, VT. Dr. Barnett has worked as a Clinical Psychologist in nursing homes, hospitals, and outpatient programs, and has trained hundreds of health professionals through workshops on addiction and mental health issues over the past 20 years. He is in long-term recovery of alcohol and substance abuse and is an active advocate for addiction treatment and recovery resources. Dr. Barnett holds a Bachelor’s degree in psychology from Columbia University, a Doctorate and Master’s Degree in Clinical Psychology and a Master’s Degree in Clinical Psychopharmacology. He is a Licensed Alcohol and Drug Counselor and holds certificate in Problematic Sexual Behavior (PSB-S) and Gambling Disorder.
In this episode of the podcast, Kyle interviews psychiatrist, Dr. Reid Robison, and clinical psychologist, Steve Thayer, Ph.D. Together, they host the Psychedelic Therapy Frontiers podcast and work at Novamind; Robinson as the Chief Medical Officer, and Thayer as the Clinical Director of Education & Training. They talk about their respective journeys from psychology into the field of psychedelic medicine, their current work with ketamine-assisted psychotherapy (KAP) at Novamind, and their combined efforts in educating and training future KAP therapists and clinicians – a need they feel is going to become increasingly urgent as ketamine becomes more mainstream. To meet the challenge of scaling accessibility of psychedelic therapies, Novamind recently combined forces with Numinus Wellness, creating a platform and standard of mental health care within psychedelic therapy.
Robison and Thayer discuss the different ketamine dosing modalities and purpose for each; the ketamine sessions Novamind provides for frontline healthcare workers (called ‘FrontlineKAP’ or FKAP); how difficulties in emotion-processing are often at the heart of mental health struggles; and how ketamine can help loosen emotional binding, allowing greater access to them. They also discuss current clinical trials on LSD for anxiety and alcoholism; how ketamine can be used for therapist burnout; the challenge of long LSD sessions and therapist stamina; the benefits of group ketamine sessions; the concept of combining ketamine with other therapeutic modalities (or substances); and the power of stepping aside and allowing the inner healer to take over.
Notable Quotes
“Difficulties in emotion processing are often at the heart of many mental health struggles. And if we can support the clients in developing skills and confidence in moving towards their emotions, and leverage the power of the corrective experience, the healing power of caregivers, [and] supporting them with emotion coaching skills, then we’re wrapping the client in this really powerful therapeutic healing environment and leveraging ketamine as a catalyst.” -Reid
“People will tend toward self-actualization and transcendence if you give them the environment to do so. To be well is not something we have to teach people to do, it’s something that they can remember how to do. It’s in them. If we can help them peel away the negative programming and conditioning and trauma and all that stuff, they’ll find their way to health and healing.” -Steve
“To me, it makes complete sense to use something like LSD for anxiety because what we think perpetuates something like generalized anxiety is what Steve Hayes of ACT might call ‘experiential avoidance’; that we don’t want to feel these intense feelings of fear or embarrassment or rejection or whatever it is, so we worry chronically, we get addicted to worry itself, [and that] keeps us safe from having to do scary stuff. And the LSD experience is just (for a lot of people) going to crack that open and give you an opportunity to face your fears, so to speak. It’s like exposure therapy on psychedelic steroids.” -Steve
Dr. Reid Robison is a board-certified psychiatrist and Chief Medical Officer at Novamind. He is adjunct faculty at the University of Utah, founder of the Polizzi Free Clinic, co-founder of Cedar Psychiatry, the medical director for the Center for Change, and was voted Best Psychiatrist in Utah in 2020. Over the past decade, Dr. Robison has led over 200 clinical trials in neuropsychiatry. Notably, he served as Coordinating Investigator for the Multidisciplinary Association for Psychedelic Studies (MAPS) MDMA-assisted psychotherapy study of eating disorders. As an early adopter and researcher of ketamine in psychiatry, Dr. Robison led a pivotal IV ketamine study for treatment-resistant depression by Janssen, leading to FDA approval of Spravato™. Dr. Robison is also the co-host of the Psychedelic Therapy Frontiers podcast.
Dr. Steve Thayer is a clinical psychologist and Clinical Director of Education & Training at Novamind. As a USAF military veteran, Dr. Thayer maintains his commitment to serving the veteran and first responder community through his position as the Executive Director of Therapeutic Operations for the World Voice Project. At Novamind, Dr. Thayer conducts and provides training in ketamine-assisted psychotherapy. He serves as Lead Therapist on several clinical trial studies involving psychedelic medicine. Dr. Thayer is also the co-host of the Psychedelic Therapy Frontiers podcast.
This talk covers a lot but really hits home on a few very important topics: the clinical model’s limited perspective; the importance for psychedelic boards to self-organize before government agencies step in; and how cannabis can actually be as powerful a psychedelic as DMT. They mull over where the field of psychedelics is going and wonder: Who gets to do this work? And can psychedelics really fit within our current medical models?
McQueen digs into the non-licensed approach to facilitation; the difference between coaching, counseling, and psychotherapy; and describes valuable harm reduction strategies, vital self-care practices for facilitators, and ways to navigate the (not talked about enough) transformational process of being a guide for others. If you experience anxiety or paranoia from cannabis, you’ll learn how Nano CBD can shut it down almost instantaneously. Last but certainly not least, McQueen shares all about the transformative work and trainings he and his colleagues are doing at both the Center for Medicinal Mindfulness and Psychedelic Sitters School.
Notable Quotes
“We’ve got to have our boards, we’ve got to become members of those boards, and we’ve got to self-organize and regulate. Otherwise, the government agencies are going to do it for us. It’s going to become super clinical, super medical. It’s going to limit the scope to only people who are really suffering and I think that’s a trap.”
“I’m thinking [cannabis is] probably one of the best psychedelics for trauma resolution work and other things. So I’m way past ‘Is this psychedelic?’ I’m stepping into: ‘This might be one of the best medicines for psychedelic therapy and guiding that we have available.’”
“I just was intuitively drawn from the beginning to do blends – to blend multiple strains [of cannabis] together – and I started to experiment on my friends. …One of my friends …sat up and said, ‘Daniel, if I didn’t trust you, I would swear you put DMT in that.’ And I hadn’t, it was just pot. And that was the moment. I’m like, ‘Okay, maybe there’s something to this.’”
“Sometimes these stories that we hear are the hardest stories to hear from another human being. So there’s an emotional impact to process. I’ve had to really evaluate my existential understanding of reality because of this job, so there’s that whole thing too. It’s not the same as psychotherapy, it’s just not. Professionally speaking, I tell people it’s more like being an emergency medicine doctor. You’ve got to take time off. Self-care is vital.”
The continued exploitation of this fragile species for its DMT encapsulates narcissism itself.
Until recently, the Sonoran desert toad, Incilius alvarius (formerly Bufo alvarius) was not on my wildlife-watch radar. Then an email from the owner of a group of psychedelic retreat centers operating in Latin America, Portugal, and the Netherlands brought the greenish brownish warty native of the Sonoran desert to my attention. He was writing to let me know that the personality disorder of narcissism, the toxic world-killer which has brought life on Earth to an environmental and climatological precipice, could be cured – with psychedelics. Specifically with “Toad Venom.”
“With expert guidance and facilitation, psychedelics can help us… be collectively healthy, happy, and harmonious in the stewardship of our planet,” he wrote.
Curious, I clicked on a link for a “Transformational Bufo Alvarius Retreat (5-MeO-DMT, Toad Venom).” According to the ad, “5-MeO-DMT, also known as the sacred toad medicine, is a beautiful teacher that can lead to profound transformation when facilitated by experienced guides,” and they would be offering dimethyltryptamine (DMT) in its 5-MeO-DMT – toad form – as the chemically mediated gateway to this process.
As something of an expert in identifying displays of cognitive dissonance, the suggestion that exploiting a toad in the interest of curing Homo sapiens of his most reprehensible trait was not sneaking past my cognitive threshold.
Toads, Poaching, and Indigenous Use
I love amphibians. I always have. When I lived in Kenya as a teenager, the red legged Hyperolius viridiflavus flashed from reed to reed in the dam below the house; on a trip to Madagascar, I observed the tomato frog, Dyscophys antongilii, sequestered in a storm drain in a village; near my former home in the Sierra Nevadas, the mountain yellow-legged frog, Rana muscosa chirped in mountain lakes every spring.
Worldwide, amphibians are the most threatened class of vertebrates on the planet. Although thought to be abundant in its home range of the Mexican state of Sonora and parts of Arizona, the Sonoran desert toad is on endangered species lists in both California and New Mexico. In Arizona, a fishing license grants collection of up to ten live Sonoran toads. Shipping them to another state or abroad is illegal and prosecutable, as is possession of the psychedelic 5-MeO-DMT.
Increased toad poaching and illegal transport across state borders and the US-Mexico border has recently triggered the Lacey Act, which prohibits import, export, sale, acquisition or purchase of fish, wildlife or plants transported, or sold in violation of US, Indian or international law. Law enforcement agents for the US Fish and Wildlife Service (USFWS) confirmed they are currently carrying out an investigation. Whether their efforts are successful in reducing illegal trade remains to be seen.
The now discredited hypothesis that Indigenous groups used a hallucinogenic compound derived from toads was put forth by anthropologist Dr. Jeannette Runquist, and reported in a 1981 issue of Omni Magazine. She described decapitated toad skeletons buried near excavations of ancient Cherokee encampments in North Carolina, and wrongly inferred that what was, in fact, food waste as the telltale sign of Indigenous mysticism.
“Food trash was taken for psychedelic magic,” said Robert Villa, Research Associate, Tumamoc Desert Laboratory, Tucson, Arizona, and President of the Tucson Herpetological Society. “Toads were skinned and eaten as survival food, as part of the ordinary diet.”
Despite claims on the part of modern healers, there is no evidence in the archeological record of toads being used ceremonially by Indigenous groups in the Americas.
“For such a significant smoke, there would have to be some record of it,” said Mr. Villa. “Even though Indigenous cultures can be good at hiding things from outside inquisition, this is too significant to go unnoticed,” he said. “The significance of the toad in Indigenous culture isn’t what people want to believe,” said Mr. Villa. One of his goals is “to stop the appropriation of Indigenous culture around the Sonoran desert toad. All of the archeological leads are dead ends.” Using the abundant depictions of toads in Mesoamerican culture to bolster the specious claim that the toads were used in psychedelic rituals represents cultural hijacking.
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For ancient cultures, the life cycle of the Sonoran toad embodied rebirth and renewal. Its seasonal appearance – they spend ten months of the year underground, emerging briefly in July and August during the rainy season to mate and reproduce – as well as its complex life cycle, which involves metamorphosis from a water-dwelling, gill-breathing, fish-like tadpole to land-dwelling, four-legged adult toad adds to its supernatural aura.
“They were thought to interact with gods of the underworld,” said Mr. Villa. In Sonora, locals avoid them as toxic. Among the Indigenous groups in northern Mexico, their appearance is associated with the arrival of seasonal rains. Disturbing them is an accursed act which can disrupt weather patterns. “You could incur damages from the gods in the form of drought or flooding if you harass a toad,” he said.
The evidence, according to Mr. Villa and other scientists who have explored the natural history of Incilius alvarius, indicates extracting and smoking toad-derived 5-MeO-DMT is a post-industrial phenomenon. It has nothing to do with cultural tradition. In recent years, however, “smoking toad” has become the new psychedelic fad, making Incilius alvarius the latest must-have in the growing list of psychedelic consumables. And in response to increasing demand from the tourism and retreat industries, one Mexican coastal group whose members have subsisted on tourism – mostly selling ironwood carvings to foreigners – have begun peddling Sonoran toad medicine to foreigners.
“The Seri, or Comcaac[an Indigenous group living on the mainland coast of the Gulf of California] adopted toad magic and medicine as a tourism item. They’re trying to make a living by facilitating people smoking this stuff. It’s not part of their history,” said Mr. Villa.
There is hearsay evidence, according to Mr. Villa, that regional cartels have begun exploiting this practice as well, as further means to extort locals in the interest of serving what is becoming a global trade.
Bufo alvarius:the Psychedelic Toad of the Sonoran Desert
The entry of toad medicine into modern psychedelia is itself a twisted tale. Back in 1981, the Omni article piqued the interest of one reclusive resident of Denton, Texas, named Ken Nelson. While studying at the University of North Texas, Mr. Nelson commenced an earnest inquiry into toad skin secretions. He came across the work of the Italian toxicologist Dr. Vittorio Erspamer, whose most important contribution to neuroscience was the identification and synthesis of the neurotransmitter, serotonin. As a toxicologist, Dr. Erspamer was most interested in the exudate from amphibian parotid glands as a possible source of new medical drugs. His chemical analysis of the venom from 40 toad species serendipitously yielded the finding Nelson had hoped for: one species, Incilius alvarius synthesized a DMT-containing substance. Mr. Nelson documented his discovery and techniques for extracting, drying and smoking 5-MeO-DMT in his 1984 pamphlet: “Bufo alvarius: the Psychedelic Toad of the Sonoran Desert,” which he published privately under the pseudonym, Albert Most.**
Hear about Hamilton Morris’ connection to the book in episode 268!
Unwittingly, Mr. Nelson opened a Pandora’s box. Since then, a fabricated sacred mysticism has evolved around Incilius alvarius and the DMT squeezed from its glands. Despite the explicit wishes of Mr. Nelson, an ardent conservationist, who towards the end of his life expressed concerns about the ecological repercussions from misrepresentation of his work, use of 5-MeO-DMT has skyrocketed in recent years. Even though DMT can be fabricated in a lab with legal, commercially available chemical precursors, many practitioners – such as the retreat proprietor – adhere to a new age belief that there is something mystically special about DMT extracted from live toads.
I questioned the proprietor of the psychedelic retreat about the authenticity of his claims about 5-MeO-DMT. Why could he not use the lab-formulated version? Endangering the life of a wild animal in order to cure narcissism did not jive with his stated intentions. This fat little toad about the size of my hand was the embodiment of nature itself; and yet he as a Caucasian, self-styled psychedelic healer was exploiting it as a commodity. The toad had no say in its own destiny.
The proprietor responded by invoking an unknowable mystical consciousness with which he and his associates – the people responsible for collecting toad venom – were imbued. “We know what we are doing is for the good of humankind, in keeping with the sacred spirit of those who have preceded [us] in this practice,” he said. Those who collect the toad, he said, are performing a consecrated task. One of his practitioners, a Swedish man who guides DMT sessions at his retreats, described collection and use of the toad as a sacrament: “I only order [5-MeO-DMT] through sources I know,” he said. “It’s energy medicine, so the energy has to be right.” The source, he said, was a Mexican friend who has tribal connections and harvests the medicine directly. He would never use toads gathered the way he’d seen in videos – en masse and thrown in garbage bags.
“My sources milk toads once a year. They do it with respect and prayers. They put the toads back in the same location. They mark the toads so they don’t milk them several times.” Safety and purity, he said, were of the utmost importance.
Knowing what I know, the invocation of sacred ancestral spirits looked a lot like chicanery. The toad was the prima facie victim of narcissism.
Identification with the Divine as a way to aggrandize oneself out of personal responsibility is, unfortunately, an all-too-common maneuver in psychedelic circles. This reflexive hopscotch affords participants the luxury of justifying anything they do: their particular psychedelic experiences are so sacred and important, normal rules do not apply. Any rules, all rules – whether psychological, medical, scientific, or ethical.
“Piaget’s concepts of schema and assimilation (vs. accommodation) seem relevant for understanding many of the less desirable potential outcomes of psychedelic use, including worsened narcissism, spiritual bypassing, guruism, unethical business practice, and bad music taste,” noted psychotherapist Max Wolff wryly in a tweet.
Assimilation occurs when we modify received information to fit with our existing knowledge and assumptions. Accommodation occurs when we reshape our perceptions in response to problems posed by the environment. We restructure what we already know so that new information can enter our universes. In the psychedelic space, real learning is so rare it is nothing short of miraculous. Most of the time, psychedelic experiences are no more transformative than a day trip to Disneyland.
Although practitioners and hobbyists argue they don’t harm the toad when they milk its glands, Mr. Villa points out toads are harmed when they are handled and moved; and collecting and transporting the toads is tantamount to killing them. “They’re very territorial,” he said. “Imagine if someone picked you from your house, put you in a sack and then moved you to the Saudi Arabian desert and left you there. Would you survive? Would you know how to get home?”
Toad Populations and a Moral Travesty
The biggest impediment to toad conservation, said Mr. Villa, is the absence of real population data. “To identify the problem, we have to have a snapshot of the past, a baseline. We don’t have that.”
The toad’s life cycle itself presents a challenge to population assessment. For most of the year, mature adults live underground in a quiescent state. They emerge when it starts raining, and there’s a breeding frenzy. Adult toads are conspicuous for about a month, then they go underground again. Tadpoles can be seen swimming in surface ponds until they mature. If there’s a lengthy drought, the subterranean toads survive in a state of something like suspended animation for years, making live populations hard to count. Years can pass when very few are observed. A rainstorm, and there are thousands where there were none.
“We think they live a long time,” said Thomas R. Jones, Ph.D., Amphibians and Reptiles Program Manager for the Arizona Department of Game and Fish. “We don’t think three or even more years of poor rainfall affects the toads. They persist. When it finally rains, they come back out again,” he said.
The Arizona Department of Game and Fish has been monitoring a population at one site, but the data don’t account for the toads’ vast range, which stretches from the Sonoran desert in northern Mexico through Arizona and parts of New Mexico. Climate change, habitat destruction, and increased poaching add further obstacles. A local population in southeastern California was extirpated decades ago. None have been observed since the 1970s.
Counting their numbers does not address the fundamental problem with exploiting the toads, though, as reducing an amphibian member of the Sonoran desert ecosystem into raw material in service of a global supply chain is a moral travesty.
“Solutions most people conceive of as viable are implicitly biased by capitalism,” said Mr. Villa. “You might hear: ‘We’ll just breed them in captivity.’ In Hungary, there’s a small-scale operator doing it. Most captive breeding programs fail in some way.” There’s the problem of crowding, of waste water contamination, and of the captive animals becoming reservoirs for amphibian diseases like chytrid. The idea of breeding something to exploit is itself repugnant to Mr. Villa.
“There are more cogs than people really understand when it comes to this,” said Mr. Villa. “Few people have the ability to contemplate whether what they’re consuming is directly exploiting Indigenous people or an ecosystem. Does someone smoking 5-MeO-DMT in an east coast city consider whether they’re directly or indirectly exploiting someone down the supply chain?”
Chemists who formulate DMT have concluded there is no qualitative difference between psychedelic trips using the lab-made product and 5-MeO-DMT extracted from the toad’s parotid gland. Although the argument has been made that other compounds such as bufotenine, another tryptamine psychedelic found in low concentrations in some toad secretions, can contribute a certain je ne sais quoi to the experience, repeated testing of Incilius alvarius secretions yielded negligible bufotenine concentrations. There is no entourage effect. Furthermore, chemically and metabolically, formulated DMT is far purer. Samples of the dried toad secretion typically contain about 30 percent 5-MeO-DMT by mass. The remaining 70 percent is composed mostly of salts, proteins, and other high molecular weight chemicals. In other words, it’s saliva.
To suggest there’s anything special about 5-MeO-DMT flouts an established, well-respected component of the psychedelic tradition. More than any other factor, the subject’s own mindset – part of the psychedelic “set and setting” equation – determines how the trip goes.
5-MeO-DMT extracted from Incilius alvarius won’t cure narcissism. Projecting our spiritual expectations onto a toad only harms the toad.
*Goncalves de Lima, O. (1946). Observacio es sobre o “vinho de Jurema” utilizado pelos indios Pancaru’ de Tacaratu’ (Pernambuco) [Observations on the “vinho de Jurema” used by the Pancaru’ Indians of Tacaratu’ (Pernambuco)]. Ariquivos do Instituto de Pesquisas Agronomicas, 4, 45–80.
**Most, Albert. Bufo alvarius: the Psychedelic Toad of the Sonoran Desert. 1984; updated 2020. Venom Press. Denton, Texas. The 2020 updated edition contains detailed instructions for synthesizing DMT in a lab.
In this episode of the podcast, David interviews lawyer, activist, and co-host of our Eyes on Oregon web series, Jon Dennis, Esq.
Dennis has been heavily involved in Oregon’s Measure 109: creating the Entheogenic Practitioners Council of Oregon, writing a proposed regulatory framework for religious practice under Measure 109, and presenting to the psilocybin board subcommittees all in an effort to protect religious psilocybin use and ensure paywalls don’t ruin the unique and historic opportunity Oregon has opened up here.
If you weren’t as knowledgeable about Measure 109 as you’d like to be, this podcast serves as a great summary of how we got here and what’s next. Dennis discusses how Measure 109 came about; how it’s gone through a reputational makeover of sorts (and is more about supervised adult-use than therapy); the role of each subcommittee; Measure 110; who defines what counts as religious practice; the complications of requiring specific psilocybin testing; community support models as harm reduction; how it will become harder and harder to make good legal change in an emerging “psychedelic industrial complex,” and how he’s using the travails of María Sabina as an inspiration to make sure people aren’t left behind as Oregon moves forward.
If you agree with us that religious use should be protected under Measure 109 (and especially if you live in Oregon), please sign his petition by April 20th, send an email by April 21st, or speak up during the comment periods during one of the upcoming subcommittee meetings on April 18th (5-7 PST) or April 21st (10m-noon PST). The board has 9 hours left of meeting time to make decisions on the recommendations of the subcommittees, so the time is now to make sure this is done right.
Notable Quotes
“I think at this point, we all will agree it’s inevitable that psychedelics are about to enter the mainstream, but how they enter the mainstream is important so that they not be delivered directly into the hands of capitalists behind paywalls that keep out millions and millions of people.”
“The depth of human suffering right now is immense. And if we only wait until Compass Pathways and other companies that are pursuing legalized medical applications of psychedelic compounds [complete their research]; not only is that a long time to wait when people are suffering now [and] hospice patients are dying now, [but] to say that they have to wait through even the three or four or five-year expedited ‘breakthrough therapy’-designation type of process through the FDA – we don’t have time to wait. People are suffering now and we have enough information to not need to be really afraid of psilocybin and other psychedelics.”
“I think over 37 million Americans live in poverty and almost 600,000 Oregonians live in poverty. And to think that we’re just going to leave those people out because of an elevated safety concern; it’s just really hard to kind of square that all together in light of what the actual risks of psilocybin in particular are. …If Oregon decides to create a program – the world’s first regulated psychedelic services program – that prioritizes business interests to the detriment of marginalized people, I think the historical record will bear the stain of scandal and corruption on this.”
Jon Dennis, Esq. is a lawyer and activist in the psychedelics ecosystem and a consultant at the firm, Psychedelics Now. He is the co-host of “Eyes on Oregon,” a podcast by Psychedelics Today exploring the latest developments in Oregon’s legal psilocybin landscape. He serves on the Executive Committee of the Oregon State Bar Practice Section on Cannabis and Psychedelics and is a co-chair of its Psychedelics Subcommittee. He is a member of the Psychedelics Bar Association and sits on its Religious Use Committee.
Jon is the chief architect of the proposed regulatory framework for protecting religious and spiritual communities who operate under Oregon’s new psilocybin program. He has presented to multiple subcommittees of the Oregon Psilocybin Advisory Board in support of religious and spiritual freedoms and a community model for psychedelic services. He is a founding member of the Entheogenic Practitioners Council of Oregon. Jon has taken the North Star Ethics Pledge and is drawn to this work by the conviction that psychedelics possess the potential to accelerate our individual and collective shifts away from self-destructive paradigms. Prior to joining Psychedelics Go, Jon worked as a civil litigator and managed a nonprofit law office giving free legal assistance to people living in poverty. Jon has a BA in Religious Studies from the University of Kansas and a law degree from Lewis & Clark Law school. He lives in Ontario, Oregon.
In this episode of Vital Psychedelic Conversations, Kyle interviews clinical psychologist and integration facilitator (and now 3-time guest), Dr. Ido Cohen.
The topic of integration sits center stage for this discussion, as the two peel back all the nitty gritty and nuance of this psychedelic cornerstone, breaking down why integration is so important, where it stands currently, and where it needs to go as psychedelic-assisted therapy grows. They discuss the importance of taking it slow when it comes to exploration of these non-ordinary states – something that can be so difficult for us in our fast-tracked, clock-watching, Western culture, where it’s quite common for people to get blasted into inner-space on a Saturday, be shaken and perplexed by the experience on Sunday, and then have to go back to work and act like it never happened by Monday.
He discusses the value that both individual and group integration holds; what happens when you sit in groups of the same people over time; why Carl Jung never tried psychedelics; and the importance of tolerance, trust, and critical thinking when processing peak experiences.
And he raises some important questions like: What does long-term care in psychedelic-assisted therapy look like? What frameworks can be experimented with and implemented now to offer real movement from peak experiences to sustainable change? What is that bridge between peak experience and long-lasting change which allows us to become the insight? Is every insight true? Where does trauma work fit into this treatment? And what is the difference between symptom reduction and real healing?
Notable Quotes
“My mission has been: what does that bridge [look like] between experience and the steps that we have to take to really integrate in a deep embodied way to move from, ‘Oh, I can become this thing’ or ‘I have this insight’ to becoming the insight or becoming the thing?”
“I always use this catchphrase because I don’t like it, but it sells the psychedelic science:ten years of therapy in one session. I always say if you get ten years of therapy in one psychedelic session, then you had really bad therapy.”
“The psyche has an organic life. It opens up in the way it opens up. You can bathe yourself in ayahuasca and eat fifty grams of mushrooms per week [but] there are certain processes you can’t rush.”
“It’s funny how when we slow down, things become clearer faster.”
Dr. Ido Cohen, Psy.D, serves individuals, couples, and groups in San Francisco. As part of his practice, Ido works with a diverse range of challenges – childhood trauma, inner critic, relational issues, as well as integration and preparation sessions with individuals and groups. His doctoral dissertation was a 6-year study of the integration process of Ayahuasca ceremonies, while applying Jungian psychology to better understand how to support individuals in their process of change and transformation. He is also the founder of The Integration Circle and facilitates workshops on the different dimensions of integration and the intersection of mental health, spiritual health, and the entheogenic experience. Ido is passionate in supporting individuals to create longterm, sustainable change leading to vibrant, authentic, expressive, and love-filled lives.
Health Canada’s recent SAP revision brings a new opportunity for patients and a clear responsibility for prescribers.
Health Canada’s recent decision to include psychedelic medicines in its Special Access Program (SAP) was met with a lot of fanfare. The SAP amendment brings good news for certain patients – specifically, treatment-resistant patients suffering from serious mental health conditions that impact individuals, families, and communities.
The new federal amendment has the potential to fill a critical gap for patients in need, including those suffering from depression, PTSD, and end-of-life anxiety. Many who suffer from mental health conditions don’t respond fully to current treatments, so there is a significant unmet need for safer and more effective therapies. The change to Health Canada’s SAP now allows physicians, clinics and hospitals to apply for previously restricted drugs for medical use, providing a new option for the patients who need it most.
I applaud the federal government for responding to the grave situation of the patients who aren’t responding to otherwise adequate treatment – and for recognizing the encouraging clinical data around psychedelic-assisted therapy. This SAP revision represents one small but important step on the road to greater access to psychedelic medicine.
Like most opportunities, this one comes with considerable responsibility. Failure to act responsibly could cause harm to individuals and to this evolving area of medicine. However, I believe that the community of experts in psychedelic medicine are ready and willing to support the practitioners who will be administering these therapies to patients.
Our new 12-month certificate program, Vital, begins April 19th. Registration is closed, but sign up for the waitlist for next year’s edition now at vitalpsychedelictraining.com!
What Does the SAP Revision Provide?
Health Canada’s SAP revision adds certain psychedelics, including MDMA and psilocybin, to the list of restricted substances that practitioners can request to treat patients in specific situations. Decisions will be made on a case-by-case basis, and will be reserved for serious treatment-resistant or life-threatening conditions, in instances where other therapies have failed, or are unsuitable or not available in Canada.
The recent amendment reverses regulatory changes made almost a decade ago that prohibited access to restricted drugs (including psychedelics). Historically, practitioners in Canada have been able to apply for unlicensed medications only through Health Canada’s Section 56 exemption – a fairly long and restrictive process. The SAP revision is expected to provide a much quicker review and more rapid access for approved patients.
Obviously, the SAP amendment will not bring broad access to psychedelic medicine in Canada, but ideally will help treatment-resistant patients, and serves as a clear signal that the government is acknowledging the potential of psychedelic medicine as a legitimate treatment option.
Celebrate the Progress, Continue the Push for Approval
To me, the government’s decision to include psychedelics in Canada’s SAP is a key acknowledgement that mental health conditions are being placed on the same footing as physical conditions, and frankly, that’s a shift that’s long overdue. Anyone working in mental health can see that treatment-resistant mental illness is indeed a serious or life-threatening condition, analogous to cancer that hasn’t responded to conventional treatment. But mental health disorders aren’t always viewed with that sense of urgency.
I’ve dedicated a good part of my medical career to raising awareness and advocating for changes in the treatment of mental health issues. I spent more than 30 years as a medical officer and psychiatrist in the Canadian Armed Forces, deploying twice and leading mental health programs in Afghanistan. I served as mental health advisor to the Canadian Forces surgeon general, and led initiatives with Canada and NATO as we explored innovative solutions in mental health. Achieving change in attitudes toward mental health and treatment innovation requires considerable effort and persistence.
We’ve seen modest improvement in mental health care over the years. However, I firmly believe we need to do better in this arena. Far superior advances have been made in the treatment of cancer, heart disease, and many other conditions that take an enormous toll on society and represent a significant medical and economic burden.
Yet in the field of mental health, so many patients continue to suffer without adequate or effective treatment. We must review the data while being mindful that each file or data point represents a person who is struggling. We must work to develop medicines with better results, realizing that mental health disorders affect not only patients, but their families and loved ones, their careers and communities.
During my time as the Chief of Psychiatry, I have experienced firsthand the enormous impact that trauma can have on soldiers and veterans. From mass graves in Rwanda to the battlefields of Kandahar, it’s difficult to see people who are putting their lives on the line to protect their country return home to treatments that will only work for half of them.
So the onus is on us to look for better solutions, to refuse to be satisfied with the status quo and to embrace ALL positive steps forward. In Canada, the inclusion of psychedelics in the SAP is one of those steps. That’s progress worth celebrating.
A growing body of evidence continues to demonstrate that psychedelic-assisted psychotherapies are emerging as a successful treatment option in many indications, from treatment-resistant depression to smoking and alcohol addiction to PTSD, anxiety, and OCD.
In the area of smoking cessation, Dr. Matthew Johnson and his team at Johns Hopkins are planning new studies to build on his team’s ongoing research, including the first government-funded clinical study in 50 years evaluating a psychedelic for therapeutic use. The team’s earlier study reported that 80% of participants who received psychedelic-assisted therapy remained abstinent from smoking at 6 months and 67% remained abstinent at 12 months. Those encouraging results show strong efficacy, and demonstrate clear progress.
We see positive data in other indications as well, including PTSD. MAPS is currently sponsoring MAPP2, the second of two Phase 3 trials studying MDMA-assisted therapy for PTSD. In the first Phase 3 study, 88% of participants with severe PTSD experienced a clinically-significant reduction in PTSD diagnostic scores two months after their third session of MDMA-assisted therapy, compared to 60% of placebo participants. Additionally, 67% of participants in the MDMA group (compared to 32% of participants in the placebo group) no longer met the criteria for PTSD remission two months after the sessions.
When governmental and regulatory agencies endorse the positive early results of new, transformative treatments, we can celebrate this success. And when organizations dedicate funding for continued research in our field, we applaud those decisions. We can use every bit of incremental progress as adrenaline to keep gathering evidence, and to use that evidence as our guide as we expand treatment options and promote best practices in administering them.
Setting Up Providers and Patients for Success
As Canada implements its recent change, the responsibility lies with clinicians and regulatory bodies to be very deliberate and safe in the way we use the SAP program. We must ensure that patient selection is based on science, and principles such as informed consent are followed.
I encourage doctors and patients considering these new treatment modalities to review the available research and have open, honest conversations with one another to determine if psychedelic-assisted psychotherapy is right for them. These are far from being first-line treatments and we must continue to turn to approved evidence-based treatments first.
Here’s the government’s process for requesting drugs through the SAP:
To administer psychedelic-assisted therapy under Health Canada’s SAP, healthcare professionals must fill out an application, which will be reviewed on a case-by-case basis.
The SAP considers a “healthcare professional” someone who:
is entitled, under the laws of a province or territory, to treat patients with an unapproved prescription drug
practices in that province or territory
has prescribing privileges in the respective province
Practitioners who receive approval can then request products from manufacturers that meet governmental requirements.
A few examples of questions asked in the application:
“What specifically about this drug makes it the best choice for your patient(s)?”
“Specify all treatments tried and/or failed…”
A request to provide references/evidence:
A question for a request for a repeat patient:
The final section:
How progressive or cautious will Health Canada be in reviewing and approving requests? That remains to be seen. But as a physician, my advice is clear: The practitioners who seek permission to use these medicines should ensure that they have the necessary training, competence, and confidence to provide these treatments safely and successfully.
The innovators in our field are scientists, doctors, and advisors offering extensive experience with psychedelic compounds, as well as mental health and addiction disorders. We must step up and support physicians who want to prescribe these treatments, but who might not have experience implementing psychedelic-assisted psychotherapy. We can provide evidence-based research, education on proper protocols, and access to experienced psychedelic integration specialists to answer questions every step of the way.
My message is simple: Let’s do this right. Let’s do this safely.
Did you know there’s another version of our classic Navigating Psychedelics course that’s all online and can be taken at your own pace? Check out the Independent Learner edition!
The End Goal: Regulatory Approval and Integration into Clinical Practice
The SAP should not be considered an alternative to integrating psychedelic-assisted therapy into existing medical practices. Rather, it provides help for those who qualify for use in exceptional circumstances under the SAP guidelines. It’s a step forward, but it’s not a solution.
Psilocybin and MDMA-based therapies are successful with specific indications and patient profiles. We need to continue gathering data to demonstrate safety and efficacy through clinical trials targeting specific indications. That’s the path to obtain regulatory approval of psychedelics with therapy protocols. Psychedelics must undergo the same rigor as any other medication vying for approval from regulatory bodies. We need to continue the work that will lead to an environment of safe, regulated access to psychedelic therapy in a medical setting. That takes patience, but will pay off in the long run.
Ultimately, the millions of patients afflicted with serious mental illness will benefit most when they have access to more advanced, more effective therapies than those on the market today. We truly see success when medical communities view psychedelic medicine as an accepted and adopted form of treatment within our existing healthcare infrastructure.
In this episode of Vital Psychedelic Conversations, Kyle interviews Dr. Devon Christie: Senior Lead of Psychedelic Programs with Numinus Wellness, clinical instructor, counselor, and Co-Investigator and study therapist for a Canadian MAPS-sponsored trial investigating MDMA-assisted therapy for PTSD.
Christie talks about the importance of biomedical ethics and the unique considerations of psychedelic-assisted therapy: how psychedelics enhance the vulnerability and suggestibility in a well-established power dynamic, and how being aware of your power and biases is of the utmost importance towards not influencing your patient’s experience. They discuss just how much that experience is affected by every detail of preparation, and how it’s a very thin line between scaring someone off, setting impossible expectations, or even giving away too much of the experience (and with limitless possibilities, is that even possible?).
And she talks about the complications of touch and establishing (and honoring) informed consent; how true mindfulness can cultivate a greater capacity for self-regulation; how to handle situations where the client wants to know if a memory is real or not; the idea of psychedelics as a placebo; and many other complicated therapeutic concepts like harm of neglect, undue influence, making pleasure a virtue, cultivating agency, combating physician burnout, and the expectation effect.
Notable Quotes
“We don’t really know, but there may be aspects of psychedelics and their impacts that may make them ultimately like super placebos.”
“From my training as a relational somatic therapist, it’s actually not about the facts or details of what happened that matter. In fact, we can resolve trauma without even recollection of facts or details because we’re working with how it shows up in the body and how it’s showing up emotionally. …We can assist that process through working with what’s actually emergent in the felt experience and not needing to stay adherent to the narrative around it.”
“I think the yardstick on how far we’re going with this psychedelic work is that, either personally in our own journeys or even in the folks we’re supporting, we’re getting to a place where we don’t need the psychedelics – where the psychedelics have given us a reference, they’ve opened up new vistas of possibility, they’ve helped us to approach our lives differently, such that we are now cultivating the quality of presence and the quality of investigation and curiosity and flexibility and all those things that psychedelics can bring us – in our ordinary lives. …We’ve got these tools and they can help us learn and they can help us connect, and then hopefully we can come full circle and we can drop the tools and just be able to live meaningful lives that are sustaining for ourselves and for each other.”
Dr. Devon Christie is a medical doctor and registered counselor with a focused practice in chronic pain and trauma. She is trained to deliver both MDMA-assisted therapy for PTSD and ketamine-assisted psychotherapy, and she serves as Senior Lead of Psychedelic Programs with Numinus Wellness. Devon is also a certified Mindfulness Based Stress Reduction teacher, Functional Medicine practitioner, and clinical instructor with UBC Family Medicine. She is currently Co-Investigator and study therapist for a Canadian MAPS-sponsored trial investigating MDMA-assisted therapy for PTSD, and co-investigator on a pilot study investigating MDMA-assisted therapy for fibromyalgia.
In this episode of Vital Psychedelic Conversations, Kyle interviews clinical psychologist, author, and researcher, Dr. Adele Lafrance.
Lafrance developed Emotion-Focused Family Therapy, which focuses on the role of the family in psychedelic work. Realizing that the healing process disrupts systems and that dealing with a loved one who is going through a massive shift can be quite challenging for their loved ones, the idea behind EFFT is teaching family and significant others emotion-processing and behavioral support skills, how to make therapeutic apologies, how to recognize defensiveness and not react in a knee-jerk way, and how to find problematic caregiving problems where families accommodate for mental health issues (and therefore perpetuate them). While not typical for adults to involve significant others or family in therapeutic processes, she has found that if done correctly, it can be extremely helpful.
She talks about anger: how we struggle with expressions of anger, the idea of healthy anger, and the ways psychedelics can help us move from rejecting anger to assertion. And she discusses the Hoffman Process; emotion coaching; the power of validation; similarities between EFFT and IFS; rolling with resistance; tips to incorporate family into therapy more; the concept of a shame hangover and checking in on “tomorrow you”; and that even with all the preparation in the world, there’s no way to adequately prepare someone for the vast array of possibilities within (and after) a psychedelic experience.
In addition to being one of the faculty of Vital (reminder that applications close on March 27th), Dr. Lafrance has a 4-Part, CE-approved EFFT Core Clinician Training course that begins April 4th. Click here for details.
Notable Quotes
“As a culture, we really, really struggle with healthy expressions of anger, both in delivering them and in receiving them, so we end up having these unconscious contracts with our loved ones where there’s this unspoken rule that we don’t …speak up for ourselves when we feel like things aren’t going okay, and both parties can be ‘okay’ with that. And one thing that psychedelics does …is that they help us connect to our healthy assertion, as a byproduct of the cultivation of self-love.”
“The paradox of rolling with resistance is that that’s exactly the most efficient route to releasing resistance.” “There’s actually no way to adequately prepare for what might come. And so I’ve incorporated that – this idea [that] there could be major shifts that are highly disruptive, you might reconnect to old memories that you completely lost connection to that are not pleasant and that will shake your world, or, you can have an experience of self-love that helps clarify your path forward in your career, and anything in between. …We don’t know what can happen. We don’t know. It can be a smooth re-entry, or it can feel like your life blows up, and you need to be prepared for that. What I do know, though, is that it is way more likely that anything that happens will be in the service of creating a more aligned life for you. That, I do feel comfortable saying.”
“Integrity is about doing your ultimate best, being supported, asking for help, and then when you fall down, you pick yourself back up, you learn from your mistakes, and then you teach others.”
Dr. Adele Lafrance is a clinical psychologist, research scientist, author, and co-developer of emotion-focused treatment modalities, including Emotion-Focused Family Therapy. A frequent keynote speaker at professional conferences, Adele has published extensively in the field of emotion and health, including a clinical manual on EFFT published by the American Psychological Association. She is passionate about helping parents to support their kids in a way that is informed by the latest developments in neuroscience. The knowledge and tips in her book, What to Say to Kids When Nothing Seems to Work is an effort to do just that. With colleagues, she also makes a wealth of caregiving resources available at no cost at Mental Health Foundations. Adele is also leader in the research and practice of psychedelic medicine, with a focus on ayahuasca, MDMA, psilocybin and ketamine. Currently, she is the clinical investigator and strategy lead for the MAPS-sponsored MDMA-assisted psychotherapy study for eating disorders and a collaborator/clinical support on the Imperial College study for psilocybin and anorexia nervosa. She is a founding member of the Love Project.
In last week’s blog, Ed Prideaux told us everything we know (and don’t) about Hallucinogen Persisting Perception Disorder (HPPD), visual snow syndrome, and flashbacks. In part 2, he addresses ways to deal with the distress of having HPPD and ways to reduce the risk of developing it in the first place.
The real “problem” with HPPD is distress: anxiety, depression, isolation, panic, and the unhelpful coping mechanisms people can develop to overcome these (alcoholism and drug dependency are sadly common among HPPD patients). Remember, this distress is what technically defines HPPD.
Many people live with significant visual changes and do not find them distressing – rather, they may be sources of enjoyment, “free trips,” artistic inspiration, or purposefully leaned into as part of spiritual or occult practice. The world looking different doesn’t necessarily mean you have a problem.
If you’re currently experiencing HPPD, though, overcoming the distress should probably be your first priority. Speaking crudely, once the distress is overcome, the visuals can more or less “take care of themselves.” With less distress, there is less fixation. With less fixation, there is less noticing. With less noticing, the visuals are less noticeable. They may rapidly normalize, filter in the background, and can disappear unexpectedly with time.
Our new 12-month certificate program, Vital, begins April 19th. Registration is closed, but sign up for the waitlist for next year’s edition now at vitalpsychedelictraining.com!
How Can We Address This Distress – and Bring the Visuals Down?
Medication and clinical help: Many in the HPPD community have found relief in the use (especially in the short-term) of medications including Lamotrigine and Klonopin. They can bring visuals and anxiety way down, though some report their symptoms getting worse. They can always bring side effects, too, so some caution is advised.
Healthy lifestyle changes: Many HPPD patients report the decline and resolution of their symptoms – or otherwise acceptance and returning to “normal” life after avoiding further drug-taking, exercising regularly, cutting out processed foods, or trying specific elimination diets.
NotingTriggers: Pay attention to your triggers and act accordingly. Visuals and other HPPD symptoms can surface in response to:
Fatigue
Stimulation, including caffeine
Anxietyand stress
The nature of the environment: visuals are more apparent in the dark, on blank surfaces, in enclosed rooms, and in environments where people had their original psychedelic experiences
Specific foods
Fixation and attention, including staring at blank surfaces and an anxious tendency to look out for visuals
Intoxication with other drugs, especially cannabis
You should also pay special attention to how your condition manifests beyond visuals, in particular, if you are experiencing Depersonalization/Derealization Disorder. More than visuals, it’s often the case that people’s distress comes from DP/DR, and a rich body of literature and therapeutic approaches have been explored for this condition.
Community: You can seek community from others, such as groups on Facebook, or the forums at HPPDOnline.com, r/HPPD, or r/visualsnow. However, tread cautiously around spending too much time on these forums. They can be extremely negative, and cause people to spiral and fixate on their perceptual changes.
Mindfulness meditation: The stress reduction and relaxation effects of meditation are well-established; many report breaking the cycle of visual fixation through learning to hone their attention.
Cognitive techniques: Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) may be useful for accepting and reframing perceptual changes. Challenging the internal beliefs triggered by HPPD could reduce both distress and the visuals – in particular, the beliefs that patients are “brain damaged,” “weird,” “isolated,” or a “casualty.”
Psychedelic integration: Introspection, journaling, and (if you can find and afford it) specialist, psychedelic-informed counseling can be helpful. In particular, you may benefit from exploring the particular details and events of what may have caused HPPD to originally materialize.
Somatic approaches: Certain somatic/bodily therapies have proven helpful for people with Visual Snow Syndrome. This includes the use of acupuncture, muscle relaxation techniques, neck massage, and specific dietary interventions.
Reframing: It may be helpful to learn that many people are not troubled by their perceptual changes. Again, they can be just a “thing” – how one sees now – that’s different, and not necessarily bad. Other people actively enjoy their perceptual changes or view them in a spiritual way, such as glimpsing auras, having broadened the possibility of the mind, or in seeing the intrinsic shakiness of ordinary experience.
Without a deep, embodied grounding for your reframing, though, it can be hazardous. Make sure the frame is not just “in your head,” but truly held across your entire mind and body in a felt way. Don’t gaslight yourself into enjoying your perceptual changes if they are actually disturbing you.
Did you know there’s another version of our classic Navigating Psychedelics course that’s all online and can be taken at your own pace? Check out the Independent Learner edition!
How Can One Reduce the Risk of Developing HPPD When Taking Psychedelics?
There is reason to suspect that the immediate period after a trip – say, one-to-five days – is important.This is because the brain is still neuroplastic and affected by psychedelics for up to a week (or longer) after the trip. And HPPD may be understood as a problem of “resetting” one’s brain back into its ordinary perceptual categories after the shock of a psychedelic experience.
If you want to avoid HPPD, what matters is ensuring that your perception re-transitions to its prior sober state safely. In this one-to-five day period, it may be advised, then, to:
Sleep well.
Avoid cannabisand further drug-taking. Some people report that their HPPD was “kicked in” by a subsequent drug experience.
Process the psychedelic experiencethrough dedicated integrationpractices, such as journaling, contemplation, meditation, and inquiry. Speaking very crudely – and because HPPD may well be a “network disorder” involving cross-connected mixtures of perception, emotion and cognition – it may be that failing to integrate the experience may cause the energy to remain and be reactivated, including in cognition and possibly in perception (especially if the right triggers are also hit).
Keep stress and anxiety to a minimum.
Re-embodiment, or reconnecting to body sensations. Practices may be recommended, including through mindfulness meditation. This may help to reduce the risk of dissociative disorders like Depersonalization/Derealization as well.
Reduce screen use. Focusing on screens may cause a disembodying effect, as well as holding back the psychological energies activated by the psychedelic experience.
Avoid triggering environments, such as places that are enclosed or rich in blank surfaces, and try not to self-induce visuals through staring and fixation. If someone wants to be extra careful, they may wish to avoid the place where they had their psychedelic experience. “Training” the brain in hallucinatory ways of seeing while it’s neuroplastic may cause lingering changes once neuroplasticity is reduced and stable categories are reaffirmed.
Important Questions to Ask Before Having an Experience
Have you optimized your set and setting? HPPD seems to be more likely after bad trips or challenging experiences – the likelihood of which strongly depends on how people organize their set and setting. In particular, stress and trauma going into a psychedelic experience may be a trigger for HPPD experiences, even at low dose (and microdose) levels.
Have you experienced some unusual visuals before? HPPD patients may have had a higher-than-normal experience of certainvisual oddities, which are rare parts of normal perception. In particular, phenomena like visual snow, halos, after-images, floaters, and colors in the dark may suggest an underlying tendency in perception that could be triggered by a psychedelic drug to be more intense.
Have you tested your drug? If so, what drug are you taking? HPPD may be more likely with Novel Psychoactive Substances (NPSs) and Research Chemicals (RCs) with more unpredictable, less-researched, and possibly neurotoxic effects. Adulterants in street drugs may also have neurotoxic and other risky properties.
It seems that long-acting psychedelics like LSDare more likely to cause HPPD. While LSD may have certain advantages over other psychedelics subjective to each user, someone very conscious of developing HPPD (at least compared to other risks) may wish to avoid LSD in favor of a shorter-acting psychedelic.
How often are you tripping? Taking lots of psychedelics frequentlyis likely to be correlated with a higher risk of developing HPPD. This can be explained in a number of ways:
A higher likelihood of having a bad trip
Activating a latent genetic susceptibility
More likely to over-excite relevant perceptual circuits
More “re-training” of perception in hallucinatory ways of seeing
Less time in which to integrate properly one’s experiences, and a possibility of a “cascade” of neuroplasticity from taking psychedelics while still in a neuroplastic state
Do you have experience of Obsessive Compulsive Disorder (OCD), Autism Spectrum Disorder (ASD), Complex PTSD, Generalized Anxiety Disorder (GAD), or Attention Deficit (Hyperactivity) Disorder (ADD/ADHD)? While there has not been research on the relationship of HPPD to these conditions, reviews of online forums directly and indirectly suggest a relationship. People with Visual Snow Syndrome seem to experience these conditions more than average based on rough overviews, and people with these conditions may independently report certain visual changes similar to HPPD. Ifthere is a relationship between HPPD and these conditions, the connection may occur through tendencies towards disembodiment, hypersensitivity, overstimulation, and dissociation, all of which may have visual components – and may be amplified by psychedelic experience.
For more, this article’s tips, advice, analysis (and more) is also featured in a more in-depth HPPD Information Guide, which can be freely downloaded from the Perception Restoration Foundation’s website, where a more direct guide for those struggling with HPPD is also hosted. Owing to the tentative nature of our HPPD knowledge base, the PRF invites any and all comments and criticisms for the Guide at info@perception.foundation, and any worthwhile amendments will be quickly published.
In this episode of the podcast, David interviews Chief of Staff, Head of Operations, and “Chief Cheerleader Officer” atNue Life, Kabir Ali.
Ali speaks about the power of ketamine-assisted therapy and how his first ketamine treatment made him overcome 10 years of addiction and depression (and realize what caused it). He talks about addiction: his struggles, how people can have these relationships with anything, concerns over the addictive properties of ketamine, and the importance of having the right people in your corner – especially when using a substance to overcome another. And he talks about the lack of education in mental health he’s seen in his travels, how our current society seems to be driving us to escape, and how self-love (and the authenticity and freedom that comes from it) is one of the most overlooked and wonderful gifts of psychedelic-assisted therapy.
And he discusses Nue Life: how the clinicians he works with are magical people, the benefits he’s seen from integration work in group settings, the health coaching they’ve made a large part of their program, what he’s most excited about, and why he views Nue Life as a next-gen mental health company rather than a ketamine clinic.
Notable Quotes
“We’re certainly living in a space today where our environment is pushing us to escape. It doesn’t necessarily feel safe. There’s a lack of certainty in our social landscape over here today. And whenever I come by someone who is struggling with addiction, whether it’s someone that I am mentoring or personally coaching, it’s quite apparent that we cannot underestimate the value or the impact of our environment.” “That self-compassion, that self-love: it’s one of the most, I think, overlooked gifts of these treatments.”
“The biggest gift, again, is that self-compassion, that self-care, that self-love. But the authenticity and the freedom that comes through these discoveries or through these experiences that we share with psychedelics; that’s one thing that I think we, at times, look over, which is: what is it that you are actually walking away with when you embark on a journey with plant medicines or with ketamine? And that’s just really the authenticity that you just touched upon right now, and that is that liberating feeling where we can actually go ahead and pursue and live the lives that we once had, or perhaps, lead a life that we never knew that we could lead.”
Kabir Ali is an advocate for accessible and innovative mental health care. As an operations executive in the wellness industry, his passion is to create collaborative teams that provide effective treatment at the highest standards of compliance. Kabir grew up in West Africa and Bombay and began his career as an actor and filmmaker in Bollywood. The pressures of the entertainment industry and the incarceration of a close family member ultimately led to struggles with addiction. While in treatment, he began working in healthcare communications, where he found satisfaction using his storytelling skills to help others heal. Today, Kabir serves as COO of Mind Body Medicine and My Ketamine Home and as Head of Operations for Nue Life, a recently-launched startup that provides at-home psychedelic therapy. In his spare time, Kabir studies the intersection of addiction and family systems and looks forward to developing additional programs that bring affordable mental health treatment to underserved communities.
If you aren’t familiar with the Internal Family Systems model, this podcast serves as a great introduction, as Schwartz discusses how it came about and what it entails; how he views the Self; how IFS relates to the body; exiles, managers, and firefighters; the 8 Cs of self-leadership qualities; how to address the actions of one’s different parts; and how often people in psychedelic-assisted therapy sessions find themselves naturally thinking within the IFC framework. He believes that the different parts of the mind each have valuable qualities and resources, and psychedelics (and other non-ordinary states of consciousness) can help to re-harmonize the damaged parts, therefore allowing the Self to do its job as the inner healer.
He also talks about the importance of preparation and facilitators knowing their own parts; his psychedelic history and why he’s no longer afraid of death; what he strives for in integration work; the 5 Ps facilitators need; Sandra Watanabe’s concept of a “cast of characters”; soul retrieval; starling murmuration; and the Pixar movie, “Inside Out.”
Notable Quotes
“[Michael Mithoefer) kept track of how often, spontaneously, the subjects would start doing IFS without any coaching from the facilitators, and in the high-dose MDMA [studies], 80% would start working with parts spontaneously. And that felt very validating to me, like I had just stumbled onto a process that people naturally do once they access enough Self.”
“There are times where you just can’t convince these protective parts to let us get to an exile and heal it. And a psychedelic session can expedite that pretty easily, it seems.”
“For me, there is a big SELF, with all capitals, that’s kind of like the ocean, and then we’re a drop of that ocean – there’s a piece of that that’s in each of us that I’m calling the Self with a capital S. And when we take ketamine and we leave [our bodies], we’re actually going back into that ocean. And there’s a lot of bliss, at least for me. I mean, there [were] a few moments that weren’t so blissful, but much of it was just– I came back, and I say this and people find it hard to believe, but I have no fear of death now. I just know that it’s a transition into that ocean.” “I think the psychedelic world has been conditioned by a kind of passivity approach to being present with people and just trusting their own process. And that can do a certain amount of good, but you’re also missing the opportunities [for] doing some really deep healing.”
Dr. Richard C. Schwartz began his career as a family therapist and an academic at the University of Illinois at Chicago. There, he discovered that family therapy alone did not achieve full symptom relief, and in asking patients why, he learned that they were plagued by what they called “parts.” These patients became his teachers as they described how their parts formed networks of inner relationship that resembled the families he had been working with. He also found that as they focused on, and thereby, separated from their parts, they would shift into a state characterized by qualities like curiosity, calm, confidence, and compassion. He called that inner essence the Self and was amazed to find it even in severely-diagnosed and traumatized patients. From these explorations, the Internal Family Systems (IFS) model was born in the early 1980s. IFS is now evidence-based and has become a widely-used form of psychotherapy, particularly with trauma. It provides a non-pathologizing, optimistic, and empowering perspective, and a practical and effective set of techniques for working with individuals, couples, families, and more recently, corporations and classrooms. In 2013, Schwartz left the Chicago area and now lives in Brookline, MA, where he is on the faculty of the Department of Psychiatry at Harvard Medical School.
In this episode of Vital Psychedelic Conversations, Kyle interviews Michael Sapiro, PsyD: clinical psychologist, writer, meditation researcher, integrative coach, former Buddhist monk, Vital teacher, and now 3-time podcast guest.
They begin with what he feels is the most vital conversation we should be having now, then he discusses the idea of bringing psychedelics to prisons; his mental time travel work with The Institute for Love and Time (TILT); building an ecosystem where those with means pay full price to enable those with less money a discount; rebuilding trust in the medical community; and the difference between a diploma and real-world experience and proper training.
And he talks about the mystical experience, working with clients, and education: how so much more training is necessary than people realize, and how so much of the true education is learning how to vocalize an internal experience (and then integrating the positive aspects into everyday life). He talks about the complicated dynamics involved in what many see as a fantasy career; how he knows when to intervene; how he views “doing your own work”; whether or not the work can be gentle or joyous; the idea of joking during a session; his work with combat veterans and the intensity of 5-MeO-DMT; mainstreaming mysticism; and trusting that the universe has our backs.
Notable Quotes
“We want people to have real, internal experiences that they’re aware of and they can vocalize, and that is the actual education; not just the knowledge I’m giving them about what this drug does to the brain or how you identify something. It’s really: What is alive in you, how do you identify what’s alive in you, how do you use it in real time, and then how do you navigate those circumstances and change and grow? That’s the real learning process.”
“The mystical experience is a present moment experience where the universe unfolds in front, within, and around you, and then we integrate that into our human self. So Mike gets this amazing introduction to the universe through an experience and then it comes in and becomes insight and knowledge, and then hopefully practical application. So that’s where I think, in the end, we actually transform; is when that knowledge becomes integrated into the fabric of our own being [and] into our personality, and now Mike and the universe are more melded.”
“Zen is serious until you learn the universe is playful, and then you get to be kind of playful with it.”
“My hope is that all of us touch on the unconditional love that’s here for us, within us. And once you touch that, you can’t not offer it. You can’t not take care of other things. …This work gives us access to what’s already fundamentally true, and helps us bridge that with everything else.”
Michael Sapiro, PsyD, is a clinical psychologist, writer, meditation researcher, and former Buddhist monk. He is on faculty at Esalen Institute, is a Fellow at the Institute of Noetic Sciences, and is completing a study on time travel, hope, and love with Dr. Julia Mossbridge of The Institute for Love and Time. Dr. Sapiro teaches nationally on the art and science of transformation, expanded human capabilities, and futuremaking. He is the integrative psychologist at the Boise Ketamine Clinic where he offers Ketamine-Assisted Psychotherapy (KAP and KAT) sessions, and is an integrative coach with VETS, helping former Navy Seals and other special operations team members recover from combat exposure with psychedelic-assisted therapy. He hosts a syndicated radio program called Radio Awakened out of KRBX. His work is dedicated to personal awakening for the sake of collective and planetary transformation. He can be found at Michaelsapiro.com.
In this episode of the podcast, Kyle interviews Laura Mae Northrup, LMFT: author, educator, somatic psychotherapist, and host of Inside Eyes, a podcast focusing on the use of psychedelics for healing sexual trauma.
Northrup is the author of the just-released Radical Healership: How to Build a Values-Driven Healing Practice in a Profit-Driven World, which, although not focused on psychedelic work specifically, was largely written on or inspired by psychedelics, and is beneficial for people entering the field as psychedelic practitioners (she calls it “a self-help book for healers”). She talks about the book and ways to make a sustainable path towards a healthy practice, with the most important factors being to build in time for joy and inspiration, and to continuously do your own work.
She discusses what “doing your own work” really means; what people struggle with when entering the field; the idea of ”action movie therapy”; the ways gained power, unconscious motivations, or issues you haven’t worked on can influence the ways you work with others; why preparation is maybe more important than integration; capitalism and why practitioners shouldn’t feel bad about charging money for their services; the importance of trauma training; the need for community and developing relationships with colleagues; and why, while society usually feels differently, you don’t actually have to be perfect to become a healing practitioner.
If you’re interested in Radical Healership, we have a discount code for you thanks to North Atlantic Books! Go here and use code psychedelicstoday for 30% off and free shipping!
Notable Quotes
“What you’re doing, especially if you’re working in a psychological or spiritual realm, is that you’re using your own being as your instrument. And so, just like somebody who is a surgeon that is using a surgical knife; you would want that person to be cleaning that surgical knife and replacing it when it’s dull and really tending to this surgical knife. This isn’t the same as just trying to cut up a tomato for dinner and it’s okay if the knife gets a little dull over the years. You want to make sure your instrument is well cared for, and that is you. It’s your being.”
“We’re so obsessed with the pinnacle moment or the peak experience that we don’t value appropriately all of the more mundane experiences that actually allow that peak experience to happen safely. Absolutely, the people I see doing the most profound healing work for themselves [and] getting a lot out of psychedelic medicine; they did a lot of prep. We talk a lot about integration, I think, in the community, but we don’t talk as much about preparation, and I actually think integration flows a lot more easily if you’ve done a lot of preparation.”
“There’s kind of this fantasy healing practitioners can get into where they’re like, ‘I’m not going to charge anything’ or ‘I’m going to charge really little.’ And I would say one individual person driving themselves into lifelong debt and not charging enough money is not actually changing the system. I think it’s masochistic. I think a lot of healing practitioners do it, and to all the healing practitioners listening right now that struggle with this, I want to speak to you and I want to say: I want you to be a okay, because we fucking need you so that you can actually help people heal, and when you’re driving yourself into the ground and stressed out and you can barely support yourself, you’re not taking care of yourself enough to support other people. So please charge enough to be okay.”
“Finding our way through capitalism involves connecting ourselves to a deep, deep, deep sense of love.”
Laura Mae Northrup, LMFT is an author, educator, somatic psychotherapist, and podcaster. Her book Radical Healership (Feb 2022) is a spiritually-informed and anticapitalist guide for healing practitioners who seek to build a values-driven healing practice. She is the host and creator of the podcast Inside Eyes, an audio series about people using entheogens and psychedelics to heal from sexual trauma. Her work focuses on defining sexual violence through a spiritual and politicized lens, mentoring healing practitioners in creating a meaningful path, and supporting the spiritual integrity of our collective humanity. You can learn more about her work here: www.lauramaenorthrup.com.
Prolonged negative body image will often lead to depression and anxiety, and unfortunately for many people, can lead to body dysmorphia or an eating disorder. Could psychedelics help reframe one’s relationship with their body?
These conditions primarily impact women, and now more of them are coming forward to share how psychedelics are helping them leave a constant cycle of dissatisfaction, body dysmorphia, and the accompanying anxiety, depression, and stress. They explain how the use of psychedelics helped them develop a new relationship with their eating disorders and improve their self-image.
While large-scale studies are (currently) scarce, the anecdotal evidence of these shifts is powerful.
“The first time I sat with a hero’s dose of magic mushrooms, I realized I could put my eating disorder down and never carry it again,” shares Francesca Rose, who is now an eating disorder recovery advocate. “It finally clicked: my eating disorder was not part of me. It wasn’t even mine. It all made sense. I was free from my eating disorder. I no longer needed to control food or my body to feel safe or worthy.” Having her life changed through the use of psychedelics and being on the recovery path for 13 years, this psychedelic-assisted shift is part of what led her to add her current work; supporting other women with eating disorders along their healing journeys.
For many women, talking about their insecurities is still seen as a taboo, weakness, or shameful. Yet finding a supportive space to speak of one’s challenges, plus engaging in embodied experiences – including psychedelic sessions – can offer a gateway to healing. Rose’s work also includes leading embodiment practices via yoga and conscious dance. By helping women speak of their struggles and reconnect to their bodies, she aims to break these stigmas.
Adding in the intentional and safe use of psychedelics can allow women to reconnect with their bodies and cultivate a gentler relationship with themselves. Rose says, “An eating disorder is unconsciously employed as an attempt to feel protected in the world and to even give a sense of meaning and identity. The internal world is fractured and the eating disorder is a way to try to stitch things together, even if it’s an unsustainable method. When we are journeying with psychedelics and engaging in post-journey integration, people can find they rely less on the eating disorder because there is a general sense of ease in the world and more internal wholeness. We can get in touch with our essence, and connect with our inherent worth, belonging, dignity and divinity. Psychedelics can help us embody pride and self-acceptance. We can connect to love, and feel our capacity to give and receive love.”
To have a better understanding of these conditions, we need to first comprehend body image. For most women, it’s not as simple as liking or disliking their own bodies. Body image is complex, and can include a combination of our feelings, beliefs, and perceptions of how our body looks to us and others, the understanding of what it can do, and its estimated size.
Body image issues can start as early as 5 years old. Changes to our physiques kicked off by puberty can deepen our dissatisfaction. Culture also exerts a huge influence on the way we view ourselves. The way society sees gender, the color of skin and hair, and countless other things can also impact the way a person thinks and feels about their physical appearance.
Body dysmorphia is a psychological disorder characterized by an excessive concern for the body, causing the person to overvalue small imperfections or even imagine imperfections. This creates a negative body image and lowers self-esteem. It can drive possible eating disorders and problems in social, professional, and personal lives. Both men and women may experience body dysmorphia and eating disorders, though women are three times more likely to have their lives affected by it.
In the United States, approximately 30 million people suffer from some type of eating disorder. Of these 30 million, 70% do not have the assistance of a specialized professional. As a consequence, anorexia nervosa, one of the most common eating disorders, has a 5.9% mortality rate – one of the highest rates within mental health conditions.
The Potential of Psychedelics in Building a Positive Body Image
Eating disorders are notoriously challenging to treat relative to other mental health disorders. Traditional treatments, such as Cognitive Behavioral Therapy (CBT), have a remission rate of about 45%, a relapse rate of about 30% within one year, and can be hard to follow. Now, some experts and researchers are considering psychedelic therapy as an alternative, and are analyzing the potential benefits of this treatment.
“Eating disorders typically develop as maladaptive coping mechanisms when internal resourcing is overwhelmed by what’s happening in a person’s life,” says Lauren Taus, a California-based therapist who offers ketamine-assisted sessions. Taus and other therapists who contributed their perspectives for this piece say that psychedelic therapy can alleviate the symptoms that are normally associated with these conditions, such as depression and anxiety, in ways that traditional therapy fails to achieve. As Dr. Adele Lafrance points out in this article for EdCatalogue, psychedelic therapy has “the potential to alleviate symptoms that relate to serotonergic signaling and cognitive inflexibility, and the induction of desirable brain states that might accelerate therapeutic processes.”
Taus shared an example of her own work with psychedelics as an alternative treatment that helped her with many of her challenges, including her eating disorder: “My experience with empathogens has invited me to see how much conflict was warring inside of me. I saw all the pain of my personal history, and all that was beyond my control in my family system. Fundamentally, these psychedelics invited me to directly process what was beneath the surface. I accessed great grief, rage, and fear while opening to deep levels of love and compassion for myself and everyone else. I understood my parents and the choices they made, so I could forgive them. I also sourced the willingness, desire, and strength to fight for myself – and my life.”
Listen to Lauren Taus in her episode, “Wellness Through Yoga, Meditation, and Psychotherapy here.
So what is it about psychedelics specifically that can facilitate profound breakthroughs like Taus’? For starters, they can positively impact the Default Mode Network (DMN), which handles communication between brain regions. This region appears to be hyperactive in some mental health conditions, including depression, anxiety, and OCD. And certain hallmarks of eating disorders, such as the poor cognitive flexibility seen in many anorexia nervosa patients, may also be related to an overactive DMN. Studies such as “Rethinking Therapeutic Strategies for Anorexia Nervosa: Insights From Psychedelic Medicine and Animal Models” indicate that psychedelics lower the activity in this area, and, by doing so, allow us to create new thought patterns, giving us a fresh perspective on life, the world, and ourselves.
Another way that psychedelic psychotherapy can be effective is by helping a person understand the true source of their feelings of dissatisfaction. A 2013 analysis of why eating disorder therapy fails reveals that a patient’s resistance stems from the disorder’s “ego-syntonic” nature. Ego-syntonic means that the ego’s demands and aspirations drive many of the disorder’s behaviors, feelings, and values. Psychedelic substances can offer a temporary dissolution of the ego, allowing the possibility of transformation, healing, and change of certain behaviors, thought patterns, or addictions.
Taus explains that “Psychedelic assisted psychotherapy supports embodied change where traditional psychotherapy often stays in the realm of cognition and intellect. A person, for example, may come to understand with depth and clarity their patterns in therapy, but still struggle to shift them.” For example, a woman might know that purging is a harmful behavior that leads to feelings of shame. “She may even know exactly why and when it all started, but still she may not be able to stop. Psychoactive substances can create experiential shifts that more efficiently translate into internally-led and sustained behavioral change. The job of the therapist is to provide a safe container for the exploration and a good relational context for a person to make sense of the experience and to anchor in the good that comes from it.”
It’s important to highlight that the use of psychedelic substances on their own does not work as a magic bullet and treatments must be done alongside psychotherapy and/or other healing modalities such as journaling and yoga. A holistic approach seems to be the most effective path to long-term healing for women with eating disorders and body dysmorphia.
Ketamine, ayahuasca, MDMA, and psilocybin are the four psychedelics that have been the focus of the majority of the latest research for the potential treatment of eating disorders. Let’s take a look at how each one could help with eating disorders:
Ketamine:
Ketamine is a non-classical psychedelic that can alter consciousness for a short period of time. This synthetic compound’s antidepressant qualities have been researched for treating severe depression, PTSD, and OCD.
Ketamine can be administered through IV, injected, taken orally, or it can be insufflated (blown into a body cavity, such as the nasal passages). The dose is titrated according to weight, with the understanding that everyone metabolizes the medicine differently. Ketamine is known for its dissociative effects, such as feeling like things are moving in slow motion or that you are separated from reality, with objects looking different and other characteristics that can be seen in this study.
“With regards to ketamine, the dissociative experience can translate into more joy in embodied experience. Ketamine-Assisted Psychotherapy (KAP) creates a break from the ordinary mind and a loosening of the belief systems that eating disorders are so rigidly held by. From a scientific perspective, psychedelics interrupt the default mode network, which governs self-image, memories, beliefs, and patterns.” says Taus. “The drug essentially creates an opportunity to reorganize the brain into a system that is more supportive for good living. Ketamine also results in increased neuroplasticity, which creates a golden hour opportunity for potent therapy work with a client 24-48 hours after a KAP experience.”
Ayahuasca is a fermented herbal drink that contains dimethyltryptamine (DMT), one of the most potent psychedelic drugs known for its role in shamanic or religious ceremonies. The brew has been utilized as a sacred ritual by various South American Indigenous tribes for at least 1000 years. Journeyers frequently claim mystical and transcendent visions that lead to self-discovery.
The ayahuasca experience has the ability to favorably affect behavior, stimulating self-reflection and increased awareness. Studies suggest that drinking it can aid in the treatment of anxiety, addictions, and depression, as well as eating disorders by also shifting body perceptions.
MDMA, another laboratory-created compound, has a physiological effect that alters people’s behavior such as openness. MDMA boosts serotonin levels while also upping oxytocin, dopamine, and other chemical mediators, resulting in feelings of empathy, trust, and compassion. The substance also has an effect on the way people process trauma and emotions for a period of several hours.
In clinical settings, MDMA is taken orally in capsules. The patient first takes a full dose (75-125 mg) and has the option to add a second dose about 2 hours into the session. An MDMA session will typically last between 6 to 8 hours.
MDMA causes an increase in prefrontal cortex activity, which is important for information processing, and a slowing in the amygdala, the part of the brain that is key in processing memories and emotions associated with fear. The key therapeutic benefit of MDMA is its capacity to excite the brain, allowing it to create and store new memories. Patients become more emotionally flexible and capable of exploring challenging memories during psychotherapy sessions, which often leads to long-term changes in how they react to emotional changes.
Psilocybin is a substance generated by more than 100 different mushroom species around the world. Psilocybin is said to have the best safety profile of all psychedelic substances. The fungi could be useful in the treatment of eating disorders by targeting the brain’s serotonin imbalance and therapeutically shifting the person away from symptom-focused treatment. This could establish changes in self-worth and self-compassion.
Aside from that, the efficacy of psilocybin therapy in the treatment of OCD shows how it could be useful in the treatment of eating disorders, as obsessive thoughts and compulsive and obsessive actions are also common hallmarks of eating disorders.
Reclaiming Ownership of Your Body with Psychedelics
Psychedelics can help women see their eating disorder as a coping mechanism and not as part of their identity. Once they embody this insight, they can also slowly start to replace bad habits with healthier and kinder new habits. They can rewrite the inner narrative of lies and self-limiting beliefs about their bodies.
Once more, there is a need to emphasize the importance of integration, relationships, and a holistic approach alongside other therapeutic methods and modalities. Change comes with time, effort, and consistency, especially when deconditioning behaviors that have been a big part of our lives for many years.
When asked about how long it takes for those changes to fully take place, Rose points out that “Eating disorders and addiction are transformational experiences that hold enriching value. Indeed, the word, ‘transformation’ means change or conversion. When thinking about recovery, it is not about stopping or restricting a behavior but rather allowing it to change and transform, taking us along for the ride so that our beliefs, feelings, thoughts, behavior, and action take a new form. Grounded, sustainable change does not happen overnight.”
“For me, recovery is about inner personal and spiritual growth, and incremental daily, positive changes. My experience with eating disorders and addiction has led me to believe that they offer lessons and advantages, transforming me into more of who I truly am: alive, free, appreciative, and connected.”
Although more research is still needed to better understand the safety and efficacy of psychedelic medicines and therapy in the treatment of eating disorders, the promising results we’re seeing show that this is a worthy goal to pursue. Stories such as Rose’s and Taus’ are just two among many other women who have experienced transformational change thanks to these compounds.
“With the support of therapy, community, spirituality, and relationships, I no longer judge my body, or effort to dominate her,” says Taus. “My experiences with plant medicines have supported me in understanding my body as a perfect part of nature, and in much the same way that I don’t complain about the shape of a leaf or a wave, I accept – even appreciate – the parts of me I’ve historically struggled with.”
“The power of psychedelic-assisted therapy is in its experiential quality,” she says. “When knowing meets feeling and understanding, we can galvanize the courage and strength needed to shapeshift our lives and reconstruct ourselves.”
In this episode of the podcast, Joe interviews Professor of Neuroscience, author, and Founder and Vice Director of the Brain Institute at Universidade Federal do Rio Grande do Norte in Brazil: Sidarta Ribeiro.
Ribeiro tells his story, discusses some of his work with dreams, and talks about what he’s seeing happen in psychiatry: that we’re realizing how little traditional psychiatry paid attention to set and setting, how much the creation and spread of antidepressants was influenced by conflicts of interest, and how the future of psychiatry and psychotherapy will mean more talking and less use of drugs (and not the other way around).
He also discusses research where MDMA was given to octopuses; how we’re arriving at many “new” conclusions that are actually old; why he’s primarily researching LSD; how all descriptions of the world are metaphors; the ayahuasca-like drink, jurema; how we need to look at things outside the realm of logical positivism; microdosing; and why we aren’t more tolerant of each other. And he talks a lot about biopiracy: how we need to honor the sacredness of these plants, learn from the knowledge that came before Western science, and respect the dream-state journey that many psychedelic companies are trying to figure out how to remove from the experience. We’re giving away 5 copies of Riberio’s newest book, The Oracle of Night: The History and Science of Dreams. Click here to enter!
Notable Quotes
“People need to be listened to. People need to dialogue. People need to have access to sophisticated techniques of care that can be aided by substances, but they cannot be replaced by substances.” “What I don’t like and I think it’s either naive or disingenuous or even quite misleading (and I see it [with] lots of people; scientists, journalists, and capitalists going in that direction) is to say that the non-psychoactive psychedelics are the good ones, the preferred ones – that this is the right way of doing the therapy. I think this would be similar to saying that sex without orgasm is better than sex with orgasm.”
“Because of the propaganda, because of the war on drugs, because of Nixon, because of Reagan, because of people that said that cannabis kills brain cells, because of people that said that psychedelics would make everybody psychotic. That really worked. People really believed those myths and it really took very sustained research work over many decades to overcome this. Now, I think the genie is out of the bottle. It’s very hard to portray psychedelics as something tremendously harmful and dangerous. This moral panic; it doesn’t stick anymore.”
“We are really close to a very big positive change. And the reason I believe it is because it’s obvious that we have accumulated in the past three million years such a wide and rich wealth of knowledge from many different sources, that if we were able to gather the best of all that we have and apply it, we would reach world balance and harmony quite quickly. If we think of the financial capital that has accumulated now, the technological capital, the human capital: we have it all. But we’re still confused about something that is quite basic, which is that we need to share.”
Sidarta Ribeiro is Full Professor of Neuroscience and Vice-Director of the Brain Institute at the Universidade Federal do Rio Grande do Norte in Brazil. He holds a Bachelor’s degree in Biology from the Universidade de Brasília, a Master’s degree in Biophysics from the Universidade Federal do Rio de Janeiro, and a Ph.D. in Animal Behavior from the Rockefeller University, with post-doctoral studies in Neurophysiology at Duke University. He is a member of the Steering Committee of the Latin American School for Education, Cognitive and Neural Sciences (LA School), and he is a senior research associate of the FAPESP Research Centre for Innovation and Diffusion in Neuromathematics and Scientific Coordinator and Member of the Advisory Board of the Brazilian Platform for Drug Policy and the Chacruna Institute for Psychedelic Plant Medicines. His most recent book, The Oracle of Night: The History and Science of Dreams, was released by Pantheon in 2021.
With the power dynamics inevitably involved in psychedelic therapies and underground facilitation, can consent truly be established? And what can we learn from past abuse?
On behalf of all the survivors of psychedelic guide abuse, or abuse under any other non-ordinary states of consciousness such as hypnosis, meditative states, or other forms of induced or spontaneous trance and non-consensual shaktipat, I write this piece to elucidate how consent is not as simple as asking beforehand in a preparation session, or reiterating before the client “goes under/in.”
We need to begin by defining our terms, and understanding what we mean by consent is the first step in unpacking this issue.
Consent: permission, choice freely given with full acknowledgement of context, circumstances, possible consequences, and with full agency.
Consent is not only about the event/action/behavior itself in the moment, but the consequences of it, and the context within which those consequences unfold. For example, if a person is abused, psychologically tortured in a session, or touched in a way that triggers past trauma, then the fallout of that – as well as what resources and needs arise in the recovery process – have to be taken into consideration as well.
If the guides/facilitators, therapists, and other space-holders do not know about spiritual emergence/y as the deepest traumas come to the surface, then they will potentially hospitalize folks, call them crazy, and then de-validate any of the grievances they may bring up about the guide abuse – when in fact, it was them that induced the state of emergency in the first place, and therefore it is their responsibility to have proper resources and support in place for these inevitable openings.
Our new 12-month certificate program, Vital, begins April 19th. Registration is closed, but sign up for the waitlist for next year’s edition now at vitalpsychedelictraining.com!
These questions need to be asked to assess the power dynamics and ability or inability to give consent under certain conditions:
Is it truly possible to give consent if:
We are in trauma states (The 4 Fs: Fight, Flight, Freeze, Fawn)?
We are under the influence of entheogens or in other non-ordinary states of consciousness?
We have a history of violation of consent (rape, assault, abuse)?
The guide/facilitator is in an authority position?
We are less privileged due to race, gender, socioeconomic status, etc. (power dynamics)
Is consent truly consent if the aforementioned conditions are present?
Methods of Manipulation and Control
Another way to begin to protect ourselves and others from abuse within these vulnerable spaces is to understand more deeply some of the methods of manipulation and control that abusers use to coerce their victims.
These are the tactics that abusers use to prey upon the vulnerability from our trauma – AKA overriding consent.
Playing the victim themselves, to elicit the Fawn Response: By saying that they are the ones in need or the vulnerable one, they elicit caring and compassion from their victims, thus creating a false sense of security and intimacy, as well as being seen as innocent.
Pointing the finger at the other, saying they are the crazy one; gaslighting: They say that someone else is the crazy one to de-validate any grievances or anything that might be heard about them or their work from former clients who were harmed.
Repetition of narratives, AKA brainwashing: This is an actual technique used by lineages of guides and torturers to break down and break open peoples’ psyches so that they will be receptive to whatever narratives they want to implant.
Cues/post-hypnotic suggestions to activate certain feelings, thoughts, and behaviors: Similar to brainwashing, some abusers use cues to manipulate the victim’s actions.
Claiming that you are not trying or working hard enough: This is the victim-blaming portion of the protocol, where the abuser says if you just let go more, take more, break down your resistance/ego more, then you will be able to heal, creating a gatekeeper effect.
Romanticizing the pain and suffering they cause as for for our benefit: They will say things like, “This is for your healing” or “This is your warrior training” or “The universe/ancestors want you to do this.”
It’s like the opposite of false memory implantation – using actual memories and vulnerabilities against their victims to take control and exert power over them. They know where it hurts and how to take advantage of those wounds for their own benefit. And how do they know the vulnerabilities? Because they are your therapists too! They know all of your wounds, trauma, and history because you have come in good faith to them for healing, and instead, these vulnerabilities are used against you.
This perspective – the veil lifting and seeing things as they are, Shadow and all – may seem bleak or hopeless, but in fact, it is the opposite. It is the opportunity to create safer, more effective psychedelic therapies, facilitators, and guides, which can allow us all to feel like this renaissance is truly an evolution of consciousness, and not the Wild West; its reckless charlatans and gurus leaving wreckage in their wake as they burn though the souls of their victims.
How Do We Persevere?
So what are the implications here? How do we vet and refine our discernment to weed out the psychopathic and sadistic? Is it even possible to ask for consent or to properly give it under these circumstances? Is that the end of the story? So consent isn’t truly possible in these cases?
Of course not, no. What this means is that we need trauma-informed guides, facilitators, and space-holders, who are well-versed in spiritual emergence/y, and who are as close as possible to the same level of privilege as their clients; which means we need more guides of color, more access to training, more BIPOC representation in the media and at conferences, and more financially-accessible and ethically-held medicine spaces.
Check out Michelle and Kyle’s course for understanding and supporting spiritual emergence, “Awakening Healers.”
And we need to check power and privilege, and understand trauma history and how to work ethically with trauma survivors. We need to implement peer-support in medicine guiding/facilitation and not hierarchy systems, which lends itself to overt or covert power-dynamics and the abuses that manifest from that. Also, we need to create accountability structures though independent bodies that are not beholden to economic, legal, or political pressures, which can protect the survivors from incriminating themselves when reporting abuse. There are many organizations that are often driven by agendas for funding and research, and have silenced concerns for decades. Survivors are through being silenced, and are now part of the solution for creating safer, more effective protocols and standards. Let their voices be heard, and help to create a safer, more ethical psychedelic movement.
Feb 15, 2022 In this episode of the Psychedelic Therapy Frontiers podcast, Dr. Steve Thayer and Dr. Reid Robison are joined by Kyle Buller from Psychedelics Today (https://psychedelicstoday.com/). Kyle is a mental health counselor, transpersonal breathwork instructor, and psychedelic therapy educator. Co-founded by Kyle and Joe Moore, Psychedelics Today is an education platform committed to exploring and discussing the field of psychedelics and non-ordinary states of consciousness.
In this episode of the podcast (and episode 3 of Vital Psychedelic Conversations), Kyle interviews Kylea Taylor: M.S.; LMFT; Grof-certified Holotropic Breathwork® practitioner; Vital teacher; and author of several books, including her newest, The Ethics of Caring: Finding Right Relationship with Clients (which you can win a signed copy of here).
She discusses her past and what she’s doing now, from learning breathwork from the Grofs at Esalen; to working through (and with) her 5-year spiritual emergency; to her work bringing breathwork to a residential substance abuse recovery program; to her InnerEthics® program, which she developed after realizing how traditional ethics education didn’t come close to covering the intricacies of working with non-ordinary states of consciousness.
They talk about how much the psychedelic community undervalues the reciprocity and knowledge one can gain from sitting for someone else; how a facilitator’s simplest question to ask when looking to intervene is, “Who’s this for?”; the need for therapists to have their own experiences and learn the territory of the medicines they’re using, how our multiple selves complicate already-complicated relationships, and three tools likely not yet mentioned in this podcast: Angie Arrien’s naming ceremony, SoulCollage®, and Brainspotting.
Plus, they talk about having dreams about taking psychedelics (have you ever had one?), and Kyle tells the story of his psychic dream – or as this show notes writer believes, his “making-prank-calls-while-sleeping” incident (sleep-pranking?).
Notable Quotes
“Informed consent is completely different, because how do you describe what a person is going to go into if they’ve never been into it? They’ve never had an extraordinary state of consciousness, let alone experience with that particular medicine. So you can describe it, but do they understand it? And can they really make an informed consent?” “There’s exponential kinds of connections between the multiple selves, and it gets really confusing to sort out, so it’s another reason to know ourselves as well as we can, and to have experience in these states, and also to trust – when in doubt, go back to trusting the inner healing intelligence.” “Therapists, with psychedelic-assisted therapy, need to be properly prepared and experienced, and know their scope of practice, and know themselves. I think trainings are doing a good job and we’ll get better as we go, but I think experience is the part that it seems like people are going to have to take care of themselves. If they really want to do the best they can for their clients, then they need to do it. We need to do it. We all do.”
Kylea Taylor, M.S., LMFT developed and teaches InnerEthics®, a self-reflective, self-compassionate, approach to ethical relationship with clients that she is now teaching in psychedelic psychotherapy trainings. Kylea started studying with Stanislav Grof, M.D. and Christina Grof in 1984 and was certified by them as a Holotropic Breathwork® practitioner in 1990. She worked with Stan Grof and Tav Sparks as a Senior Trainer in the Grof Transpersonal Training throughout the 1990s, and worked for nine years in a residential substance abuse recovery program. She is the author of The Ethics of Caring: Finding Right Relationship with Clients, The Breathwork Experience, Considering Holotropic Breathwork® and is the editor of Exploring Holotropic Breathwork®.
In this episode of the podcast, fresh off the heels of the announcement of (and opening of applications for) our new 12-month certificate program, Vital, Kyle sits down for episode 2 of Vital Psychedelic Conversations; this week with two figureheads lending their knowledge to the course: Annie & Michael Mithoefer.
While also supervising and training therapists for MAPS-sponsored trials, the Mithoefers are probably best known for groundbreaking trials they’ve been involved in, including two MAPS-sponsored Phase II trials studying MDMA-assisted therapy for PTSD, a study providing MDMA-assisted sessions to therapists completing the MAPS therapist training, and a pilot study treating couples with MDMA-assisted therapy combined with Cognitive Behavioral Conjoint Therapy. They are also both Grof-certified holotropic breathwork practitioners, and huge proponents of breathwork in general.
They talk about why they connected so much with breathwork and how it cured Annie’s panic attacks; how they’ve used breathwork in their practice in conjunction with therapy; what trusting or following the process means (for the patient and facilitator); the concept of the inner healer (or “inner healing capacity”); touch and bodywork in therapy; how the communal, group process aspect of breathwork is inspiring ideas for group MDMA sessions; how we can best scale therapy; updates on new trials for 2022; and their best advice and biggest takeaways they’ve learned from decades in the field.
Notable Quotes
“It’s not that you never offer any direction or engage and help people if they’re stuck, it’s that that only happens in service of what’s already trying to arise spontaneously; that the point is to give plenty of time and encouragement for that process to just take its own path and unfold in its own way. …You may be offering quite a bit sometimes in terms of support and direction, but it’s only in service of what’s already happening.” -Michael
“Stan learned it by working directly with thousands of people with LSD in the beginning. And of course, other cultures (in some cases, for hundreds of thousands of years) have developed knowledge about wise use of these kinds of states. So it sounds a little new-agey or woo woo (‘Trust the process’ and the inner healing intelligence, you know), but it’s based on reality that people have observed for a very long time. And we see it. We just get it reaffirmed again and again.” -Michael
“People do get better with love and care. Sometimes it’s just that extra fifteen or twenty minutes at the end of a breathwork session when somebody is still kind of shaky, or sitting with them and having a meal after breathwork, or the extra times that you take with people. Supporting people: it really makes a difference.” -Annie “There’s something great about breathwork, to know that you can have these experiences without taking anything – just having that experience of: ‘Wow. These places are not as far away as I thought they were.’” -Michael
Annie Mithoefer, B.S.N., is a Registered Nurse living in Asheville, North Carolina, where she is now focused primarily on training and supervising therapists conducting MAPS-sponsored clinical trials, as well as continuing to conduct some MAPS research sessions in Charleston, South Carolina. Between 2004 and 2018, she and her husband, Michael Mithoefer, M.D., completed two of the six MAPS-sponsored Phase II clinical trials testing MDMA-assisted therapy for PTSD, as well a study providing MDMA-assisted sessions for therapists who have completed the MAPS Therapist Training, and a pilot study treating couples with MDMA-assisted therapy combined with Cognitive Behavioral Conjoint Therapy. Annie is a Grof-certified holotropic breathwork practitioner, is trained in Hakomi Therapy, and has 25 years experience working with trauma patients, with an emphasis on experiential approaches to therapy.
About Michael Mithoefer, M.D.
Michael Mithoefer, M.D., is a psychiatrist living in Asheville, NC, with a research office in Charleston, SC. He is now a Senior Medical Director at MAPS Public Benefit Corporation (MPBC). He is a Grof-certified holotropic breathwork facilitator, is trained in EMDR and Internal Family Systems Therapy, and has nearly 30 years of experience treating trauma patients. Before going into psychiatry in 1991, he practiced emergency medicine for ten years. He has been board certified in Psychiatry, Emergency Medicine, and Internal Medicine, and is a Fellow of the American Psychiatric Association, and Affiliate Assistant Professor Department of Psychiatry and Behavioral Sciences Medical University of South Carolina.
“Education is not the filling of a pot, but the lighting of a fire.” – William Butler Yeats
The interest in psychedelics as a therapeutic tool is growing at a rapid pace, both by individuals looking for better solutions outside the current medical regime, and by practitioners looking for new and better ways to help their patients.
Even though regulatory systems lag behind, a paradigm shift in healthcare is clearly under way. The demand for safe, ethical, and effective treatment and integration is growing exponentially. Now more than ever, it is vital that educated, informed practitioners are ready and equipped to provide care when called upon.
After enrolling over 9,000 students in our eLearning platform and graduating over 500 in our eight-week, 47-hour program, Navigating Psychedelics, we’ve heard a lot about what people want and need from an in-depth training program – and also, what isn’t being offered out there. Our students have told us that training can be overly prescriptive, rigid, and clinical, with logistical hurdles and barriers to acceptance.
That’s where Vital comes in. Our new 12-month certificate program fills gaps in the current landscape of psychedelic training – both in course content and structure – and takes a holistic, experiential, and reflective approach to psychedelic practice and integration.
Here’s how Vital is different:
A truly inclusive training program. Vital welcomes students of all backgrounds – licensed or unlicensed clinicians, medically-trained healthcare professionals, legacy operators, and integrative wellness practitioners. All previous experience, informal learning, and formal training will be considered when reviewing applications.
A drug agnostic approach that equips practitioners with the knowledge to work with clients who use or are interested in exploring a range of psychedelics. There is no one-size-fits-all approach to psychedelic therapy, and the potential benefits are not limited to a handful of substances.
A holistic curriculum balanced between clinical and scientific research and protocols, while also focusing on philosophical self-reflection, transpersonal psychology, Indigenous traditions, and somatic approaches to healing trauma.
An opportunity to learn from and interact with world-renowned researchers at an economical scale.
A modular and malleable curriculum with finance and scheduling flexibility, designed to accommodate a global student population.
An open forum on harm reduction that encourages honest discussion on personal experiences with substances in a safe space.
Vital at-a-Glance:
Vital was created by Psychedelics Today Co-Founders Joe Moore and Kyle Buller, M.S., LAC, and a team of people dedicated to helping others master the elements of psychedelic practice and contribute to the healing of the world. The culmination of over 15 years of work in psychedelic practice, the first Vital cohort of 100 students kicks off on “Bicycle Day,” April 19th, 2022.
Course content is packaged into five core modules, covering: psychedelic history and research; clinical therapies; the art of holding space; medical frameworks; and integration theories and techniques. Each comprehensive module spans between seven to ten weeks of specialized lectures led by guest expert teachers as well as more intimate study groups facilitated by our instructors.
The best teachers are those who show you where to look, but don’t tell you what to see.
-Alexandra K. Trenfor
World-Class Teaching Team:
Over the years, Psychedelics Today has developed relationships with a humbling number of leading researchers, historians, clinicians, and bright minds working in research and application, advocacy, spiritual practice, and patient care. We’ve assembled some of the very best to work with Vital students, including:
Ben Sessa, M.D. Chief Medical Officer at Awakn Life Sciences, licensed MDMA and psilocybin therapist, academic writer, and psychedelic psychopharmacology researcher.
Ayize Jama Everett, M.A., M.F.A. Fiction writer, practicing therapist, and Master’s of Divinity who teaches a course called “The Sacred and the Substance” at the Graduate Theological Union.
Richard Schwartz, Ph.D. Developer of the Internal Family Systems (IFS) model, adjunct faculty of the Department of Psychiatry at Harvard Medical School.
We believe that no amount of learning from clinical studies, reading textbooks, or listening to an instructor can make up for first-hand experience with holotropic states. Furthermore, we believe openness and sharing of experience validates clinical evidence, helps inform research and the approach to patient care, and helps undo stigma and misguided perceptions caused by the war on drugs.
Throughout the course, students will be challenged to deepen their personal understanding of psychedelics and reignite their transformation by attending one of six experiential retreats (in either the United States or abroad). Stay tuned for more details on dates, locations and pricing.
While the deeply experiential nature of the course supports the growth of practitioners, the course is also designed to equip participants with the knowledge they need to establish a psychedelic-informed practice from the ground up. For coaches, facilitators, mental health and complementary health practitioners, Vital provides a thriving community of specialists to support their mission.
Promoting Equal Access and Career Development:
Fair access to psychedelic medicine begins with fair access to essential education. In addition to flexible payment plans for all students, we’ve committed to provide scholarships for 20% of students from each cohort, sponsoring up to 100% of tuition to support their mission.
Scholarships are awarded on a case-by-case basis, and are reserved for people who:
Are in demonstrated financial need
Identify as BIPOC
Identify as LGBTQIA+
Are military service members/veterans
Serve marginalized or geographically underserved communities
At the end of the program, graduating students receive a certificate in Psychedelic Therapies and Integration. CE credits will be offered, but stay tuned for more details.
Full details on scholarships and credits are in the extended course brochure, available on the Vital website.
Program registrations are open now, and close at midnight EST on March 27th. Acceptance will be offered based on eligibility and order of submission (with priority to students receiving scholarships). Once all seats in the initial cohort are filled, subsequent approved students will be placed on a waitlist and invited to join the course when a spot becomes available. Interested students are encouraged to apply as soon as possible. Apply here.
In this episode of the podcast, Kyle sits down with Joe Tafur, MD, for the first episode in our new weekly series, “Vital Psychedelic Conversations.”
Vital is the name of our new 12-month certificate program launching in April, and each episode of Vital Psychedelic Conversations will feature one of the teachers we’ve been honored to be able to include in the program. While the official announcement with all the important details is coming next week, we’re pretty pumped about Vital and wanted to start this new series today!
Joe Tafur, MD, is a family physician and author who was trained in ayahuasca curanderismo at the Nihue Rao Centro Espiritual in Peru. He also is a co-founder of the Church of the Eagle and the Condor, which is currently pursuing legal protection for ceremonial ayahuasca use.
He discusses the frustrating application process for the church; the idea of the substance only being a part of the experience; how a truly transpersonal moment seems to make people start asking about the sacred; the scientific community’s struggles with the transpersonal; soul retrieval; the interconnectedness of all things; and he makes an argument for allowing religious tokens in therapeutic containers. And he talks about what we can learn from Indigenous tradition and their holistic and health-focused mindset, connection to nature, relationship with substances, and embrace of spirituality.
Through the Church of the Eagle and the Condor, Tafur is running a webinar series to speak to and learn from Indigenous elders called “Wisdom of the Elders.” The first is next week, January 27th, and features Diné Elder Josie Begay-James.
Notable Quotes
“People are with this kind of direction: they’re partying, they’re having a great experience, maybe making some big memories, maybe they are shifting, some people are growing, maybe not. But then, on this other side, you have this high percentage of people really turning around decades-old mental health issues. So that’s a big, big difference. So what’s going on in those sessions? And what’s going on around those sessions? The focus has been the substance, the substance, the substance, the substance. They think they can sell it, whatever they want to do with it. But that other meat of what’s happening with people – there’s a lot of mysterious elements in that space.”
“The ones who are doing the psychotherapy with ketamine, I find, over and over again, that they become very curious about the sacred. …Those people want to know about people that have experience with this, from that perspective (from a spiritual perspective), because you can tell them: ‘These molecules did this and these neural patterns did that,’ but they’re not satisfied. It doesn’t answer the questions that they’re seeking, about: ‘What do I do with that?’” “Why does it have to be separate? Why would it be separate? It’s not separate, I don’t think, in sports. I don’t think they try to get people to dissociate from their intuition and their feeling. I think they encourage it strongly. …They’ll say, ‘He’s possessed!’ They’ll say a person is ‘inspired.’ Similarly with music; you wouldn’t have that ‘I’m not going to try to feel into my soul while I’m on stage.’ It’s actually the opposite, is the discussion quite often. Isn’t that true? Isn’t that what sells tickets all over the world? Isn’t that what distinguishes the big ticket sellers in general, that they’re able to tap into something that is transpersonal?”
“We have to deal with the transpersonal, not only for the sake of expanding ourselves and to be better people or to grow, but it’s a matter of health. That’s the reason.”
Joe Tafur, MD, is a Colombian-American family physician originally from Phoenix, Arizona. After completing his family medicine training at UCLA, Dr. Tafur spent two years in academic research at the UCSD Department of Psychiatry in a lab focused on mind-body medicine. After his research fellowship, over a period of six years, he lived and worked in the Peruvian Amazon at the traditional healing center Nihue Rao Centro Espiritual. There he worked closely with master Shipibo healer Ricardo Amaringo and trained in ayahuasca curanderismo. In his book, The Fellowship of the River: A Medical Doctor’s Exploration into Traditional Amazonian Plant Medicine, through a series of stories, Dr. Tafur shares his unique experience and integrative medical theories. After the release of his book in 2017, Dr. Tafur has been spending more time in the U.S. and with his spiritual community in Arizona, has co-founded the Church of the Eagle and the Condor (CEC). This spiritual community is dedicated to promoting the spiritual unity of all people with the Creator through the practice of traditional Indigenous spirituality and sacred ceremonies. The CEC is currently pursuing legal protection for their practice of sacred Ayahuasca ceremony. Dr. Tafur is also a co-founder of Modern Spirit, a nonprofit dedicated to demonstrating the value of spiritual healing in modern healthcare. Among their projects is the Modern Spirit Epigenetics Project, an epigenetic analysis of the impact of MAPS MDMA-assisted psychotherapy. Their first results have now been submitted for publication. He is currently a fellow at the University of Arizona’s Center for Integrative Medicine. Additionally, he is involved the Ocotillo Center for Integrative Medicine in Phoenix, Arizona. To learn more about his work you can also visit Drjoetafur.com.
In this episode of the podcast, Kyle and David interview Andrew Penn: nurse practitioner, Co-chair for Sana Symposium, Associate Clinical Professor at the University of California–San Francisco School of Nursing, and Co-founder of OPENurses; a professional organization for nurses interested in psychedelic research.
Penn discusses how he came into the world of psychedelics and how in his early days, the only way to talk about psychedelics for therapeutic use was in a sidebar to speeches on drug abuse. He talks about reframing that conversation, the progress he’s seen, why psychedelics and SSRIs may actually work together, microdosing and the placebo effect, how the placebo effect may play into other aspects of healthcare you might not have thought about, why psychedelics needs more skeptics, and the importance of care in healthcare.
He talks about OPENurses (The Organization of Psychedelic and Entheogenic Nurses), which he co-founded to make sure more nurses are involved (and front-facing) in the psychedelic space. He feels that nurses are more prepared for psychedelic treatment than other professions, but the biggest hurdle they’ll face will be learning when to not intervene and just let something play out (something that’s very common in psychedelic therapy but not at all in traditional medicine).
And lastly, he talks about how we need to stop romanticizing the idea that you need to have a huge experience with re-lived trauma in order to heal, and that we should have an appreciation for the subtle – that change is gradual, and often it’s more about creating a better relationship with the thing we can’t change than eliminating it.
Notable Quotes
“Back in those early days, the only way I could talk about psychedelics was, essentially, embedded in a talk about drug abuse. In fact, the very first time I talked about MDMA as a therapeutic agent was in a talk about bath salts.”
“I think it’s interesting that as a community of people who really are not necessarily rational materialists – you know, we’re not necessarily mechanistic in our way of thinking – that people get really mechanistic about microdosing; that it’s like, ‘Oh, it’s this tiny little dose of LSD or whatever that is making this change.’ And I’m a little puzzled why people want to essentially take a regular dose of a psychedelic. I mean, how is that any different than taking a regular dose of Fluoxetine or Lexapro or something like that? I just don’t see it as being that radical, quite honestly. …LSD is not a naturally-occurring compound. It has to be synthesized. So does Fluoxetine. I mean, maybe psilocybin, but I’m just a little puzzled by the phenomenon.”
“I think psychedelics needs more skeptics, honestly. I think we either have to bring the skepticism ourselves, or other people and other forces who are not as convinced as people in the psychedelics community will do it for us. I used to have a therapist years ago who liked to say, ‘Do you want to be uncomfortable on your terms or on somebody else’s?’. And I think that’s a great question that the psychedelics field could ask themselves, because if we don’t bring this level of scrutiny and skepticism to our work, then other agencies like the FDA will.” “When you’re trained in healthcare, we’re often explicitly taught (or implicitly taught) that we need to dosomething; you know, what’s the intervention? What’s the thing you’re going to do? And often in psychedelics, the thing to do is to hold still. …I think the drive to intervene is well-intended but often, ultimately can be incorrect. What we all need to learn (not just nurses, but just all of us in this profession) is that sometimes the right answer is to watch this unfold. Choosing not to intervene is actually an active process.”
Andrew Penn, NP was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. He has completed extensive training in Psychedelic-Assisted Psychotherapy at the California Institute for Integral Studies and recently published a book chapter on this modality. A leading voice for nurses in psychedelic therapy, he is a cofounder of OPENurses, a professional organization for nurses interested in psychedelic research and practice and was a study therapist in the MAPS-sponsored Phase 3 study of MDMA-assisted psychotherapy for PTSD and is a Co-I in the Phase 2 Usona sponsored study of psilocybin-facilitated therapy for major depression. Additionally, he is a co-author in a recent article in the American Journal of Nursing on psychedelic assisted therapies, the first in 57 years. He is the Co-chair for Sana Symposium, a leading national CME meeting on psychedelic therapies.
Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing and is an Attending Nurse Practitioner at the San Francisco Veterans Administration. He has expertise in psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. As a steering committee member for Psych Congress, he has been invited to present internationally on improving medication adherence, cannabis pharmacology, psychedelic-assisted psychotherapy, grief psychotherapy, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. He also keeps regular blogs on all things psychiatric and has been interviewed in Forbes, the Los Angeles Times, and on the BBC World Service.
In this episode of the podcast, Joe interviews co-founder and CEO of Journey Clinical, Jonathan Sabbagh.
Journey Clinical is a telehealth platform specializing in remote and in-person ketamine-assisted psychotherapy, but what makes them a bit unique is their larger focus on the needs of the psychotherapist, by helping approved psychotherapists integrate KAP into their practices, and by building out a platform to facilitate the delivery of customized treatments of all modalities to their patients under the same umbrella – the idea being that more specialized treatments can lead to more patient progress and less therapist burnout, which is a bigger problem than many people realize.
Sabbagh tells the story of his own burnout after 20 years in finance, which led to ayahuasca and a career change, and discusses data privacy; why ketamine is just an adjunct; how Journey’s process works; the importance of building a safe container (in therapy and digitally); wearables and the future of combined tools; what he’s most excited about; what it meant to see his company’s banner hanging at Horizons; and why it’s important to have a growing industry be led by true believers.
Notable Quotes
“I think people don’t talk about this enough – about the impact of being with patients who are stuck and who are not progressing in their therapy for years – and that’s really a big driver of therapist burnout. And we’ve had people work with patients who were stuck, really stagnant in their progress, have a few ketamine sessions and have major breakthroughs at a reasonably low dose, and say, ‘Wow, this person has never been so open, this has changed the psychotherapy.’ And that really re-energizes them and I think that is just really wonderful.”
“People are looking for ways to feel better, mental health isn’t taboo anymore. And so I think that as we progress, we’ve got technology, psychedelics, there’s a lot of work being pushed forward, openness to mindfulness-based practices; and I think they’re all going to support each other.”
“I think one of the beauties of the stage where we’re at in our industry (and also the nature of our industry) is that it’s still believers that are building it out. And so we’re all figuring ourselves out a little bit but we care about doing this. We’ve got a personal stake and personal experience into it and I think that’s true for the majority of people involved.”
Jonathan Sabbagh the co-founder and CEO of Journey Clinical. He spent the first 20 years of his professional career working in finance, where he occupied a variety of roles including building two businesses from the ground up. While building one of them, he suffered a burnout that was the result of undiagnosed post-traumatic stress disorder. After being heavily medicated, suffering from substance abuse issues, and undergoing a lot of psychotherapy, Jonathan finally found relief in a series of traditional ayahuasca ceremonies and ketamine-assisted psychotherapy; experiences where he discovered he needed to lead a more integrated life and to be in service to others. He quit finance and went back to school to study clinical psychology. While he was on his path to becoming a clinician, he felt the need to integrate his background as an entrepreneur with his long-term goal of becoming a psychedelic therapist in order to expand access to psychedelic-assisted psychotherapy. This is the genesis of how Journey Clinical was born.
In this week’s Solidarity Fridays episode, we tried to have a 2-parter, but like many things in 2021, that just didn’t quite go as planned. Hopefully, the Compass Pathways patent analysis (with patent attorney Stefan J. Kirchanski) can be re-recorded for a future episode. Stay tuned…
In the part that was successfully recorded, Joe and Kyle highlight some recent news: most notably the emergence of the Natural Medicine Healing Act, which will allow Colorado voters to decide whether or not to legalize possession and personal cultivation of ibogaine, DMT, non-peyote-derived mescaline, psilocybin, and psilocyn up to 4 grams (of the actual drug, meaning 4 grams of psilocybin, not 4 grams of mushrooms containing psilocybin), as well as establish “healing centers,” where adults could receive treatment from trained facilitators.
They then cover the University of Texas’ Dell Medical School opening a center to study psychedelics, YouTube user Psyched Substance’s recent admission that his drug use had gotten out of hand and he has quit everything, and Colorado health leaders working to establish specific guidelines around how police, paramedics, and EMTs handle ketamine – which obviously needs to happen after Elijah McClain’s 2019 death from being forcibly given entirely too much.
Also discussed: drug exceptionalism, Carl Hart, Run Ronnie Run!, and how much having family involved in ketamine-assisted therapy could help with the process (even if they have absolutely no understanding of it).
Notable Quotes
“Yes, decriminalizing psychedelic compounds is a step in the right direction. To me, it’s not a holistic step, because we’re still putting people in jail.” -Joe “We do need situations like this with really weird drugs like ketamine. …Are the authorities using it properly? And I think this is a good sign that, in some cases, even though it’s years late, we can improve drug policy.” -Joe
“You have this massive transcendent experience. Who’s to say your friends, family, and people you’re around are going to have any way to relate to that, especially a way that’s positive for you?” -Joe
In this week’s Solidarity Fridays episode, Joe and Kyle sit down for an old fashioned freestyle session, taking a macro dive into microdosing.
Inspired by their conversation with James Fadiman from a few weeks ago, they discuss all things microdosing: Why people are doing it, what they’re using, possible negative effects, how it could work with pain (pain management and/or neurogenesis), what other indications it could help, how research studies are pretty limited (yet very polarizing), how other life variables are likely at play when microdosing, and how the classic self-blinding study that many deemed the death knell for microdosing should actually be seen as the beginning of a long road of research.
Joe then shares an Instagram post from author Kelly Starrett that sarcastically showcases the problems with physical therapy in a careless healthcare system, which leads to a conversation about how one decides what a good outcome is in mental health therapy: What are the patient’s goals and how do they differ from those of the therapist (or insurer)? How do you measure progress? Can we avoid a model of “therapy forever”? And they discuss the problems with self-scoring, high cocaine use being linked to strokes, the coaching industry, chronic pain, Star Trek, and reconsidering the use of the word, “overdose.”
Notable Quotes
“This thing needs to be a long conversation. This isn’t one study and done because [Balázs Szigeti and David Erritzoe] did that self-blinded, self-reported study with a lot of samples. That’s not the end of the story. That’s the beginning of the story.” -Joe
“It would be interesting to get some data around somebody’s day. How are they actually creating their day? Are they starting off with an intention that this is going to help them? [Are] they putting a lot of value on it? Are they doing any meditation once they take their microdose? Are they engaging in any sort of ritual? Anything to enhance that? …What type of role do those other extracurricular activities play in enhancing wellbeing? …Is it the microdosing or is it actually the whole day and the activities that you’re engaging in and your mindset around: ‘This is going to be helpful for me’?” -Kyle
“I think we have to thank microdosing quite a bit for where we are in psychedelics today (no pun intended).” -Joe “Don’t just shut the door on microdosing. Understand [this] thing is really complex and we don’t know much yet. But some people? It’s fucking saving their lives.” -Joe
In this episode, Joe and Kyle interview CEO & Co-founder of Nue Life, Juan Pablo Cappello, from his home in Miami during the Wonderland conference.
Cappello first talks about growing up in Chile and provides some history; covering how peyote became religious and how Catholicism spread through the Americas like a franchise system. And he talks about his family’s relationship with San Pedro, his entrepreneurial past (starting the first online bank in Latin America), and how selling that company for $700 million felt like an abject failure.
He discusses how the idea of depression and PTSD being symptoms of an unaddressed root cause led to the creation of Nue Life, and what he wants to do with what he considers a primarily data-based company: use the massive amounts of data connected devices are already harvesting from us (digital phenotyping) for our benefit rather than our detriment. He believes most medical models focus primarily on the continued income from maintenance medications like antidepressants, and instead, A.I. could use this data to recognize patterns in behavior and make recommendations based on each user’s specific data points – a sort of health ecosystem attuned to what works best for each person.
While he’s very excited about the progress so far (data from 2k people, Nue Life being licensed in five states with five more coming soon), he also talks about his concerns with the current psychedelic gold rush: how Big Pharma is pushing pioneers in the space into restrictive models, and why we will soon see a flame-out of many of these emerging highly-appraised companies.
Notable Quotes
“At the height of the drug war under Clinton, we had 2.2 million people going to jail for drug crimes. This year, it’ll be 2.1 million. So we still have huge, huge numbers of people being incarcerated and going to jail, and for me, that’s because of the way we’ve managed the cannabis industry. And I really, especially at a conference like this where it becomes about the money (not about the impact); I’m very, very concerned that we’re going to find ourselves missing this once-in-a-generation opportunity to make real progress. And real progress really begins with decriminalizing these amazing substances.”
“We’re not a psychedelics-focused company. We’re a mental wellness-focused company that’s going to use whatever technologies are available to drive these extraordinary patient outcomes.”
“How can we, rather than having our phones be a source of body dysmorphia and negativity and a place I feel compelled to go to but it ultimately is bringing me down – how can we turn that technology around and have it be something that helps elevate our patients? …We’re constantly giving out [data] but that data can be used, like a lot of tools, for good as well as for bad, and we’re in a position where we’re really saying: let us be one of the first companies that’s going to use this data for good.”
Juan Pablo Cappello is a passionate entrepreneur who believes in the power of technology and innovation to address humanity’s biggest challenges — mental wellness being one of them. In his home country of Chile, Juan Pablo has seen both the trauma caused by years of a military dictatorship and the power of psychedelic therapies to heal that trauma. As Nue Life‘s CEO & Co-founder, Juan Pablo measures the company’s success by how many lives Nue Life positively impacts.
Some commentary on recent events and long-standing issues in psychedelia.
The psychedelic world had a major shake-up in the past few weeks. A few popular teachers in the space had some pretty serious accusations leveled at them by Will Hall, who has previously been on our podcast here and here.
You can read Will’s article on Mad in America here. He had further things to say in this article on Medium.
I’ve been hearing rumors and firsthand accounts related to the accused for a few years now and have been working internally and with allies on the best approach for dealing with it all.
It’s not talked about a lot, but sex and psychedelics are closely linked (drugs and sex generally, for that matter). Think about the sexual liberation that boomed in the 1960s and is still seen in parts of the Burning Man and EDM culture today. Think about how powerful feelings of love and connection can be while on any number of mind-altering substances, and how easily they could morph into something more sexual.
Perhaps you’ve never experienced it, but regularly in psychedelic therapy sessions, sexual feelings do arise and can create challenging dynamics for both the client and therapist to navigate. What does someone in a fragile mind state, dealing with a maze of conflicting emotions and energies, do with an affectionate or sexual feeling they may suddenly have? What does the therapist do? How does either person know they can truly trust the other? This all leads to a big question many may not want to consider: Is it possible to totally divorce sexual feelings and ideas from psychedelic sessions?
I’d suggest that no, it isn’t possible. Psychedelics unleash all sorts of energies without any bias or filter, so why would sexual energy be exempt?
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I believe that psychedelics can be transformative for mental health, religious practice, spirituality, physical healing, creativity, celebration, rites of passage, and even for the development of planet-saving technology — and this is an abbreviated list. Psychedelics are extremely powerful things that can serve as near miracle cures and beautiful spectacles, but unfortunately, they can also be used as weapons.
For a long time on the podcast (and in day-to-day life — sorry, friends), I’ve complained about how I’ve unintentionally taken on the role of the “Psychedelic Police.” Because of my many years in the psychedelic world and my perceived expertise, many folks have divulged negative or abusive stories about what they’ve experienced in underground (and occasionally aboveground) situations. I shouldn’t complain about this, since it’s an honor to be so trusted, and some stories may have helped me side-step traps Psychedelics Today could have fallen into.
It is frustrating though, and puts me in a tough spot.
Due entirely to the drug war, there are serious legal and financial consequences for bringing such things to light on behalf of someone else. What if the story isn’t entirely true? What if it is, but can’t be proven? What if proving it relies on multiple people admitting illegal activity and they’re not willing to do that? I could be hit with cease-and-desist letters, defamation lawsuits, or just be perpetually dragged into court for any number of things. Lawyers are expensive and what’s right doesn’t always win. Without ruining my reputation and finances, and possibly destroying my best tool for bringing positive impact to the psychedelic space (this very website), I have little recourse. We have developed some ideas about the next best steps, but it is hard to know with certainty if we are doing the right thing. So I do what I can, which never feels like enough. I anonymize these stories and turn them into generic ethical warnings, encouraging people to do their research and be as safe as possible.
At the Horizons Conference in 2019, Dr. Carl Hart suggested that immediately ending the drug scheduling system would be an amazing first step in resolving a range of harmful consequences from the war on drugs. Others have proposed that a state-by-state or region-based decriminalization similar to what we’ve seen over the last few years in Oakland, Oregon, and Denver would be the ideal starting point (especially from the perspective of political expediency). Whichever side of the solution you land on, I think we can all agree that we need to fix our laws around controlled substances and plants.
Given that facilitators and guides work with substances that are federally illegal, there could be massive consequences for someone participating in underground work who is apprehended by law enforcement for any reason. For both the facilitator and the participant; consider the attention to detail needed to ensure you’re protected from liability, the knowledge and support systems needed to be able to handle serious medical cases, and the amount of apprehension and secrecy necessary to maintain anonymity for all involved. Add in the complications of how differently an action can be perceived by different people in different mind states, and this almost creates an incentive structure to sweep things under the rug — a bypassing of anything perceived as a threat to the overall good. People who could force change can be, and often are banished from communities for asking the “wrong” questions.
Since so many people are forced to operate in an underground capacity, it makes sense that these problems exist. And they will continue to exist if we can’t have open and honest conversations about what we’re experiencing, and start working together to figure out how to answer so many of these complicated questions within the confines of the drug war.
How do we talk about sex and psychedelics?
What are the appropriate ways to deal with sexual energies and consent in situations where people consume mind-altering substances in situations with clear power dynamic differentials?
How do we report issues of abuse to local leaders and elders?
Will they fight for us?
Do they have any teeth?
What capacity do they have to investigate?
Does the victim have any legal ground?
Will law enforcement toss out reports due to drugs being involved?
What if other senior leaders become complicit in a cover-up surrounding their colleagues?
At what point should leaders step down and elevate new leaders?
Is restorative justice even possible if the victim or perpetrator doesn’t feel safe or supported enough to come to the table?
While some acts are inexcusable, we have to be honest with ourselves and understand that good people make mistakes; bad people can be anywhere; and while it’s easy to blame the individual person, bad policies and dysfunctional systems incentivize bad behavior and can scare good people into silence.
Ending the destructive and racist drug war in the US and internationally would improve safety and transparency in vulnerable spaces that often don’t have much of either. When the legal status of underground work is improved, frameworks for safety can be established, and abusers simply won’t be able to get away with bad behavior to the same degree they can today. When we can be more open, people will be safer, and practices can be improved more rapidly.
Ending the drug war is an enormous undertaking, and while there aren’t clear steps on how to accomplish such an incredible feat, many in this field are working tirelessly to do what they can.
The best thing I can do is to use my voice at Psychedelics Today; creating courses, podcasts, and articles that help normalize psychedelics as part of everyday, contemporary life; shed light on under-discussed topics; and give voices to people who aren’t well-known in the space.
I will continue to do my best to address these tough questions around abuse. I hope you’ll join me.
In this episode, Joe interviews Rebecca Kronman, LCSW: Brooklyn-based therapist offering ketamine-assisted psychotherapy, writer, and founder of Plant Parenthood; a digital platform investigating (and de-stigmatizing) the relationship between family and psychedelics.
She dives into the very controversial topics of psychedelics and parenthood and psychedelics and pregnancy, discussing the safety concerns (medical, emotional, spiritual, and legal); the difficulties of drawing conclusions from inadequate data; the many confounding factors in analyzing children born of psychedelic-using parents; the near impossibility of ethically researching the outcomes of pregnancy and psychedelic use; and why, when you consider the multitude of prescription drugs and unnatural foods so many of us consume, does the idea of a mother taking a psychedelic during pregnancy feel so wrong to so many?
And they talk about much more: the need for affinity groups and how the safety they can provide can lead to better decisions; the concept of considering psychedelics as life-saving medicine (or at least a factor towards the happiness (and therefore health) of the parent); the societal scrutiny mothers face; harm reduction; the idea of addiction being a complication of PTSD; drug exceptionalism; and how disclosing drug use to your children is a great opportunity to move the conversation into one of both compassion and injustice.
“When we look at doing an environmental study (where people are already doing this and then we’re looking at the outcomes), then we have another issue, which is the confounding factors. I can’t put you in a bubble and feed you the food that I want to feed you or [not] expose you to environmental toxins …and not expose you to stress in your personal circumstances and your sociocultural circumstances- that’s not a thing. There’s a lot of different substances that birthing parents are exposed to during their pregnancy, and to parse that out and say, ‘Does this one create a birth defect?’ for example; it’s very, very difficult. And maybe not even possible.”
“We need to really take a look at how the criminal justice and child protective system is intervening in cases where yes, [the] birthing parent is using drugs, but does that necessarily mean that they are not parenting adequately? We’ve made the leap that it must be true that if you’re a drug-using parent, you must be an inadequate parent. But that’s bullshit.” “We’re moving into this phase of psychedelics where people are using these as life-saving treatments. Literally. You don’t take away a life-saving treatment during pregnancy. We don’t have a framework for doing that with SSRIS, for example. We don’t have a framework for doing that with heart medication. So why are we thinking about this so differently?”
Rebecca Kronman, LCSW, is a licensed therapist, mother of two and founder of Plant Parenthood, a digital and in-person community of parents who use psychedelics. She is a psychotherapist with a private practice in Brooklyn, New York, where she offers ketamine-assisted psychotherapy and works with clients to prepare for and integrate after psychedelic experiences. She is also a writer, and wrote “Psychedelics and Pregnancy: A Look Into the Safety, Research and Legality” for us.
In this episode, Joe interviews Jessica Cadoch, MA: Medical Anthropologist, former Executive Director of the Montreal Psychedelic Society, and current Research Manager working at Maya Public Benefit Corporation.
She talks about her psychedelic path and two most important pieces of research: First, how the rites of passage one experiences at a psytrance festival emulates the traditional ritual structure (and how the reintegration back into society is the most important part), and second; the concerns for people in long-term recovery and 12-step programs using substances therapeutically, for getting off their problematic substances, and even recreationally (when those substances have been labelled “dangerous drugs” their whole lives).
She discusses Maya, a platform where psychedelic therapists can gain better insights into their practices by learning from one another’s reports, developing better, more consistent protocols, and creating better qualitative questions and measures for patients. She’s now seeing her main role as bridging the gap between nonprofits and for-profits.
And as this was the rare time Joe was able to record in-person, this episode feels a bit more conversational and far-ranging than some. They also discuss how people view different substances based on if they’re man-made or not, spiritual bypassing, Carl Hart and the dangers of drug exceptionalism, the need to decriminalize all drugs, the Nacirema people, 12-step programs and the risks of 13th steppers, how our culture views medicine as gospel, and how we all need to stop the in-fighting and division within our psychedelic communities and learn to work with the big corporations many are scared of.
Notable Quotes
“What is the real definition of ‘recreational’? It’s to recreate and to reconnect and maybe to fix things. So we have these really strange conceptions around recreational use being almost like an antithesis to therapeutic use.”
“I do not enjoy psychedelic exceptionalism, particularly because I did that. I did that with my best friend who died of heroin. I said, ‘My drugs are better than your drugs. You should come do LSD with me instead.’ And what did that do? It made her feel judged, it pushed me away further, and I almost didn’t get to speak with her before she died to say sorry. And that’s what psychedelic exceptionalism can do, is it puts people who are using other substances into a category lower and lesser.” “In thinking about where [we’re] going with this movement, it’s up to us. We get to write this script, and we get to be a part of it, which is why it’s really important to be in the conversations with the big companies rather than to run away from them.”
“The way that we believe in science is so cultural. We’ll believe it in the same way that another culture might have this faith in a sacrament or might have faith in a certain crystal or a rock. …We idolize the research paper.”
Jessica is a Medical Anthropologist working at Maya Public Benefit Corporation (PBC) as a Research Manager. As the former Executive Director of the Montreal Psychedelic Society, Jessica is passionate about bridging the non-for-profit and for profit world of psychedelic initiatives. With a particular interest in the intermingling of 12-step methods of managing addiction and psychedelic-assisted therapy, Jessica is concerned with ensuring that psychedelic practices are carefully and ethically integrated into modern Western society and culture. Email her at: jessica@mayahealth.com
In this week’s Solidarity Fridays episode, Kyle discusses Hulu’s show, “Nine Perfect Strangers“ with previous guest, Dr. Ido Cohen.
If you haven’t watched “Nine Perfect Strangers” yet, it’s a show that takes place at a boutique wellness resort, promising healing to nine stressed city dwellers as they begin a 10-day retreat. This episode (which does contain spoilers!) focuses on the themes portrayed in the show and how they relate to the psychedelic space, looking at the role of community and accountability when abuse is happening within healing containers (whether at a retreat or in the larger community). They also look at the negative aspects of the show such as poor protocol, lack of consent, and the facilitator, Masha, having her own agenda and providing trauma treatment without being trauma-informed.
For those of us doing our own healing, how do we develop boundaries on saying no when something doesn’t feel right, but let those boundaries down when they take away something meaningful or helpful? How do we learn to discern when the space isn’t more important than the abuse within it? How do we distinguish between a desire for healing and a desperation for it?
Hopefully, shows like “Nine Perfect Strangers” open space for us to think together as a community and create more integrity, support, and honesty around facilitators and psychedelic retreats. And hopefully they also encourage us to become more empowered to acknowledge in ourselves when to draw the line when we don’t feel safe.
Notable Quotes
“When you open yourself up with plants or psychedelics, you really give the other person a non-verbal permission to look deeply at yourself. You’re really putting yourself in someone else’s hands in a very, very vulnerable way, even if you’re an experienced psychonaut.” -Ido
“I think when it comes to abuse, the lines should be very clear. If someone is touching someone inappropriately, that’s what it means. There is no working around it. If you feel repetitively shamed or you don’t feel safe in your body or you feel confused around someone repetitively, that’s a sign. “ -Ido
“Needing that element of death, a real threatening of our safety, does produce something within us at times. It gets us to some sort of experience that goes, ‘Holy shit, this is real.’” -Kyle
Dr. Ido Cohen is based in San Francisco, working with individuals, couples, and groups, and the Founder of The Integration Circle. Ido has been working with individuals and groups in the context of preparing, understanding, integrating, and implementing experiences from altered states of consciousness for the last 7 years. He also has supervised doctoral interns at the California Institute of Integral Studies for the last 4 years. Using Jungian, relational, and holistic psychologies, as well as eastern/shamanic and kabbalistic cosmologies, Ido believes in the ability to work psycho-spiritually and turn the lived experience into knowledge and a meaningful, embodied, and whole life.
Understanding what spiritual emergence and spiritual emergency are, how they differ from psychosis, and how to integrate them as a psychedelic traveler or practitioner.
This is part of our ongoing series on transpersonal psychology and how it can help us understand psychedelic experiences. Check out part 1, ‘What is Transpersonal Psychology?’ here.
In recent years there has been a resurgence of interest in the therapeutic potentials of psychedelic substances within both clinical and non-clinical settings, with many seeking out psychedelics and plant medicines for spiritual purposes and attempts at self-healing. Psychedelics have the ability to catalyze immense shifts in our understanding and perceptions of reality as well as the potential to bring forth that which is latent within the psyche. Although the sudden eruption of psychic content or change in ways of seeing the world is at the core of psychedelic healing, it can be a destabilizing process that occasionally triggers a type of unintended psychological distress known as “spiritual emergency.”
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What Is Spiritual Emergency?
The term “spiritual emergency” was introduced to the field of transpersonal psychology by psychiatrist Stanislav Grof and his late wife, psychotherapist Christina Grof, in the 1980s to refer to a kind of spiritual or transformative crisis in which an individual could move towards a greater state of integration and wholeness. In their groundbreaking book on the subject, Spiritual Emergency: When Personal Transformation Becomes a Crisis, the Grofs describe spiritual emergency as “both a crisis and an opportunity of rising to a new level of awareness.”
Intentionally constructed as a play on words, the term “emergency” indicates crisis, all the while containing within it the term “emergence”, pertaining to the process by which something becomes known or visible, implying that both—crisis and opportunity—can arise. The Grofs thus differentiate between a spiritual emergency and the more gradual, less disruptive process of spiritual emergence.
Compared with spiritual emergency, the process of spiritual emergence, sometimes referred to as ‘spiritual awakening’, consists of a slower, gentler unfoldment of psychospiritual energies that does not negatively affect an individual’s ability to function within the various domains of their life. Thus, spiritual emergence is a natural process of attuning to a more expanded state of awareness in which individuals generally feel a deeper sense of connection to themselves, others, and the world around them.
Conversely, cases of spiritual emergency usually share many characteristics with psychosis, and as such are often misunderstood and misdiagnosed. However, spiritual emergencies differ from psychosis in that they are not suggestive of long-term mental illness, and provide individuals with an opportunity to use their woundedness to go deeper into themselves and find healing.
The fact that the concept of spiritual emergency is not known and widely accepted beyond the context of transpersonal psychology is partially bound up with an age-old argument that has long permeated Western science and culture. In culture at large, spiritual and mystical-type experiences have long been ridiculed and pathologized, being considered delusional and reflective of mental illness. Dominated by materialist approaches to consciousness and mental health, Western science generally lumps spiritual crises together with psychosis, attributing their origins to biological or neurological dysfunction and treating them on the physical level. However, in the context of transpersonal psychology, spiritual experiences are considered to be real and integral to the evolutionary development of the individual.
Inherent to the Grofs’ concept of spiritual emergency is their holotropic model that revolves around the central tenet that we have an innate tendency to move towards wholeness, possessing within us an “inner healing intelligence.” Similar to the way the body starts its own sophisticated process of healing when we injure ourselves physically, the psyche possesses its own healing intelligence that takes place unseen within us. Just like fevers fighting off infections, spiritual crises can be understood as the psyche’s way of signalling that imbalance needs to be overcome as it moves toward a state of greater integration.
Although experiences of spiritual emergency are highly individual, they all share in the fact that the typical functioning of the ego is impaired, and the logical mind is overridden by the world of intuition. Scary and potentially traumatizing, spiritual emergencies can be interspersed with moments of fervent ecstasy in which an individual believes that they have special abilities to communicate with God or cosmic consciousness, giving way to a temporary messianic complex.
Conversely, a person might become possessed by a potent feeling of paranoia, feeling that the universe is conspiring against them, or they may feel detached from material reality, only connected to this realm through a fine, ephemeral thread. Happenings and material objects might become imbued with symbolic, other-worldly meaning. For some it means spirit possession, compulsive behaviors which lead them to forget to eat and sleep, or a soul-crushing sense of depression that makes them choose to isolate themselves from others.
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Spiritual Emergency Triggered By Psychedelics
Although states of spiritual crisis can come about spontaneously, they can be triggered by emotional stress, physical exertion, disease, near-death experiences, childbirth, meditative practice, and exposure to psychedelics, among other things.
Psychedelics, in particular, have the ability to trigger spiritual emergencies in that they rapidly propel a journeyer from one state of consciousness to another in a mere matter of hours. If an individual is not adequately prepared, these sudden encounters with the numinous can be incredibly destabilizing and have challenging, unintended impacts.
Furthermore, psychedelics can activate parts of the psyche, throwing us off balance by rapidly bringing forth material from the unconscious that we need to integrate. The Grofs expand on this further in their book, Stormy Search for the Self: A Guide to Personal Growth through Transformational Crisis, writing, “Occasionally, the amount of unconscious material that emerges from deep levels of the psyche can be so enormous that the person involved can have difficulty functioning in everyday reality.”
According to Kyle Buller, Co-Founder and Director of Education here at Psychedelics Today, M.S. in Clinical Mental Health, and certified Spiritual Emergence Coach, psychedelics and engaging in spiritual and contemplative practices can make individuals more prone to spiritual emergencies. “Psychedelics and plant medicines open us up to new ways of seeing the world, and this new way of being or seeing can be destabilizing for some,” he says.
Additionally, Buller explains that those with existing traumas or underlying mental health disorders are more at risk for spiritual emergency-type experiences. “I come back to Grof’s notion that psychedelics are ‘non-specific amplifiers of mental or psychic processes,’” he explains. “If someone is already dealing with a lot and difficult content is brought to the surface and amplified, they might not be able to contain it without a proper set and setting or support.”
In the context of psychedelics, spiritual crises can occur when there is an expansion of consciousness that happens without adequate containment. For that reason, most spiritual emergencies triggered by psychedelics don’t occur in the context of clinical studies, but rather through recreational use, self-exploration, and even ceremonial use. Arguably, within plant medicine ceremonies, there are clear parameters that contain the experience as it is unfolding, however, upon leaving the container of the ceremony, most individuals go back to their normal, everyday lives, and this shift can be challenging.
Research fellow at the Centre for the History of the Emotions at Queen Mary University of London, Jules Evans, detailed his experience of a psychedelic-induced spiritual emergency in his self-published, Holiday From the Self: An Accidental Ayahuasca Adventure. In Evans’ case, he went to the Peruvian Amazon to participate in an ayahuasca retreat.
Although Evans gave it careful consideration and had a positive experience at the retreat, once he began travelling back to Iquitos, he found himself feeling disconnected, and moreover disorientated. As the days passed by, an eerie and intense feeling of doubt around his sense of reality washed over him. In an article recounting his experience he writes, “When I got texts from loved ones, I thought my subconscious was constructing them. I felt profoundly alone in this fake reality.”
Evans had previously spent time studying ecstatic experiences academically, and was partially familiar with the concept of spiritual emergency, helping him to not “freak out.” However, for most of us, that isn’t the case and when spiritual crises start to unfold, not knowing what is happening can plunge us into a deep state of fear and terror.
Another reason why those who experiment with psychedelics are more prone to spiritual crises is the lack of cultural support. Buller places emphasis on the need for adequate cultural containers, suggesting that the fact that psychedelics and plant medicines are not accepted by dominant culture poses another hurdle for integrating these experiences.
“When a person has a profound experience, where do they turn or seek support? Does the cultural cosmology around them embrace these types of experiences and if not, how does that exacerbate one’s difficult experience?” Buller says.
In Western culture, we have lost the cultural frames and mythological maps that could usher us through intense experiences of psychospiritual opening, a process which we need to go through at times. Reflecting on this subject in a 2008 paper, medical anthropologist Sara Lewis, explored how Westerners are at increased risk for experiencing spiritual crises and psychological distress following ayahuasca ceremonies due to what she describes as a “lack of cultural support.”
Spiritual crises have been suggested to resemble instances of ‘shamanic illness’ as experienced by shamanic initiates in certain Indigenous cultures. Compared with those in Indigenous communities, however, Westerners lack community resources and guidance to contextualize experiences produced by psychedelic plant medicines, and often fear becoming mentally ill as a result.
Distinguishing Between Psychosis and Spiritual Emergency
The Grofs suggest in their book, Spiritual Emergency, that mainstream psychiatry and psychology make no distinction between mystical states and mental illness, tending to treat non-ordinary states with suppressive medication rather than recognizing their healing potentials.
For psychedelic practitioners and integration providers working with those experiencing psychological distress after a psychedelic experience, evaluating whether the individual is a danger to themselves and others, and determining personal or family history of mental health disorders can be incredibly helpful in understanding whether the phenomenon is a psychotic break or a spiritual crisis. An additional indicator is understanding how a given individual relates to their spirituality, ascertaining whether it brings them a sense of hope. Further, it is useful to rule out any form of neurologic or physical disorder that would impair normal mental functioning such as an infection, tumor, or uremia.
Another crucial factor is the client’s ability to understand the phenomenon as an unfolding psychological process that they can navigate internally as well as cooperatively with the mental health provider, being able to differentiate to a substantial degree between their internal experience and consensus reality.
In a 1986 paper on the subject, the Grofs caution, “It is important to emphasize that not every experience of unusual states of consciousness and intense perceptual, emotional, cognitive, and psychosomatic changes falls into the category of spiritual emergency.” Further highlighting that the concept of spiritual crisis is not intended to counter traditional psychiatry, but rather offer an alternative to those who are able to benefit from it.
Thus mental health practitioners looking to learn how to distinguish between spiritual emergency and psychosis must learn there is a fine line between the two which often makes it difficult to discern. While there is a tendency for traditional psychiatry to pathologize mystical states, the Grofs jointly warn of the dangers of “spiritualizing psychotic states”, placing emphasis on the need to use proper discernment around a given individual’s experience.
Speaking to the subject, Buller offers advice, “I would encourage a combination of open-mindedness and critical thinking. For many mental health professionals, this concept is going to push against most of our training, however, we need an open mind to explore this area and do our best to listen to the experiencer.”
In a culture where spiritual issues are not easily understood, spiritual crises can be incredibly isolating and shameful in that the person undergoing them feels that they cannot open up and share about their experience with others for fear of being labeled as “crazy.”
Reflecting on people’s reluctance to share about these types of challenges, Buller offers, “I think this highlights some distrust in the current system around these types of experiences.” He adds, “It also makes me wonder how many people may be struggling with difficult experiences and aren’t reaching out for help because of fearing what might happen if they disclose their experience to a mental health professional.”
For those undergoing a spiritual emergency, it can feel comforting to know that they are not alone in their struggle, and that many other people have been through similarly challenging experiences. It is also helpful to remember that the crisis is part of the healing process, and that it too will pass.
One resource is the Spiritual Emergence Network (SEN), founded by Christina Grof in 1980, or its global sister project, the International Spiritual Emergence Network (ISEN) which provides practical advice for navigating spiritual emergency as well as offering a specialized mental health referral and support service for those seeking help. Additionally, for those merely looking to learn more about the subject, Psychedelics Today offers a free webinar called, “Spiritual Emergence or Psychosis,” which explores some of the research around psychosis and spiritual emergence.
When experiencing a spiritual emergency as a result of psychedelic use, it is important to factor in set, setting, and integration, just as one would factor those components into an intentional psychedelic trip in the first place. In terms of ‘setting,’ the person experiencing the spiritual crisis should seek out a non-judgemental space in which they feel safe and supported—whether that be with a mental health practitioner or in the hands of family and friends.
Beyond the environment, ‘set’ refers to our mindset and the way we frame the experience. Because there is a conceivable amount of stigma surrounding spirituality, cultivating one’s mindset means understanding that there is nothing ‘wrong’ with the person experiencing a spiritual emergency, and that the difficulty may very well be a crucial stepping stone on their personal path to healing.
Lastly, meaning-making in the context of psychedelic integration is of paramount importance as it allows individuals to take the crucial step of transforming negative experiences into something of value, which could take anywhere from a couple of months to the rest of their lives.
When working with someone experiencing a spiritual emergency, it is important to take a destigmatizing and non-pathologizing approach. Recognizing this, Stanley Krippner, psychologist and parapsychologist, wrote in a 2012 paper, “The naming process is one of the most important components of healing.” As such, mental health practitioners working with those experiencing psychological distress after a psychedelic experience need to be mindful in how they frame what is happening.
Spiritual Emergency Beyond the Scope of Transpersonal Psychology
While the Grofs’ concept of spiritual emergency was undoubtedly ahead of its time, there is still room for growth and maturation, and some suggest it may be helpful to use different terminology around the concept.
David Lukoff, professor of psychology at Sofia University and licensed psychologist specializing in the treatment of religious and spiritual crises, was influenced by the Grofs’ concept of spiritual emergency early on in his career, and has partially used the concept to inform his work in co-authoring new diagnostic category of “Religious or Spiritual Problem” included in the Diagnostic and Statistical Manual (DSM) 4 and DSM-5.
Lukoff suggests that although the term spiritual emergency, which is well-known in transpersonal psychology, is not used or necessarily accepted in mainstream circles, spiritual and religious issues are now becoming understood through different terminology.
“I think Stan and Christina nailed the concept, but as soon as you use the term ‘emergency’ in the healthcare field, it implies the worst case scenario in which a person might need hospitalization,” Lukoff tells Psychedelics Today. “The more neutral term ‘problem’ is now used within psychiatry as a result of the DSM category that I helped author, and the term ‘struggle’ is now used within psychology.”
Further, Lukoff emphasizes that he has seen a major shift, even though it is still a minority, in psychology and psychiatry programs on the coverage of religion and spirituality. “I know that the transpersonal world doesn’t always pick up on this, but there is a real renaissance within the healthcare field in which more attention is being heeded to religious and spiritual strengths as well as problems and struggles,” he says.
“There are definitely times when spiritual issues can become crises or conflicts, however, it is also true that for the majority of people their religion and their spirituality are sources of strength, more often associated with positive coping,” shares Lukoff.
In his early 20s, Lukoff experienced his own LSD-induced spiritual crisis in which he believed that he was a reincarnation of Buddha and Jesus, manifested in his present form to unite the peoples of the world. In part, Lukoff attributes his career trajectory as a clinical psychologist and professor of psychology to the psychosis-like transformational crisis he experienced early on.
Reflecting on his own psychedelic-induced spiritual crisis, Lukoff offers the view that careful preparation goes a long way in being able to mitigate the potential negative effects of psychedelics. Even so, it is important not to trivialize or reduce psychedelic-induced spiritual crises to conjectures about “bad trips.” Spiritual crises need not merely be the product of challenging psychedelic experiences as they can be similarly triggered by potent positive experiences.
Spiritual Crisis and The Future of Psychedelic Healing
Psychedelic healing is not linear. It is not as simple as popping a pill and being miraculously cured. Rather, it is a messy process which sometimes involves psychospiritual distress that is integral to the healing process. As medical and mainstream interest in psychedelic substances continues to expand, and more and more people have these kinds of experiences, it is imperative that psychedelic practitioners develop literacy around the concept of spiritual crisis, as well as develop frameworks to help individuals contextualize their challenging experiences.
With increased awareness and use of psychedelics, are practitioners ready to deal with some of the transpersonal experiences that clients will bring to them? Buller emphasizes the need for diverse and nuanced perspectives as we move forward into the psychedelic renaissance.
“While I appreciate the trauma focus and narrative in psychedelic research, I worry that we might end up reducing everything down to psychological terminology, discrediting a person’s experience,” he shares. “What happens when someone has an entity encounter in a psychedelic experience? Do we just reduce that experience down to a possible traumatic event in someone’s life or write it off as unreal because we have a mechanistic understanding of what that experience is?”
Moving towards the future, it is important to remain open-minded, and take holistic approaches that interweave multiple narrative frameworks, including that of transpersonal psychology, through which people can understand and make meaning of their experiences, including the potential for spiritual emergencies and their transformational—yet difficult—outcomes.
Everything you need to know about Carl Jung’s theory of the collective unconscious and how it can help us process, navigate and guide psychedelic journeys.
This is part of our column ‘Psychedelics in Depth‘ which defines and explains depth psychology topics in the context of psychedelics.
A boundless sea rises to engulf the land. A solitary ship floats delicately on its churning surface. On the boat there are two figures, rapidly bailing out water from the deck, while a pair of animals look nervously over the edge. Out of the water bursts forth a massive tree, lifting up the boat in one of its thousand limbs, rescuing the people and the animals from the murky abyss below. The moon blocks out the sun, an eagle soars across the sky, and all falls into darkness…
Dream, psychedelic vision, or ancient myth? Can you tell the difference?
If you answered no, that’s because this outlandish sequence of events cannot possibly be based in objective reality, and therefore must be subject to interpretation. Who’s to say what any of it means—for now it remains a tapestry of evocative images containing infinite avenues where we might create meaning.Perhaps only the dreamer, journeyer, or culture of origin is truly capable of this, since an image’s deeper meaning can only become clear when its context is provided.
What is clear, however, is that the images which emerge in dreams, psychedelic states, and myths share themes in common, which is a foundational principle of depth psychology.
While the patterns or images themselves might be considered ‘archetypes,’ the question of where they come from is our main concern in this article.
Did that story above seem somehow familiar? Did it remind you of other stories you’ve heard before, once upon a time? Jung and other depth psychologists would likely say that they emerged out of the ‘collective unconscious,’a foundational concept in depth psychology.
The idea of the collective unconscious is perhaps one of the most unique and enduring concepts of Jungian and depth psychology. The very question of its existence caused the never-healed split between Freud and Jung, which marked one of the most significant moments in the history of psychology.
To embrace the reality of this mysterious, timeless realm is to embrace the notion that there are indeed regions of consciousness that we cannot, and will not, understand by our usual ways of knowing.
In this regard, the collective unconscious opens the way to the unknown, which psychedelics can, gracefully or otherwise, escort us into closer communion with. It could even be said that modern Western culture’s long standing fear and stigmatization of plant medicine, psychedelics and altered states of consciousness is an intense fear of the unknown projected onto the plant, pill or powder in question.
Psychedelics can ferry us across the river into the storehouse of repressed human experiences that modern culture has sought to obscure, dilute, or completely ignore. This can look like vivid encounters with death, powerful reminders of humility or sobering wake-up calls that break us out of whatever psychological trance state we all seem to occasionally fall into.
Despite all of our technology and scientific discoveries, to this day the collective unconscious remains as mysterious as the dark side of the moon.
What Is the Collective Unconscious?
According to Jung in his Collected Works, Volume 8, the terrain of the collective unconscious “contains the whole spiritual heritage of mankind’s evolution, born anew in the brain structure of every individual,” and can seem “something like an unceasing stream or perhaps ocean of images and figures which drift into consciousness in our dreams or in abnormal states of mind.”
In other words, the collective unconscious is a universal aspect of the human experience—something akin to a genetic heritage of the psyche, composed of primordial images and which express themselves symbolically through dreams and myths across time and space.
In his later writings, Jung used the term‘objective psyche’to refer to the collective unconscious because of a refinement in his thinking and a desire to steer his work away from focusing on overtly social phenomena like collective projection or groupthink. While this was a facet of Jung’s work, the true scope of the collective unconscious far surpasses this domain.
Additionally, there exists the personal unconscious and the collective unconscious, the difference of which is important to understand and explore.
The personal unconscious contains all of the unique aspects of your personality and psyche which have been repressed, such as difficult memories, traumas, and behaviors you’re not even aware of. The personal shadow, according to Jung, is composed of all the aspects of your personality which fail to neatly conform to your ego’s idea of who you are, which is called your ‘persona’. Unless these shadow aspects are consciously faced and integrated (often called ‘shadow work’), they inevitably tend to be projected outward. But more on that another time.
The collective unconscious is a different beast entirely, and refers to regions of the psyche far beyond the personal repressed material described above. Nearly all of Jung’s most evocative concepts, such as complexes, archetypes, anima/animus, and shadow arise from or are connected to the collective unconscious. By its very nature, the collective unconscious is unknowable and imperceivable to us by our usual methods of perception.
Over the course of his life and work, Jung postulated different ideas as to what this infinite realm might be and what its purpose could be for humanity. His work contained within The Red Book expresses his personal journey of delving into his own uncharted depths through cryptic prose and evocative, semi-religious artwork.
What is clear is that the collective unconscious remains an elusive concept, and that any discussion of it requires a healthy dose of mystery and wonder. Because it is ineffable and eludes full definition, the collective unconscious remains something beyond our ability to fully control, manipulate, and know—actions which, from a depth perspective, all emerge from the ego. And perhaps it should remain so.
“Psychedelic substances don’t cause specific psychological effects. Although they increase energy levels that activate psychological processes, which allows one to consciously experience otherwise unconscious content, they don’t give rise to specific experiences or content. The content that arises from the unconscious during a psychedelic session, like the content that arises in a dream during sleep, is what is available in the unconscious at the time. What emerges can naturally vary, then from session to session for each person, and can certainly vary from person to person.”
Psychedelics cause a “lowering of the threshold of consciousness,” according to Jung, meaning that they bring one into closer contact with the unconscious. Another way of looking at it is that unconscious material bubbles up to the surface during altered states of consciousness, leading to the vast array of reactions that psychedelics are known to evoke. From this perspective, the unconscious material rising to the surface is emerging both from the personal and the collective unconscious.
The ego has a hard time believing that anything could be beyond its realm of knowledge and control. Experiences of fear, which can often infuse the onset or peak of psychedelic experiences, can be seen as the ego’s response to losing its grip on psychic control. As we plunge ever more deeply into the waters of the unconscious, fear is the ego’s alarm system, signaling that it’s well-maintained boat appears to be going down. Yet this descent, as we know from some of the world’s oldests myths and ceremonial traditions, is where real transformation begins, and as any psychedelic guide worth their salt will tell you, the best course of action at this point is to surrender, breathe, and go within.
What actually happens within the psyche while immersed in a powerful psychedelic experience can be interpreted from a variety of perspectives, as decades of psychedelic literature and multidisciplinary studies demonstrate. But like most great mysteries, psychedelics create more questions than they can possibly answer.
From a depth perspective, however, one could say that psychedelics catalyze the emergence of previously repressed psychic material which arises from both the personal and the collective unconscious —a sentiment expressed by many before. Stanislav Grof deemed psychedelics ‘abreactives,’ meaning that they bring to consciousness whatever material which has the most emotional charge.
Because psychedelics can open one’s psyche to experience aspects of the collective unconscious, various archetypes, images, complexes, and energies can be personally experienced, leading to profound moments of catharsis, healing, insight, and what Jung called, ‘numinosity’: overwhelming feelings that burst forth when one is confronted with the power of transpersonal images, archetypes, and experiences. In other words, a full-blown mystical experience.
The implications of understanding the psychedelic experience through a depth psychological lens cannot be overstated, and helps us better understand what Grof meant in his famous axiom: “Psychedelics are to the study of the mind what the telescope is for astronomy and the microscope is for biology.”
The Collective Unconscious and Psychedelics For Psychedelic Facilitators
If you are a psychedelic therapist or facilitator seeking to integrate a depth psychological approach into your practice, it is important to never overlook the significance of the unconscious and the critical role that it plays in psychedelic work. This means expecting the unexpected, listening for the deeper, unconscious threads in a client’s process, and always approaching this work from a place of humility and caution. One could say that the essential function of psychedelic therapy, from the beginning of preparation, through the dosing session, to post-trip integration sessions, is essentially one long process of integrating material from the personal and the collective unconscious.
Depth psychology will inevitably require you to learn to speak two languages at once, as you keep one foot grounded in the world of ego consciousness, persona, and outer objective facts, while maintaining another firmly rooted in the world of symbol, metaphor, myth, and subjectivity. Becoming literate in this dream language takes time, practice, and a dedication to your own inner work as well.
Join us for our live 8-week course on everything professionals need to know about psychedelics, integration, and so much more, Navigating Psychedelics for Clinicians and Therapists. Next semester starts on September 23, 2021.
It’s important to remember this challenging stance requires letting go of dogmatic perspectives, beliefs and certainties, as well as cultivating a certain level of humility and openness. Never forget that each time your client is venturing into psychedelic space, they are venturing into the unknown. The role of the guide or psychedelic therapist is to be a light along the way, to clear the path as much as possible, and to point the journeyer in the right direction as they bravely step into their own star-lit darkness.
The enduring message of depth psychology, however, is that those stars, and that darkness, are not yours alone. The inner world is not an empty void of nothing, but a fertile space utterly saturated with meaning, the comprehension of which can take a lifetime. The collective unconscious belongs to the collective heritage of humanity, is passed down to us in myth over countless millennia, and is remembered in our dreams and visions.
Perhaps this is what Joseph Campbell meant when he famously said, “And where you had thought to be alone, you shall be with all the world.”
About the Author
Simon Yugler is a depth and psychedelic integration therapist based in Portland, OR with a masters (MA) in depth counseling psychology from Pacifica Graduate Institute. Weaving Jungian psychology, Internal Family Systems therapy, and mythology, Simon also draws on his diverse experiences learning from indigenous cultures around the world, including the Shipibo ayahuasca tradition. He has a background in experiential education, and has led immersive international journeys for young adults across 10 countries. He is passionate about initiation, men’s work, indigenous rights, decolonization, and helping his clients explore the liminal wilds of the soul. Find out more on his website and on Instagram , Twitter (@depth_medicine) or Facebook.
About the Illustrator
Martin Clarke is a British Designer and Illustrator from Nottingham, England. Specializing in branding, marketing and visual communication, Martin excels at creating bespoke brand identities and striking visual content across multiple platforms for web, social media, print and packaging. See more of his work here.
In this episode, Kyle interviews Dr. Devon Christie: Vancouver-based counsellor, instructor, and Therapeutic Services Director for Numinous Wellness Inc., and Will Siu, MD, DPhil: Los Angeles-based Psychiatrist. Both are MAPS-trained in MDMA-assisted psychotherapy and are currently co-investigators on a study investigating MDMA-assisted therapy for fibromyalgia.
They talk about chronic pain: how it overlaps strongly with PTSD, why MDMA is the best candidate for success in treating it, and how we can retrain the brain and shift our relationship in how we experience pain. And they talk about how psychedelics are great tools but also a risk for retraumatization: If the movement for access to these medicines outpaces both the science and the amount of people trained in helping someone work through an experience, could we be creating even more trauma?
And they discuss the mind-body connection: how implicit memories and lack of touch and reciprocal engagement can lead to a developing brain not learning how to manage pain; the concept of learned response looping, how to complete a survival impulse in an organized way, and the optimal arousal zone; how oppression and religious or cultural judgement changes one’s relationship with their body; and how learning more about the fascia could be the key toward understanding how the body’s different systems influence each other.
Notable Quotes
“Even in modern medicine, when people get sick, you can almost see this philosophical orientation of: ‘The body is not to be trusted; I’ve been betrayed by my body.’ There’s a lot of fear people have towards their bodies, which I think is perpetuated in how Western medicine holds things in general (not necessarily intentionally, but through the legacy of time), whereas in my post-graduate learnings and forays into somatics and trauma and functional medicine, it’s like: Actually, the mind-body split is false, and every single moment, my felt experience is informing my cognitive processes and my thoughts and vice-versa. And so I think where this then brings us, in terms of pain management, is needing to really acknowledge this as true and start to really empower people back into trusting the wisdom of their bodies.” -Devon “In my first intramuscular ketamine experience, I sat in my Doctor’s office and I was doing all these different movements, which, at the time I didn’t know what they were, but they were different yoga poses (yoga is nothing I’ve ever been into). But I was able to do [them] and flex and be more supple in so many different ways during my ketamine session, and that made very little sense to me at the time. …I wonder if ketamine- it’s so physically dissociative and it’s so unique compared to the other psychedelics- is it almost like opening up and loosening the unconscious of the fascia itself, and is that why we’re able to move and dance and flow from a physical nature much more differently than with other psychedelics?” -Will
“One of the things that we know in healing chronic pain is that we need to help people reconceptualize pain, and perhaps pain, instead of being this big, bad, awful thing that’s happened that I have to live with; well, what if pain had a voice? What would it be saying? If our body-mind is intelligent, then what is this manifestation of physical pain about? And to get curious about that and to then be able to explore it and with the help of psychedelics …there’s tremendous opportunity to really shift our internal relationship, not only in how we think about it, but truly in how we experience ourselves.” -Devon
“When we really shift our attitude and we have a very powerful emotional experience in terms of maybe reconceptualizing who we think we are [or] our relationship to our pain, and that has a very positive emotional valence, then there’s this opportunity that that’s really going to stay with us. If a traumatic experience can have such a lasting impact on us, well, why not also an extremely positive experience, and one that’s shared relationally, where we’re witnessed and there’s connection?” -Devon
Dr. Devon Christie, MD, is a clinical instructor with the UBC Department of Medicine and has a focused practice in chronic pain. She is a Registered Counsellor emphasizing Relational Somatic Therapy for trauma, and a certified Mindfulness Based Stress Reduction teacher (UCSD) and Interpersonal Mindfulness teacher (UMass). She is trained to deliver both MDMA-assisted therapy for PTSD (MAPS USA) and ketamine-assisted psychotherapy. She is passionate about educating future psychedelic therapists on trauma-informed, relational somatic skills and is co-founder of the Psychedelic Somatic Psychotherapy training program. She also teaches for the California Institute of Integral Studies (CIIS) Certificate Program in Psychedelic Therapy and Research, the Integrative Psychiatry Institute Certificate Program in Psychedelic Assisted Therapy, and the ONCA Foundation Psychedelic Therapy program. She is currently Principal Investigator and study therapist for a Canadian MAPS-sponsored open-label compassionate access study investigating MDMA-assisted therapy for PTSD, co-investigator on a study investigating MDMA-assisted therapy for fibromyalgia, and is the Medical and Therapeutic Services Director with Numinus Wellness Inc.
Will Siu, MD, DPhil, completed medical and graduate school at UCLA and the University of Oxford, respectively, before training as a psychiatrist at Harvard Medical School. He remained on the faculty at Harvard for two years prior to moving to New York City to further pursue his interest in psychedelic medicine as a practitioner and public advocate. Will is an advisor to Bexson Biomedical and People Science. He, along with Devon Christie, MD, and People Science, is preparing a pilot research study for MDMA-assisted psychotherapy for fibromyalgia. Will has been trained by MAPS to provide MDMA-assisted therapy and maintains a private practice in Los Angeles. He teaches and supervises therapists and psychiatrists as part of his clinical practice.
In this episode, Michelle and Joe interview writer, psychedelic advocate, and creator of the online community and non-profit, Black People Trip: Robin Divine.
Divine talks about her path from pandemic depression and knowing nothing about psychedelics to becoming a figurehead, mentor, and people-connector through her Black People Trip Instagram account. She talks about how psychedelics are not seen as options in the Black community partly due to a fear of being arrested, but also because so few Black people are open about therapy, and even fewer talk about psychedelic use. She discusses ways to destigmatize psychedelics in the Black community, the challenges of quickly becoming a representative for others in a new field, the difficulties of living paycheck-to-paycheck and trying to take time to integrate an experience, the extra work and small pieces of “fuckery” BIPOC people have to deal with that so many people don’t think about, “The Gods Must Be Crazy”, Carl Hart, drug exceptionalism and privilege, and the racism of the drug war.
And she talks about all she hopes to do with Black People Trip: a 4-week course on the basics of psychedelics, safety, and trip-sitting, a psychedelic equity fund for Black women, a BIPOC-centered conference, and the continued encouragement of more Black people getting involved in this space. If you follow Black People Trip on Instagram, you know that her last few months have been, in her own words, “hot trash,” and she could use some help. Donate via herGoFundMe or Venmo (@divinerobin) to help her get back to helping others.
Notable Quotes
“I think it’s going to be on Black people to actually get out into neighborhoods and share their own stories and teach each other, because honestly, for me, it helps for me to learn from someone that has a shared history and that looks like me and that I can relate to. I don’t want to go to a conference and hear from a white woman that has a different life story than me. I just can’t relate to that. I can’t relate. It’s all love, but I can’t relate. …I did a very brief ad campaign on my own page just to share Black folks’ stories. People were like, “Oh yes, I want to see more of that.” And it was really so simple, but just seeing someone’s face that they can connect with made a huge difference.”
“I’ve had so many women tell me that they’ll go to a group and they’re the only one. And they’re like, ‘Yeah, it was fine, but I wanted somebody else there.’ So I really want to create spaces where we aren’t the only– we’re it.” “We’re big on church. We love our church. I don’t, but a lot of Black folks do. And so the answer is supposed to be [that] if something is wrong, go to church. Pray it away, go repent or whatever we do, and mental health is not for us. Again, it’s something that white folks do. ‘We shouldn’t need that.’ So when people do go to therapy in the Black community, we’re seen as crazy, we’re labeled as weak, and who wants that? So we avoid it, and if we do go, we don’t talk about it. Me? I love therapy. I go twice a week. I tell everybody about it.”
“I’m in full support of Black-only spaces, the same way I’m in full support of queer-only spaces and women-only spaces. Sometimes you just don’t want to be on guard.” “I think about my own family and our own history of trauma and how I can literally visibly see it just being passed down. And I think if we had been able to sit together, Grandmother, Mother, and me, and just do mushrooms or have MDMA, how different would our lives be right now?”
Robin Divine is a writer, psychedelic advocate, and the creator of Black People Trip: an online community with a mission to raise awareness and create safe spaces for Black women interested in psychedelics.
Robin discovered psychedelics last year as she searched for relief from the symptoms of chronic depression. As she became more involved in the community, she noticed a definite lack of diversity. As a result, she started Black People Trip. Her goal is to raise awareness about psychedelics in marginalized communities. She is also in the process of establishing the Entheogenic Equity Fund, a non-profit which will raise funds to help make psychedelic therapy more financially accessible and available to Black women. Donations accepted via Vemno: @divinerobin
“Until you make the unconscious conscious, it will direct your life and you will call it fate.”
-C.G. Jung
This is the first article in a series called Psychedelics in Depth, in which we will explore the many ways that depth and Jungian psychology intersect with the many multicolored permutations of the psychedelic experience.
Our intention is to provide readers with a foundational understanding of the depth psychological tradition, define important terms like shadow or archetype, and explore how this way of interfacing with the psyche can inform psychedelic work for both facilitators and psychonauts alike.
There is a high likelihood we may encounter a mythical beast or two along the way as well. Thanks for being here. Onwards.
When you think about psychology, what images come to mind? A person laying down on a couch, talking about their mother? A man with a thick European accent, cryptically jotting down someone’s dreams? Ink blot tests? Cigars?
Believe it or not, all of these clichés come from the tradition of depth psychology. Sigmund Freud and Carl Jung, who’s work we will examine later, were both depth psychologists. But before we get any further, let’s take the advice given to young Alice during her first bleary steps into Wonderland, and begin at the beginning.
What Is Depth Psychology?
Traditionally, depth psychology was any method of psychoanalytic work which focused on the unconscious. Today, the term “depth” is often used as a shorthand for the various permutations of thought influenced by Carl Jung, which can include everything from mythology, to archetypal astrology, to Internal Family Systems Therapy.
Despite Jung’s enduring association with the term, “depth psychology” was actually coined in the early 20th century by one of his colleagues, the Swiss psychoanalyst Eugen Bleuler, who also coined the term schizophrenia.
Depth psychology differs from other schools of psychology (behavioral, cognitive, humanistic, etc.) in that it takes the unconsciousas the primary driving force on our behaviors and emotions. Because it is itself unconscious, the unconscious cannot be known by our usual, logical, and rational ways of “knowing.”
Therefore, depth psychology employs the use of symbols, images, and metaphors to translate the language of the psyche, which historically was approached through dreams and patterns in mythology. Working with myth is one of the hallmarks of the “depth approach,” and clearly distinguishes this field of psychology from others.
Yet it is important to remember that in depth psychology, symbols and images are always used to describe something “as if,” and not as literal representations. This is one of the most important tenets of depth psychology: Images and symbols are used by the psyche to reference something deeper and likely unknown, yet something that our psyche yearns for us to discover. In true depth psychology, there is always space for the unknown.
The etymological roots of the word psychology can be understood as “the way into” or “the study of the soul.” Depth psychology emphasizes this ineffable notion of the soul, and continually places this unknowable facet of the human experience at its core. What this means in practical terms is a focus on the most important and vexing issues which have accompanied humanity since the dawn of time: birth, death, love, loss, mystery, purpose, growth, decay, and the meaning of it all. The very things which make us human.
Who Is Carl Jung?
Carl Gustav (C.G.) Jung (1875-1961) was a Swiss psychiatrist who helped shape psychology into the discipline we know today. His method of understanding the psyche, which he termed analytical psychology, forms what is now popularly called “Jungian psychology.”
For many years, Jung was slated to become Sigmund Freud’s “crowned prince” and protege, but their paths diverged in 1912 over disagreements as to the reality of the ‘collective unconscious,’ which Frued summarily rejected. Jung’s insistence that there is an ancient, unknowable, species-wide repository of psychic information which informs the human experience flew in the face of Freud’s increasingly dogmatic theories, which focused on sex and pleasure as the driving forces behind all human behavior.
This break led Jung into a long period of introspection which he termed his “confrontation with the unconscious,” during which he delved deep into his own psyche and imagination. Eventually, this process resulted in his detailed map and terminology of the psyche, his practice of active imagination, as well as The Red Book, and the recently published, Black Books.
Jung employed a variety of terms to describe his understanding of the psyche and all of the mysterious dynamics he observed within his patients (especially those suffering from severe schizophrenia), and within himself. Concepts such as the collective unconscious, archetypes, the shadow, anima, synchronicity, individuation, and the Self, are all terms that Jung coined and wrote about extensively. They are also topics we discuss in our course that explores psychedelics and depth psychology, Imagination as Revelation: The Psychedelic Experience in the Light Jungian Psychology.
Yet again, it bears repeating that these terms are to be understood as mere symbols or points on a map, referring to places or dynamics within the psyche that our conscious mind struggles to grasp. Jung himself said, “Theories in psychology are the very devil. It is true that we need certain points of view for orienting… but they should always be regarded as mere auxiliary concepts that can be laid aside at any time.”
Depth Psychology and Popular Culture
While the mainstream psychological establishment has eschewed the work of Jung for many decades, his legacy informs our collective imagination and culture in profound ways, perhaps more than any other figure in the history of psychology.
Mythologist Joseph Campbell drew deeply from Jung’s work, and based many of his ideas of The Hero’s Journeyon Jung’s theories. George Lucas consulted with Campbell while creating Star Wars, arguably one of the most significant film series of all time. The poet Robert Bly mentions Jung throughout his book Iron John, which paved the way for the body of work that is now called “men’s work.” Jungian analyst and author Clarissa Pinkola Estes, in her enduring text, Women Who Run With the Wolves, worked directly with Jungian concepts to address aspects of the feminine psyche.
Any reference to ‘archetypes’ or something being ‘archetypal’ plainly invokes Jung and his work on these illusive, yet omnipresent patterns of being. The shadow, or ‘shadow work,’ which has become something of a buzzword in psychedelics in recent years, conjures Jung as well. We have a whole course that examines Jung’s concepts of the shadow, the difference between the ‘Golden’ and ‘Dark’ shadow, and other related issues called, Psychedelics and the Shadow: Exploring the Shadow Side of Psychedelia.
Similarly, Jung also coined the term ‘synchronicity,’ which could be defined as a meaningful coincidence, and was a phenomenon that captivated him for decades. Lastly, any reference to ‘the collective,’ harkens to Jung’s notions of the ‘collective unconscious,’ which is a foundational aspect of his psychological model, and which we’ll address in our next article in this “Psychedelics in Depth” series.
Despite all of these enduring contributions, Jung still remains somewhat of a marginal figure. There are a multitude of reasons for this, a major one being that his theories escape empirical measurement, and eventually lead one outside the rational-materialist worldview we now call “science.” Mention Jung’s name in most mainstream psychology degree programs and the odds are you will be met with skepticism.
Subversion and marginality have arguably always been at the core of depth psychology. Dreams themselves exist at the margins of our consciousness, and can often direct our attention to marginal areas of our psyche which we would rather not see. Concepts such as the anima/animus, which imply that every male has inside him a female soul (and vice-versa), directly subverts our culture’s basic understanding of gender. Archetypes reveal to us that our personal life story is not a unique, singular event, but rather, connected to a greater chain of human experiences.
Lastly, depth psychology’s pervasive insistence on the reality of the soul can be seen as a revolutionary act within a culture that seeks to actively deny the very existence of such a thing. The consequences of this denial can be seen within every great historical, interpersonal, and environmental tragedy perpetrated upon people and the planet across time.
Therefore, the significance of depth psychology extends far beyond the confines of the therapists’ office or the university lecture hall, and stretches out into the old growth forests, indigenous communities, and inner cities across the world.
Depth psychology is not just a school of psychology, but a lens through which to intimately perceive and meaningfully engage with the wider world.
Depth Psychology and Psychedelics
Depth psychology offers an immensely useful framework for approaching psychedelic work, both as a facilitator and a psychonaut. Stanislav Grof, pioneer of psychedelic-assisted psychotherapy and transpersonal psychology and one of our biggest influences here at Psychedelics Today, described the role that psychedelics play as a psychic “abreactive,” meaning that they bring to the surface whatever unconscious material has the most emotional charge. Seen from this lens, psychedelics, which often work directly with unconscious material, could therefore be seen as part and parcel to the larger field of depth psychology.
Interpreting the variety of imagery and experiences that psychedelics can evoke can easily be aided by a grounding in basic depth psychology, especially understanding the interplay between image, archetypes, and complexes. Facing and integrating one’s shadow is a central aspect of both Jung’s work and using the psychedelic experience for personal growth and healing.
Many worthwhile books have been written on the interplay between psychedelics and depth psychology, including Grof’s body of work, Confrontation with the Unconscious, and much of the work by Ann Shulgin,Timothy Leary and Ralph Metzner. Yet the interplay between depth psychology and psychedelics offers immense potential in the realms of research, therapeutic methodology, and integration—more so than I believe has been fully realized.
The history of psychedelic research is almost inseparable from the tradition of depth psychology. Stanislav Grof, mentioned above, as well as other early psychedelic researchers, approached their work from a depth psychological lens. Because of certain cultural shifts over the 20th century, current psychedelic research prioritizes quantitative and statistical analysis which can often overlook the highly personal and emotional aspects of the psychedelic experience.
Yet, depth psychology requires us to return to the real, troublesome, subjective experiences of the individual as its primary territory of work, and for this reason offers one of the most valuable lenses from which to view the psychedelic experience. Because, just like human beings, no two psychedelic journeys are alike, since they are in essence reflections of the multifaceted and endlessly mysterious inner world of the brave souls who dare to explore their own uncharted depths.
About the Author
Simon Yugler is a depth and psychedelic integration therapist based in Portland, OR with a masters (MA) in depth counseling psychology from Pacifica Graduate Institute. Weaving Jungian psychology, Internal Family Systems therapy, and mythology, Simon also draws on his diverse experiences learning from indigenous cultures around the world, including the Shipibo ayahuasca tradition. He has a background in experiential education, and has led immersive international journeys for young adults across 10 countries. He is passionate about initiation, men’s work, indigenous rights, decolonization, and helping his clients explore the liminal wilds of the soul. Find out more on his website and on Instagram , Twitter (@depth_medicine) or Facebook.
About the Illustrator
Martin Clarke is a British Designer and Illustrator from Nottingham, England. Specializing in branding, marketing and visual communication, Martin excels at creating bespoke brand identities and striking visual content across multiple platforms for web, social media, print and packaging. See more of his work here.
How do you draw the line between a healthy escape and a dissociative disorder? And could dissociative psychedelics like ketamine play a part?
We live in a deeply interconnected world. From our ecosystems to our societies, the Earth is made up of living things held in dynamic relationships. We as humans are deeply woven into this fabric. But sometimes, all this connection can be too much to hold. Whether from acute trauma, overstimulation, or constant societal stress, our bodies have built-in intelligence that allows us to dissociate or disconnect from our current experience when we’ve reached our saturation point.
On the heels of the COVID-19 pandemic, the question of how we cope with and heal from traumatic experiences has been front of mind. I spoke with somatic practitioner, Claudia Cuentas, MA, MFT, and Psy.D., psychologist, ketamine specialist and founder of KRIYA (Ketamine Research Institute), Raquel Bennett, to discuss the psychology of dissociation, what happens when it becomes a disorder, the healing power of escapism, and where psychedelics like ketamine fit into the conversation.
Raquel Bennett, who has been studying therapeutic ketamine since 2002 and who teaches the Masterclass on Ketamine in our Navigating Psychedelics for Clinicians and Therapists course, put it this way: “There are different kinds of dissociation or disconnection, including dissociation from your body or bodily sensations; dissociation from your thoughts or awareness; and dissociation from your biographical history, identity, or sense of self.”
Claudia Cuentas explained it another way. “Dissociation is a physiological self protective response, and it is activated when the body feels saturated or overwhelmed by an input or by too much information at once. That information can come from an internal or external stimulus. Dissociation is our bodies’ ability to remove its attention from the present and take a break, pause and/or, hopefully, recalibrate back into presence. Children do it all the time. That gazing and daydreaming is self-regulating. It is an amazing regulatory system we have.”
While they may look the same from the outside, many experts say that dissociation is different from absent mindedness. Many of us can relate to driving home and not remembering the drive, or checking out during a meeting because we are distracted by something going on in our personal lives. Dissociation is a common experience, and not necessarily a cause for concern. The question is: Is dissociation or the dissociation patterns you have developed to cope with internal/external stressors interrupting your ability to enjoy life?
On top of this, the pressures of modern life can almost be too much to bear at times. We are inundated with unlimited newsfeeds and chaotic information overload in a way that no generation has ever been. What are embodied creatures like us meant to do with the realities of systemic injustice, climate catastrophe, and economic collapse, on top of personal concerns like relationships, mortgages, and health issues?
In response to these pressures, we’ve normalized a culture of disconnection. Checking out of life may become a habitual way of coping with the strain of daily life: binge watching TV or scrolling on social media. Gaming out. Numbing with drugs or alcohol. Swiping on Tinder. These are activities that put us in passive roles and don’t require our engaged presence or participation.
Tuning out itself isn’t necessarily problematic. When it comes as a response to overstimulation, it serves a purpose and then the person can return to present awareness naturally when they feel ready. However, this disconnection can sometimes happen involuntarily or becomes a default way of moving through life. Often, chronic dissociation comes as a result of acute or ongoing trauma.
For people living with dissociative states, this disconnection from one’s body, mind, emotions or identity can be distressing and have a major impact on relationships and quality of life. They may experience depersonalization (feeling as though they don’t control their body, thoughts or emotions) or derealization (a disruption in one’s perception of reality, as though the world is unreal, hazy or flat).
Dissociation can show up in a lot of ways: tuning out during a difficult conversation, personality changes, forgetting major memories or stretches of time, difficulty staying present during sex, or feeling unaware of one’s own body. Sometimes these episodes begin in response to overstimulation or an event that triggers traumatic memory or association.
I asked Cuentas how these disorders happen, and how they might be addressed.
“At times, we may feel that life is not that safe or that the present is not that safe. This is especially true when there has not been an ability to heal, digest and process past trauma and understand why an experience was so frightening or difficult. People don’t want to feel present because if they do, they will be overwhelmed by sensations associated with pain, sadness, overwhelm. The body sends a signal to the brain through the nervous system, and the brain and/orr the body disconnect from the present reality. So the mind says, I am going to release attention from the whole system so that you are here… but not here. I am going to keep you safe.. This way, you don’t have to feel the pain you have gone through.”
“Dissociative diagnoses arise when we are using this way of coping as an unconscious default,” she adds. “Sometimes people struggle because they aren’t feeling like themselves. Maybe everything is numb. Or they feel like they are witnessing a facade of somebody else. Most of the time, dissociative diagnoses are connected to intense, deep, unaddressed trauma from very early on stages of life.”
This questionnaire is a useful tool for distinguishing between normal and problematic dissociative experiences.
Could Somatic Practices & Dissociative Drugs Like Ketamine Be The Path Back?
According to Cuentas, the way to alleviate dissociative disorders is to increase one’s tolerance over time for sensations that may be uncomfortable or overwhelming, essentially moving through the trauma at a pace that’s comfortable and tolerable to the individual.
“We have to get beyond this self-protection mechanism that kicks in automatically. So how do we decode the experience to relieve the body from the automatic response in order to enjoy the present? If you keep unconsciously self protecting to not feel the pain, then you’re missing everything– joy, love, intimacy, all your senses. You turn off your ability to sense comfortable or uncomfortable experiences, like enjoying a sky full of colors, feeling the softness of your skin, hearing a song and go, ‘wow, I like that’. It’s numbing, and the person may not, at times, even realize.”
Finding pleasurable ways to exist in one’s body is an essential part of processing, healing, and moving through trauma. Many trauma therapists work with a particular focus on the body, known as “somatic” practices. This is essential because, although the mind can check in and out through dissociation, the body carries the load of a lifetime of experiences. Cuentas’ work focuses on the use of embodied approaches, like art, dance, music, drama and storytelling as healing modalities for families and communities.
Psychedelic substances may offer another path to doing this work. Part of the theory around why psychedelics help with trauma is related to capacity building. By promoting states of openness, they create opportunities for people to re-engage with painful or traumatic experiences and form new relationships to these memories.
Psilocybin and MDMA have received the most press in recent years, but ketamine has held a steady role as one of the only legal psychedelics clinicians can currently offer. It’s common to hear people speak about ketamine as a dissociative. I asked Bennett her thoughts on this classification.
“When you take ketamine, you may be dissociated from your body; in other words, the signals from your sensory input organs may be temporarily muted,” she says. “However, when ketamine is utilized in a physically and psychologically safe setting, people tend to be keenly aware of or connected with their own thoughts and internal images.”
The dissociation felt with ketamine is more physiological than psychological. I asked Cuentas to expand upon this. She explained that, based on a somatic perspective, it seems like ketamine temporarily disconnects the body and the mind, whereas the coping mechanism of dissociation can often disconnect people from their own consciousness as well.
“Seems like Ketamine can turn the body off so the mind doesn’t have to negotiate how to to keep the body safe or what to do with the body’s intense signals of stress, which are common during or after traumatic experiences,” says Cuentas. “So for a period of time, it may not have to navigate the usual intensity and discomfort. If this happens, the mind is released from its usual concerns/stressors, and its attention can possibly concentrate on other sensations or realms of awareness.”
“As the body experiences numbness or dissociation, it is still tracking the experience, but not reacting. When a body is affected by an anesthetic like Ketamine for therapeutic uses, it will put the body in a highly suggestible state,” Cuentas adds. “From a somatic perspective, there is a window of time as a person is coming back to feeling their body again— that is the moment of doing a lot of processing. I believe this is possibly the most effective way to work with ketamine. Whatever happens in this window of reconnection between unconsciousness and consciousness or body awareness, will be recorded in the body. You would have to be intentional because whatever you introduce in that state can have a great impact on your psyche.”
Feeling good is an essential part of our healing.
Returning To Safety From Dissociative Disorders
Dissociation is the human body’s way of trying to achieve safety. As we are unlearning automatic responses that don’t serve us, the need for a sense of safety is still present. How do we develop a sense of safety within ourselves when we can’t guarantee it in our external environment? Therapists refer to resourcing—tools that help people develop a higher tolerance for discomfort. In this way, we can stay in the present moment longer without needing to dissociate.
Especially for people from marginalized communities, creating microcosms of safety, even temporary ones, can be essential practice for dealing with life. These pods of comfort can come from affinity spaces, keeping a close inner circle, getting immersed in something you love, and for some people, exploring altered states.
In pursuit of safety, a natural response to triggering scenarios is to remove oneself from further harm. However, safety can’t necessarily be achieved in a societal context which is inherently unsafe for many people in our communities. Some people may feel they always have to be shut down or running to escape harm. For these folks, there is an even greater need for networks of support and practical tools that grow the ability to stay present. It can be empowering and freeing to stay present through a practice of pleasure, feeling the body’s sensations, and finding what feels positive and safe in the here and now.
When Dissociation Can Be a Positive
For those of us not dealing with chronic dissociation, the question to ask is whether we are habitually checking out from the present moment and if so, what shifts in these habits might help us have a more fulfilling quality of life. Perhaps instead of relying on screens or substances to wind down, we could incorporate activities that invite pleasurable presence: music, dance, breath work, meditation, meals, or the company of a loved one. It helps to view this as something to practice, rather than something to be good or bad at.
On the other hand, escapism isn’t always a bad thing. There is agency in choosing when and how to turn off the outside world for a while. In order to absorb the benefits of this freedom, dissociating needs to be something that is consciously chosen, rather than an automatic stress based response.
In some ways, escapism is a combination of dissociation and resourcing. Tuning out on purpose, or even altering one’s perception, can offer a healthy way to find rest and recovery from the concerns of daily life. It can also help us to remember what it is like to feel good and build capacity for pleasure. Feeling good is an essential part of our healing.
Grammy nominated singer Jhené Aiko often writes songs about the use of cannabis and psychedelics as medicine. As a mixed race woman of color, she poetically contrasts the peaceful haze of altered states and the harsh realities of the world outside.
She says it well in her hit, “Tryna Smoke”:
Life’s no fairytale, I know all too well/ Gotta plant the seed sometimes /Then you let it grow
Inhale, exhale some more/ Heaven in Hell/ If you know, you know/ That sh*t is beautiful
You gotta just let it go/ Spark up a blunt and smoke
Similarly, in her song “Bed Peace”, featuring Childish Gambino, she sings:
Yeah, what I am trying to say is/ That love is ours to make so we should make it
Everything else can wait/ The time is ours to take so we should take it
We should stay right here/ We should lay right here’Cause everything is okay right here
Conclusion: Dissociation Is Complex
Dissociation is multifaceted. It can signal trauma, offer temporary respite from trauma, and potentially even a path to healing trauma.
Altered states of consciousness, whether from known dissociatives like ketamine, or other substances, give us an opportunity to choose when and how to leave our physical realms and return. They shift our awareness of our spirits, minds and bodies, and often create pleasurable sensations and new insights along the way.
Cuentas closes our conversation by reminding me that the intentions we bring to these experiences are important. “You are recording information in your subconscious/psyche. So what do you want to put there?” she asks.
We can’t necessarily make the world safer today. So there is power in creating microcosms of the world we are dreaming forward. In creating a practice of pleasure and joy, we’re able to fill our spirits like a well to draw upon during difficult experiences. Perhaps eventually, as these micro-moments of safety and resourcing find their way into our embodied realities, they will spread like mycelium and we will create a world that is less traumatizing to begin with.
This article was updated on July 19, 2021 to reflect changes by one of the sources.
Rebecca Martinez is a Xicana writer, parent and community organizer born and raised in Portland, Oregon. She is a co-founder of the Fruiting Bodies Collective, an advocacy group, podcast and multimedia platform addressing the intersections between healing justice and the psychedelics movement. Rebecca served as the Event & Volunteer Coordinator for the successful Measure 109 campaign, an unprecedented state initiative which creates a legal framework for psilocybin therapy in Oregon. She is also the author of Edge Play: Tales From a Quarter Life Crisis, a memoir about psychedelic healing after family trauma, spiritual abuse, and police violence. She serves on the Health Equity Subcommittee for Oregon’s Psilocybin Advisory Board as well as the Board of Advisors for the Plant Medicine Healing Alliance.
In this episode, Joe interviews Australia-based psychiatric nurse practitioner andNavigating Psychedelics graduate, Matt.
He tells the story of his first experience with psychosis and his eventual diagnosis of schizophrenia, followed by the realization years later as to what he may have been trying to express through that break. He digs into different frameworks for considering what the mind is doing when it dissociates or when suicide feels like the right decision, and what we can learn from the stories of people going through such tribulations. Through hisJust Listening community, he is exploring the idea of facilitating environments where people can feel safe enough to not have to resort to these extreme states.
He also discusses his concepts of “dissociadelic” and “dissociachotic,” the Power Threat Meaning Framework, targeted individuals, the Hearing Voices movement, his Suicide Narrative approach, how schizophrenia has never been clearly defined, how the DSM isn’t based on science, how spiritual experiences and receiving messages are celebrated in psychedelic experience but considered a disorder in mental health, and how dissociation happens regularly in our daily lives.
Notable Quotes
“A lot of the story around suicide is how we have to get rid of people’s experience of considering ending their own life, and my interest is in about understanding the meaningful human narratives that manifest in the experience of feeling like we need to escape this life. And so that leads into this idea of mind manifesting realities, which is of course, so central to psychedelics.”
“When we say, ‘You have a chemical imbalance which is depression,’ that’s a bit like saying, as I’m talking to you, I have a chemical imbalance because I’m a little bit nervous, [and] I’ve got a lot of points to make so the energy in my body has gone up. Well there’s a change in chemicals, right? But I don’t need bloody medication for it, I need to be able to be in relationship with you about it.”
“That’s what I’m talking about: the courage to allow the other person to have another reality to mine, and [to] not, at some point, undermine it by saying we’re ‘accepting’ their reality. You’re not accepting their reality, their reality is their reality. I’m accepting my reality and they’re accepting theirs. I don’t need to accept somebody else’s reality, I need to stop trying to impress my reality on somebody else.”
“The problem with complex PTSD is the D at the end of PTSD. ‘It’s a disorder.’ Well, it’s not a disorder to respond to threats in the way you’re responding to them. That’s normal.”
Matt previously led the training of 250 staff in the Maastricht approach to hearing voices in the public mental health system in South Australia. He was also a co-convener of ReAwaken Australia and released a single series ReAwaken podcast through Humane Clinic.
Matt continues to pursue the reality of a mental health system that does not medicalize human distress. He is committed to understanding common human experiences as best being approached by seeking to provide justice to the story of any individual through deep and intentional listening and human connection.
The two have an intimate conversation that spans from how Carhart-Harris’s work began, how his theories, like the REBUS model, took shape, and what other applications psilocybin may have for treating mental, spiritual, and physical health conditions.
The interview has an interesting twist because Wing participated in an NYU trial of psilocybin for major depressive disorder and experienced full remission from a recurrent battle with depression after his first dose of the magic mushroom compound. Wing shares a lot of his first hand experience with Robin Carhart-Harris on how the trial he participated in changed his mood state and mindset, and what the possible neurochemical changes felt like subjectively.
Court Wing: Is this, in any way, in the arc of what you expected to see when you started out this research?
Robin Carhart-Harris: Wow. Hmm… Maybe it is. Or… no it’s not. No. [laughs] I mean, after a few years, you start to realize the therapeutic potential, or I did.
Initially, it was like, psychedelics are fascinating tools… Powerful tools to revolutionize our understanding of the mind and the brain. That’s what drew me in. And then I was like, “Oh, and the therapeutic application is actually very compelling.” Once I caught onto that (and this was probably sort of midway through my PhD in the late noughties, you know, late 2000s). Then, I remember, Ben Sessa was trying to get a psilocybin for alcoholism study going at Bristol, where I was doing my Ph.D. We had meetings with seniority, who basically weren’t interested in our idea. And then I said, “Leave it ten years,” and we’ll be able to do this research. I think someone said once, “You overestimate what you can achieve in a year and underestimate what can be achieved in ten.”
That rings true. The changes in a decade have been colossal so it’s been beyond expectations, really.
CW: Personally, it’s hard not to feel a great deal of gratitude for the work that you’ve all done. As you know, I went through the NYU psilocybin study for major depressive disorder a year ago. And [now I’m in] total remission. I mean, just so unexpected. And I read the research, I saw the reports, I read the review paper of the neural mechanisms, which actually was the first thing that truly excited me because I had lost track of the prefrontal cortex atrophy and seeing words like neurogenesis, synaptogenesis, dendritic arborization; it’s like, that’s part and parcel of what I had been studying in things like chronic pain for the last ten plus years. But to go through it and to feel a physical absence of the depression; I don’t have a better term for it. Like a missing burden.
Anyways, what type of data were you seeing [early on] that made you want to pursue this on a study level? Because it’s one thing to hear about this stuff occurring anecdotally, but then to [say], “Boy, there’s enough traction there that I think we really have something”?
RCH: Yeah, yeah. I think if we rewind to the end of the 2000s or even earlier, mostly in terms of mental health data, it was abstract. It was the work done in the 50s and 60s that we looked at as a historical curiosity.
It wasn’t enough to put that and Indigenous use in [a] healing context. It wasn’t enough to put that together in my mind and think, “Oh, this is really compelling.” So a few things made the difference. And I think sometimes you need to (even though I’m a scientist, and I shouldn’t say this, in a way), you do sort of need to see things with your own eyes. And what made a big difference for me was doing our own brain imaging research.
Taking healthy volunteers, looking in their brains and seeing things that were suggestive of an antidepressant effect, and then listening to them say, “I feel lighter. I feel unburdened.” And then thinking, well, now this seems really tangible. And that makes sense in the context of Roland [Griffiths]’s work in healthy volunteers, and Charlie Grob’s work in end-of-life anxiety.
So then we started piecing things together for a UK Medical Research Council grant. And that got through. And the reviews were remarkably good. I don’t know, but I imagined some fellow researchers in this space were allowed to review our proposal and did us a favor, because the reviews across the board were top marks. And I think, then the UKMRC were in a difficult situation, because [they thought], “How do we reject this when everyone’s saying this is really top quality research that they’re proposing?” And actually, we proposed a double blind randomized control trial then in 2012 that we couldn’t complete until 2021 because of the difficulties of actually doing the research. We ended up doing that open label trial that was published.
But I would say, a turning point for me was the first patient in our TRD [Treatment Resistant Depression] trial. She just responded remarkably. She visibly became a different person from heavy, head down, minimal eye contact, tearing up when starting to open up, no smiles—gosh, no, just frowns. And then, after the treatment, the warmth and the color and the smiling and a beautiful smile came on her face. And it was just a wonderful, beautiful thing. It’s such a privilege to be able to do that for someone. And that was a massive turning point. It was like, “Oh, my goodness, this really works.”
CW: Yeah. It’s startling, trying to describe to people the one-day turnaround quality of this. And I think it’s actually very much undersold, because I told the researchers, Dr. Stephen Ross at NYU and my facilitators afterwards. You know, I went through the MADRS scores, which you are now more than familiar with [laughs], and at the end of the session, one of the facilitators [asked me], “So how do you feel?” And I’m like, “Oh, good.” And then I did a deeper scan, like reflexively, and I was like, “Good.” Like, I could tell it was gone. And I was like, “That fast? Honest to God, that fast?” And they’re like, “Well, we’ll know when you’re unblinded.” But in retrospect, if I had been given the chance to take the original MADRS evaluation again, my scores would have gone higher. Because now in the absence [of depressive symptoms], I can tell how much more severe they were. It’s a strange thing.
One thing that you’ve said a couple times here, and perhaps it’s a figure of speech, but I believe there’s a somatic quality to it. And since you brought up the fMRI studies, you mentioned people discussing feeling lighter, feeling unburdened, like there’s this description of the condition that has this feeling of extreme heaviness or being bogged down. So there’s some aspect that involves this interoceptive quality where there’s obviously slower reaction times and things like that, but what do you think is operating there? Because I remember, in the fMRI studies, you guys were a little bit surprised by seeing the type of changes in blood flow that were going on. I believe, [you] expected one thing and instead ended up with something else. Do you have any thoughts to that area?
RCH: Yeah, yeah. I’ve often thought (and experience has endorsed this view) that we often intuit mechanisms through our language, the way we’re describing the experience, and whether or not there’s some kind of priming effect or not. Maybe it is [priming], but also, I’m not sure it really matters, when ultimately you do the research and see that it’s endorsed. But the analogies that you’re used to hearing today (the popular ones, or the well-used ones) around heaviness and being bogged down; it’s all weight related. There’s heaviness, there’s weight. You know, you get bogged down. So there’s a gravitational pull to the depression, which means it pulls you in and you can’t get out very easily. And I think (I’ve got to intuit, because we don’t know yet, but) it’s something to do with synaptic weighting, and that certain circuitry gets weighted. If we really zoom in on a very low level, it’s probably the synaptic weighting certain connections belonging to certain circuitry associated with heavy introspection. [They] get heavily weighted in depression.
What happens? Well, that’s another fascinating question, and maybe a different question. But let’s just say that that’s the character. On a descriptive level, that’s the character of chronic depression and a depressive episode is that you get stuck. Literally, you get stuck in a certain sort of dynamic configuration because that heavy synaptic weighting is the reinforcement of that.
RCH: Yeah, it’s very relevant. In people’s people’s mind’s eyes, they can imagine a landscape. And in a depressive episode, you literally have a depression in that landscape. And if you imagine a ball being able to move in this landscape, and that being your mind at any given time, then in a depression, the ball is spending a disproportionate amount of time in the depression in that landscape. It falls in very easily, [and it’s] very difficult to get it out. And so what psychedelics are doing is just pushing up that depression and flattening the landscape.
CW: Right. I’ve heard the ski slope analogy. So either we have fresh powder that’s either filling up the depression, or we have some sort of artificial means like a snow plow that’s smoothing everything out. So if we were to just roughly characterize the nervous system as biasing towards efficiency, even if that depressor, that enemy energy minima is more efficient, it’s not necessarily more effective anymore in our daily lives. At some point, it was the 2A adaptation toward some high priority event, but now it’s become maladaptive… I listened to that lecture byAndrés Gómez Emilsson of QRI [Qualia Research Institute]. There’s this discussion of criticality with the mind and with a depression. It’s almost, to some degree, like an event horizon, almost. Right? The pull is so strong, it’s very hard to get out of there. So why is it, once that landscape is flattened, as these new neural connections in the functional connectivity are occurring, why does it resort into a better, healthier connection? I mean, if this quality of openness is being promoted, why are we defaulting back to something that’s more useful, something that’s healthier, something that’s more, I guess, effective, as well as efficient?
It’s one of the issues with doing psychedelic research. [It’s] almost by saying, “I’m a psychedelic researcher,” [that] you’re seen as somehow a lesser scientist.
-Robin Carhart-Harris
RCH: Yeah. I actually do think that the fresh covering of snow is a good analogy. So if you’re born into this world, and you haven’t been affected by life in any particular way, you have a very smooth, fresh ground of snow there. And I suppose, what’s happening with the psychedelic experience; I mean, this is very mechanistic, and is not putting much on the therapeutic component and so, that’s a little dangerous to put it all on, like, “The brain resets.”
CW: Sorry. Yeah, well, the intent makes a huge difference. That’s clear.
RCH: It does. And so, you could have the snow falling, and you can manipulate things in a way that potentially could even reinforce certain circuitry. But that doesn’t happen, because the contextual; the environment in which you have the psychedelic experience is nurturing in the way that it should be for a newborn coming into the world: You’re not trying to heavily indoctrinate them or drive them in any particular direction, other than to care for them and just say, “You are safe, and I will hold you as we move through life.”
But you know, things could go in a horrible direction there. Horrible kinds of things could happen that could start to reinforce a certain shape to the snow. And so anyway, I think it’s a mix. It’s a mix of the fresh falling of the snow [and] shaking the snow globe, [which] is the one [metaphor] that I came up with personally. But the fresh falling of the snow is like an old neuroplasticity analogy. And there is something called the plasticity paradox, which says that plasticity, in and of itself, isn’t necessarily healing, but if the plasticity comes and is utilized in a positive way (and so in the context of psychedelic therapy, it’s utilized and honest in a therapeutic way), then you have the magic sauce.
And so I like to say these days in as many interviews as I can [is] that psychedelic therapy is fundamentally a combination treatment. It’s not just shaking the snow globe. You could shake the snow globe in someone already psychologically unstable, and when the snow settles, it might not be a great picture. But you shake the snow globe in someone who’s ready for this to happen, and it happens in a perfectly nurturing, supportive environment, then the snow is going to settle. I think you can feel quite confident that the snow is going to settle in a healthier way.
CW: Do you think beyond just the psychiatric applications, which seem quite vast still—I mean, honestly, the smoking cessation and cocaine addiction early results… are just completely astonishing—but do you think there are lateral applications? Obviously, I’m quite invested in the changes that are possible, I think, for chronic pain of a potentially non-nociceptive type, but even for nociceptive chronic pain. I have to give credit here to Dr. Brendan Hussey. I saw his presentation on your REBUS model back in July with a MAPS Canada Journal Club, and he had an amazing slide deck. And, I, myself, personally, had a very deep revelation on March 6th, which was the day after I went through [psilocybin-assisted therapy] (March 5th [was] my dosing day) where it’s like, all of these things suddenly opened up where it’s like this can change this whole picture here. Once I saw Brendan’s work describing yours and I had a visual, [I realized] the REBUS model completely overlies the descriptions for the last decade and a half of what’s going on in chronic pain, in terms of how a pain neurosignature is formed. Have you thought about it at all? I think it’s like, beyond psychological.
RCH: Well, that’s fascinating. Maybe there’s some things there that I don’t know that I could learn. We are planning a chronic pain trial in fibromyalgia with psilocybin therapy.
It’ll start at the end of this year at Imperial. I’m moving to UCSF, but that trial will carry on with the money that I was lucky enough to bring in.
[It relates to] the REBUS model in the sense that the precision weighting is exactly what we’re talking about here. Assumptions are heavily weighted. Certain assumptions—you might call them pathological assumptions, you might even call them adaptive assumptions, defensive assumptions—deserve a bit of compassion, because the body of [the] mind is doing its best to try and stabilize things in a way. So in a sense, depressive episodes, eating disorders, image disorders, chronic pain, they’re often the body and the mind trying to do their best defensive strategies. But we’d rather not have them, you know? And then that takes some bravery, doesn’t it?
Perhaps this is most acute in something like anorexia, where the [adaptation] is so maladaptive, it’s killing people often. It’s ego-syntonic for the sufferer, meaning they don’t see themselves as suffering, like, “This is good, this is working.” And so, it’s adaptive, maladaptive, it depends how you look at it, but to most eyes, it’s maladaptive. But it takes bravery, because [people think], “Oh my goodness, you’re going to take away this thing that I need?” like in an addiction. Like, “I’m not ready to give this up, I need this!”
You know, and there’s sort of irony there: “I’ll die without it.” It’s like, “No, you’ll die with it.” But that’s the sort of pivot, isn’t it? And again, it brings us to the requirement. Sometimes, actually, a conscious decision needs to be made to let go, both in the experience itself, but also the decision to have the treatment in the first place.
CW: You spent the better part of a week, pre-publication [of the “Psilocybin vs. Escitalopram for Depression” trial], going through this long explanation of how someone should look at a study as both proposed and then executed, and then how the results are interpreted, and how a journal can also interpret those things. But you took it upon yourself, I think, slightly unusually, to kind of let people know: Really go to the tables, go to the appendices, that’s where you’re going to see the striking numbers. And there’s been many expert reviews saying, “Well, okay, they were wise to in fact not do an adjusted comparison, because then it doesn’t account for the random chance possibility that it’s just a statistical anomaly,” right?
At the same time, honestly, I met someone who also went through the same trial I went through up at Yale, [being treated for] 26 years of major depressive disorder and [then experiencing] full remission. We couldn’t stop going on about the MADRS [depression rating] scores. I understand the QIDS [depression symptomatology scale] one, and now there’s a little buyer’s remorse in there about like, “Ahh, why [did we choose] this one [for the psilocybin vs escitalopram study]? Why this one [QIDS]?”
RCH: [laughing] I know.
CW: And there’s been some criticism that in the prereq, if I’m saying it correctly, where there was kind of one expected outcome that was supposed to be measured, and they [New England Journal of Medicine] were saying there is one way that was registered with the US boards and another way with the UK boards, and that, in the paper itself, it didn’t actually discuss those things. But it doesn’t feel like you guys were pulling a dodge or anything like that. And I think even if people just look at the QIDS remission and response rates and the secondary outcomes; I mean, I am trying not to fanboy all over the place, but it’s so commensurate with what happened for me and what other people have described.
RCH: Yeah. It was a very interesting experience. We certainly didn’t in any way, or could be accused of pulling a dodge. I would say one way to look at how all of this has gone is that we played it so straight, and so the miss on the primary has to be reported because it was pre-registered ahead of the trial to be the primary.
Do we regret choosing the QIDS as the primary? Well, of course we do. And now we understand. Actually, and this could be sort of sour grapes, speaking to a bias in favor of psilocybin, but I do believe it’s not a great measure. And you just have to look at that forest plot that I’ve now pinned to my Twitter page, to see that it’s an anomaly. It looks like a false negative. And I think the right interpretation is that it’s likely to be a false negative and these two conditions do separate.
So we played it very straight. Was it bad luck? Well, if you believe that the ground truth is that psilocybin is the better treatment, and that hasn’t come through because of the miss on the primary, then yes, it’s bad luck. And so part of the effort in trying to get ahead of the messaging was just that; to try and keep people closer to the results themselves, and to say, “Look at the results in some detail.” And that’s quite unusual, I think, for researchers to do.
RCH: They’re often more wanting people to hear their narrative. And I was sort of, in a sense, saying, “Look beyond the narrative (because it wasn’t our narrative, it was the editor of the journal), and look at the results. And you decide.” I felt that we were made to spin the results in a way that misled the reader, that didn’t accurately represent the results. And that bothered me. So I felt I had to communicate to people early on, and I couldn’t say it at that stage, because I couldn’t reveal the results.
So all I was saying to people was trying to explain the nature of the stats, and then say, you know, if there’s anything you do here, just look at the results in detail, and go to that supplementary appendix. The way we were treated in terms of not being allowed to include that forest plot, what’s the agenda there? Hiding results? It’s very questionable. And I’ve stopped short of getting conspiratorial about it, but it’s almost like, “Well, let’s move that out of the way, and, you know, lift this one up, it’s missed on the primary.” And there was so much more to see.
It was an unusual experience. And it felt like the power of [the] deep establishment wanting to frame things a particular way, like, “Nothing to see here. Carry on, everything’s as usual everybody. SSRIs are for everybody.” I don’t know.
CW: It certainly wasn’t your first rodeo. It’s not as if you were fresh to letting results out or doing deep, intimate work with a well-received theoretical basis, right? And yet, they’re almost acting like, “Well, these young fellows, what a nice idea they have,” or something like that.
RCH: Yeah, [it’s] one of the issues with doing psychedelic research. [It’s] almost by saying, “I’m a psychedelic researcher,” [that] you’re seen as somehow a lesser scientist.
And the deep establishment has that position on things. I actually think there’s some published work on this where people have looked at the opinion of scientific peers on those who declare whether they’ve had a personal psychedelic experience or not, and it does transpire that peers view people disclosing their personal uses as suggesting that they’re a weaker scientist in some way. And that’s kind of frustrating, but it is what it is.
But there are some very high standards that we’re being assessed by here, standards that haven’t always been in place. As SSRIs have developed and got through, there’s been a lot of scandal and bad practice in terms of the data on SSRIs. So playing it very straight as we did, and, in a sense, underselling the results, I’m kind of okay with, because I know in time, the truth will [come] out. And the whole area has been getting so excited and expectations are so high that a little bit of moderation at this stage with this particular trial is probably a good thing. So I sort of accept it somewhat reluctantly, in terms of the way the paper was framed. But it got into the New England Journal of Medicine.
CW: Yes it did.
RCH: And that was really important.
CW: And even if it was a moderate, conservative, staid description of the results, the results were like: It [psilocybin] was just as good as our standard of care [SSRIs] right now. And the appendix; that’s why I wrote the Op-Ed for Psychedelics Today, just to say, look, he’s been telling us, and anyone who’s gone through this, that went into full remission, can say this is not even remotely close to the same thing. I almost wonder if the quality of remission that we’re discussing between the SSRI and psilocybin, if, internally, it’s two different types of remission? Because I’ve been on the other stuff, and this is not that. It isn’t.
RCH: The one result that’s most impressive is probably the remission rates. What we’re seeing with the escitalopram (and this probably reflects a more general rule) is improvement in symptom severity, but not reliably into remission. I think that’s it. If remission is ultimately what you want with a treatment, which of course it is—to be free of the disorder—then you’re much more likely to achieve that (twice as likely to achieve that) on the most conservative measure on the trial with the psilocybin.
CW: I think [on] day two of the study, there [were] approximately (depending on which score you used), something like 25 to 30 plus people [who] had stopped being depressed on day two. I truly envied the fact that you guys were running a two-dose study, because it did seem like, from my perspective, even though things had gotten remarkably better [for me], that a second dose would have made a big difference.
RCH: What time point, Court, do you think a second dose would have made [the] most sense?
CW: I think you guys have got it right on the money. Honestly.
I think three weeks. It’s like you have that first week where you’re just kind of in this freefall, like, “My God, is it really this simple?” And then starting to incorporate it in the following week, you know, kind of like, “Is this stable?” Probably doing a lot of reality checking. And then [you’re] just waiting for that ghost of the previous condition to kind of re-emerge. And then by week three, you’re now actually starting to incorporate all this and it’s like, “I have more questions.” I keep regretting the time I didn’t spend under the eyeshades. [laughs]
Honestly, you know, at a certain point, there [were] things [I was] so compelled to talk about, you know? I wasn’t psychedelically naive. 25 plus years earlier, someone had led me on a set-and-setting transpersonal session with [a] high-dose [of] LSD, and that had been remarkable, honestly, for years. But this was… the psychological material that emerged, it’s like, I had no idea [that] the things that came up were going to, and so a second session, like, by week three, it’s like I had formed enough around what had occurred in the first session. It could have been five weeks and that would have been fine.
But I think if you’re talking about things in the course of treatment, like say, spatial summation vs. temporal summation, I think to kind of maintain that intensity level for that neuroplasticity to really gel, usually you need novelty and intensity. And I think Andrés Gómez Emilsson could probably argue this quality of valence. I think three weeks seems just about right. I don’t know. I’m thinking of Ros Watts, and she’s like a bodhisattva on the planet, I swear. Every time I hear her voice, it’s so calming and reassuring. But I think in the three week period, beyond that, you start to get almost lonely for your therapist and the session, if that makes sense. So, you know, it’s just like, “Ah, good. I finally got to go back to that thing again.”
It’s an extraordinary time [considering] what’s just happened with the MDMA and PTSD studies. And I think that’s about their spread there, too. They have three sessions. And I think (don’t quote me on this) it’s something like three weeks apart.
RCH: Right, okay. Maybe we intuited things the same way.
CW: Yeah.
RCH: It’s a promising time.
CW: Yeah, it is. I’m sorry, we’ve come to time and I don’t want to chew up any more of yours. You’ve been very generous. And just once again [nervously laughs]… See, I used to be very reactive. When I’d say things like this, it was impossible not to get choked up and I’m kind of struggling to be a good representative here, but honestly, it’s [holding back tears]… quite a life.
RCH: Yeah, I hear you Court.
CW: I took mine [psilocybin-assisted therapy] 10 days before the lockdown in New York City. I can’t imagine… I’ve been inside with my boys for a year. I can’t imagine what would have happened if it had been the placebo…
Anything in closing? And also I should [mention], Kyle and Joe, and now Michelle, at Psychedelics Today, were extraordinarily welcoming. They’ve created such an incredible community with so much information there, and really a very broad spectrum. This brings in a very large tent of people. But any final thoughts to offer or anything that’s emerged from the studies in terms of like, lateral effects that have surprised you or anything like that? I’m fascinated to see what else is going to be changed by this quality of openness being enhanced. Because that really, that’s so many things besides just like, no longer being locked in iterative rumination. It’s a whole spectrum of life possibilities and cultural assumptions.
RCH: Yeah. There’s a lot of other measures in the paper, the secondary measures. The REBUS model has a focus more on the relaxing of the top-down, but when you talk to people, often the pertinent statement is, “The things that came up.” I think that’s an important space to get a better handle on in the future. What is that? You know, what is that mechanistically, “The things that come up”? I’d love to understand that better. I mean, I’m mechanistically minded, so I tend to go there.
But it’s been wonderful to chat to you and I very much am moved by what you told me. And I’m so pleased that you’ve had the experience that you’ve had, and it’s helped you as it has. It’s wonderful to hear that. It makes it all worthwhile, what we’re all doing.
This interview has been edited for clarity and grammar.
About the Author
Court Wing has been a professional in the performance and rehab space for the last 30 years. Coming from a performing and martial arts background, Court served as a live-in apprentice to the US Chief Instructor for Ki-Aikido for five years, going on to win the gold medal for the International Competitors Division in Japan in 2000 and achieving the rank of 3rd degree black belt. In 2004, Court became the co-founder of New York’s largest and oldest crossfit gym, and has been featured in the New York Times, Sunday Routine, Men’s Fitness, and USA Today. He is also a certified Z-Health Master Trainer, using the latest interventions in applied neuro-physiology for remarkable improvements in pain, performance, and rehabilitation. You can find out more on his website: https://courtwing.com .
In this episode, Kyle interviews licensed professional counselor specializing in somatics and ketamine-assisted psychotherapy, regular contributor toNavigating Psychedelics, and vinyl DJ (who DJed our 5th-anniversary party), Pierre Bouchard.
Bouchard digs into the art of somatics and the importance of adding it as another tool to the data set of one’s healing practice, and discusses how many people don’t yet understand how to interpret (or even define) these sensations, how learning to tune in to bodily sensations can often reveal what needs to be worked on before other therapeutic modalities can, and how physical touch and working with the body create an ethical dilemma. And he breaks down the polyvagal theory and how different types of trauma affect the nervous system and its go-to “fight, flight, or freeze” actions.
They also talk about the top-down and bottom-up approach, Holotropic Breathwork and Stan Grof, dissociation and ketamine, what they’d like to see in the future of therapy, and more. This is a conversation between two counselors, so if you’re behind on therapeutic modalities and concepts, this episode is for you.
Notable Quotes
“When we’re talking about learning to tune into body sensations, we’re really helping somebody develop a new language, a new way of understanding themselves. …It’s not that things weren’t happening and now they are, it’s that they’re learning how to tune into it.”
“Before our conscious mind catches something, often, our body catches it. And we might have a belief about ourselves that then, when we actually tune into body sensations, we find out there’s actually something different going on here. To me, that’s the deep beauty of this; is that you can be intellectually cut off from an experience or belief or just something about yourself, but the body doesn’t lie. The body has no stake in negotiating. The body’s just interested in the truth.”
“There’s a way in which so much of our wounding is about what did or didn’t happen and getting a chance to have some reparative experience around that. Finding out that you’re God and that everyone else is God; it might help that journey, but it’s not going to heal that knot in your nervous system.” “We’re learning to be more interested in our own experience. I think this is something that psychedelics are so fantastic at. We start to have a much greater range of who we are and what’s possible. I can be screaming and raging, I can be crying, I can be in ecstatic bliss. …The psychedelic life, in this way, is about continuing to learn to be a more rich meal.”
Pierre Bouchard is a Licensed Professional Counselor with a private practice in Boulder and Denver, CO. He specializes in blending somatics, embodiment, attachment theory, and trauma therapy with ketamine-assisted psychotherapy. A graduate of Naropa University (in Contemplative Psychotherapy), he has trained in several somatic psychotherapy modalities, most recently the Hakomi Method under Melissa Grace, and currently, in Ido Portal’s movement system at Boulder Movement Collective. He has maintained a meditation practice for 19 years, is working on opening a ketamine clinic, and in his spare time, works as a vinyl DJ.
The psychedelic space has an abuse problem, but how do we resolve it? Community accountability and transformative justice can help.
In the past few years, the global psychedelic community has weathered countless ruptures as patterns of problematic behavior have come to light. While calls for accountability have been increasing, we have yet to establish frameworks and processes that support it. Such are the challenges of a decentralized, citizen-powered movement: It is as diverse and situational as the psychedelic experience itself, and accountability is not a one size fits all process. The ways we approach massive, powerful institutions often look very different from the ways we approach those in our immediate social groups.
We have seen sexual assault in underground healing environments and leaders aligning with sexual predators. We’ve witnessed the shameless commodification of ceremonial practices and silencing of voices championing equity and diversity. We can also be sure that more issues are just around the bend. They are bound to surface as the movement grows and we attempt to create practical systems for accountability that can keep up with this rapid expansion.
The mainstream paradigm of accountability is rooted in the legal system. It is centered around the concept of penalty—simply put, if someone breaks the law or a societal contract, they will be punished, often by being removed from community or being made to experience the same pain and suffering they have caused. Justice is seen as a contract between the individual and the state, and harm is defined by legal institutions. It can be static, rigid, and lacking nuance. Among the many issues with this punitive model is the simple fact that the needs and experiences of survivors and those impacted are often an afterthought. In addition, punishment does little to prevent further harm, rehabilitate the person responsible, or address the underlying conditions which contributed to the event.
If we don’t dedicate ourselves to a new vision of accountability while the psychedelic movement is still relatively small, the fallout and damage could be much greater. We are in a world where cancelling and punishing people is our main choice for dealing with harms. If we want to be a culture built on the cornerstones of healing and relationship, we will need to find ways to embody these values in our approach to accountability.
By modeling clear, compassionate, and dialogue-based systems for accountability, we can prevent the invasive seedlings of harm from growing into weeds which choke out the entire garden of psychedelic healing.
The Opportunity
It’s high time for us to circle up, from our smallest pods to our largest public forums, and form agreements on how we are going to show up as a movement to destigmatize and create safer access to psychedelics. What are our core values, and how do we bring them to life? How do we, as a global community, intend to prevent and respond to situations of harm and abuse? We need to define our agreements and put them into practice at home. Whatever we create together in the microcosm will determine what takes shape in the large scale later on.
In the past few years, I have been involved in many behind-the-scenes conversations where I have been earnestly warned about problematic individuals and organizations in the psychedelic scene. I have been given firsthand accounts of behaviors ranging from ethically questionable to outright violent and predatory.
Perhaps this secretive dynamic is a reflection of the social contract around psychedelics. While the space is splintered, we share a broad collective cause—one that is just beginning to gain legitimacy in the eyes of the government and general public—and thus, we have a call to protect one another. This is a community which generally understands the potential legal and reputational ramifications of outing anyone who is a part of the psychedelic underground for bad behavior. But are we more loyal to the movement for psychedelic access itself, or the people who have been harmed within it?
Over and over, when I hear these accounts, the same questions arise for me:
Have we brought these concerns to the person in question? Is mycelial, grapevine-style dialogue the best way to establish safety amongst ourselves? There must be a better way forward which could actually interrupt patterns of damage and promote reconciliation. I fear that our current non-confrontational approach allows problematic behavior to continue due to our own unwillingness to address it head on.
In addition, each person with this insider knowledge must now carry the burden of sorting out what to do with it. Should I warn everyone I know? Should I approach the person directly? How do we get to the truth of a situation, and at what point (if any) should these truths be made public? Who gets to decide? When should someone be muted, removed from a position of leadership, or barred from participating in community? How do we set terms for their reentry?
These are difficult questions that we need to explore together and within ourselves. Though it is more laborious and does nothing to satisfy our own sense of self-righteousness, there are ways to address problems without calling someone out, cancelling them, or permanently destroying their reputation. The challenge is that each situation is different, so developing a formulaic approach for an entire movement is impossible.
It’s no secret that psychedelics are going mainstream. We have an opportunity to set the tone and shape the culture of this movement by how we conduct ourselves amongst one another, how we cultivate community and how we organize our institutions and advocacy efforts. By modeling clear, compassionate, and dialogue-based systems for accountability, we can prevent the invasive seedlings of harm from growing into weeds which choke out the entire garden of psychedelic healing.
Recently, North Star, a new psychedelic nonprofit, launched the first widespread code of ethics for psychedelic practitioners and organizations, based on input from 100 stakeholders in the field. The seven principles in the North Star pledge are:
Start within
Study the traditions
Build trust
Consider the gravity
Focus on process
Create equality & justice
Pay it forward
These values can serve as guiding lights and a first step toward a culture of accountability. The problem with voluntary creeds like this one is that they are mostly symbolic in nature. Without a clear way to vet those who are self-associating with the pledge, there is no way to know whether someone’s public commitment is deeply rooted or performative. We don’t actually know what an individual or an organization is made of until they have been involved for a while and have been given space to act, connect, contribute, and most likely, be under a little pressure.
Ultimately, the nature of accountability is relational. The act of uncovering messy truths and the challenging processes of responsibility often happens at kitchen tables and park benches, not board rooms and convention stages.
Fortunately, we don’t have to reinvent the wheel. The psychedelic community may be new to the justice discussion, but leaders from other disciplines such as Emergent Strategy, mutual aid networks, and prison diversion programs have spent many years engaging with the messy, daily practice of addressing and repairing harm. We would be wise to learn from these leaders. If we do, the psychedelic field will be better off for it.
What Is Accountability?
The basis of accountability is simple: When damage has been done, there is a healing process that needs to take place. At its most basic, accountability is a cycle of harm, recognition, and repair.
But before we can talk about holding one another accountable, it’s essential that we each develop the practice of holding ourselves accountable. It’s hard, lifelong work to take responsibility for our actions and their impacts; it requires us to labor through our own barriers to receiving critique. Only once we get past our own denial, fragility, and excuses can we reach a place of acknowledgment and growth. While reconciliation isn’t always guaranteed, self-responsibility can open the door to remaining in community after harm has been caused. This long-term work rarely happens in isolation—it happens in our homes, partnerships, friendships, professional collaborations, and within the larger movements we champion.
Accountability takes many different forms.
Self-accountability, which is about as sexy as steamed kale, begins with identifying our values. It asks each of us to recognize that we live in an interconnected world in which our actions have immediate and indirect impacts. Once we have clarified our value system, we must then cultivate the practice of tracking whether or not our behavior is aligned with these values. But we all have blind spots; this is why we need community.
Interpersonal accountability can be enticing. On one hand, there’s some primal part of us that feeds off of scandalous news when someone in the community goes rogue. There is an impulse to see folks who are doing damage taken down; perhaps witnessing these takedowns makes us feel superior. Maybe punishment creates an illusion of safety, or at least, demonstrates that the community has boundaries and agreements we can all lean on. The responsibility here is to ensure that before we expend energy confronting others about their behavior, we check ourselves. We need to ask: “Am I the best person, and is this the best time, to call this person in? Is there inner work that I am responsible for at this moment? And importantly, am I ready to participate in a process without doing further damage?”
Then there’s institutional accountability—the fantasy we can’t seem to get enough of. Mainstream media publishes pieces vilifying Compass Pathways and ATAI Sciences, and we eat it up and express our outrage on comment threads and podcasts. Perhaps this is because it is easy to see large corporations as faceless, evil monsters to rail against. But again, we have to go deeper—who is leading these organizations? What worldviews and assumptions are they operating under? What wounds might be beneath the problematic behaviors we love to hate? And importantly, what are the ugly parts within ourselves that are so uncomfortably reflected in their behaviors?
Within a movement like the psychedelic resurgence, accountability becomes a long term process of choosing to stay in relationship. We set out to do this while understanding that as flawed humans, we will certainly hurt one another and we need clear agreements, safety parameters, and systems for repair. While it isn’t always safe or possible to keep people in community who have done harm, it is a pursuit which can create more opportunity for long-term healing than the scorched-earth mentality of punishment and eradication.
When reimagining the idea of safety within community, there are two terms that are often used interchangeably: restorative and transformative justice. While they are related, they have key differences.
The United Nations Working Group on Restorative Justice (RJ) defines it this way: “A process whereby parties with a stake in a particular offense resolve collectively how to deal with the aftermath of the offence and its implications for the future. In essence, we seek to repair the harms caused by crime and violence.” The process seeks to restore the conditions that were present before a harm took place. RJ efforts often work in tandem with local judicial systems. Check out these firsthand accounts of the accountability process from Restorative Justice Victoria.
Transformative Justice (TJ) goes even deeper. It seeks to address the context in which harms occurred and, through a community-centered approach, catalyze long-term shifts in the very fabric of society. This can serve to not only prevent harm, but to create conditions that lead to healing and thriving, as well.
For years, transformative justice efforts have been a part of the movement toward building healthier, more intact communities and reducing the reliance on policing as our only means of creating safety. It is a holistic approach which focuses first on resourcing the victims/survivors of harm, who are often erased within the punitive justice system. Rehabilitating the person responsible is a secondary consideration, in the spirit of prevention. In addition, it holds an eye toward the source and root cause of the harm, rather than treating individual situations as isolated incidents. This enables us to make systematic shifts which can ultimately ripple outward and help reshape the culture of our communities as a whole.
Transformative justice understands that the harms we inflict upon one another are the downstream effects of larger dysfunctions within our society. They may stem from a culture shaped by scarcity, disconnection, domination, and generational trauma. In order to truly prevent harms from repeating, we have to transform the underlying issues and the belief structures that uphold them.
Interrogating our community standards and assumptions, strengthening interdependence, and addressing the root causes of harm are at the heart of transformative justice.
Benefits of the Transformative Justice Approach
Enables intervention before small harms and patterns escalate into major problems
Centers the needs and experiences of survivors or those impacted
It enables all involved to increase their capacity for clear communication, generative conflict, and ownership of responsibility
It creates opportunity for the person who has done harm to reflect on and understand the impact of their actions
It requires an actionable plan for repair
It cultivates greater safety, resilience and trust within the community
Limitations of Transformative Justice
Accountability processes sometimes happen months or years after an incident has occurred
Defining repair is much harder when death or major damage has occured
Results are slower and more systemic (we have to be invested in the long view)
Confrontation can be extremely uncomfortable
Those who are confronted cannot be coerced into accountability processes
Making amends doesn’t often have a clear timeline or resolution
Community involvement over time is required
Potential Misuse of Transformative Justice
People who aren’t committed to their inner work may harness the language or tools of accountability in an attempt to control situations or deflect culpability
People may repeat serious harms over time and rely on the optics of transformative justice to save face when held accountable
Those invested in upholding existing power structures may discourage efforts toward transformative justice, as it is rooted in systemic change
What If We Are All Responsible?
There is a tempting, self-righteous satisfaction in punishing or cancelling people we view as problematic. Part of why punitive systems exist within our society is because they allow us to rely on a convenient binary. When we frame complex situations in right/wrong, good/bad, or involved/not involved, we get a free pass to look the other way. Effectively, we absolve ourselves of the nuanced and laborious process of conflict transformation.
Community based approaches to healing can have major benefits, but they require work. If the goal of accountability is to interrupt cycles of harm and create long term vitality in our communities, we must also work to create healthier systems at the root level. This reimagining takes all of us. In an interview with the Barnard Center for Research On Women, Esteban Kelly, co-founder of AORTA (Anti-Oppression Resource & Training Alliance), put it this way:
“[Transformative justice] distributes the culpability a bit. Which isn’t to say it is even, but everyone holds some amount. What environment enabled the silencing to go on, such that this pattern was able to continue until a crisis? What allowed things to escalate? What were the subtle hints around male supremacy, sexism, white supremacy, or different forms of class power that gave people hidden messages that this was acceptable or that we’re not going to intervene?”
Steps of Accountability in Transformative Justice
Transformative justice acknowledges that there are no quick fixes to complex problems. Calling someone in is a first step, but there is no way of knowing how they will respond. Given the complex dynamics which can often lead to damaging behavior, it is possible that someone will refuse to participate in peacemaking efforts. If they are willing, however, a loose framework can look this way:
Identifying the harm: A problematic behavior or pattern is identified, either by the individual, someone affected, or the surrounding community.
Calling in: The person in question is called in. (Learn about the differences between calling in and calling out here.) If you are called in, it may take some time to wade through your initial reaction and emotional activation, but ultimately, see if you can receive the call to accountability as a loving act. You are being invited to change a behavior instead of being rejected because of it.
Taking responsibility: Feeling badly or saying sorry isn’t enough here. True accountability requires that we take responsibility for our actions and identify where we had freedom of choice when we may have felt we had no options.
Commitment to repair: The person responsible dedicates themself to repairing the harms that were caused.
Clarifying agreements and actionable steps: Ideally, those impacted will be involved in the decision making process around what repair should look like. The more specific you can be, the better. For example, if the person responsible is in leadership, do they need to be asked to step down from their platform for a set period of time? If someone has harmed another person in the community directly, do they need to help cover the cost of healing services?
Following up and ongoing relationship: This is where the rubber meets the road. Change takes time, and the process is not linear. To fulfill agreements and develop new habits, people need to be held in community while also keeping those who have been harmed safe.
The above model is not a hard and fast formula, but more of a roadmap through common situations. Sometimes, harm is so deep and shattering that basic steps toward repair may seem simplistic. For example, what if someone dies during an underground medicine retreat or a clinical trial? Worse, what if there are efforts to conceal or rewrite the narrative of what has happened? When facing situations where loss of life has occurred, the family of the deceased must be heard and empowered to define what efforts toward repair feel supportive on their own terms.
But, what if the person in question refuses to accept responsibility? What if the survivor or person impacted has no interest in being a part of an accountability process? Can Transformative Justice principles still serve when the process is less tidy?
I spoke with Esteban Kelly about his perspectives on creating a culture of accountability within movements. In addition to being a co-founder and worker-owner of AORTA Co-op, he also spent fifteen years as a volunteer member of Philly Stands Up!, a community-based transformative justice collective which worked directly with people who caused harm in sexual assault situations. Through PSU!, Kelly amplified the lessons of transformative justice to help local communities navigate scenarios of interpersonal harm and healing.
“If someone won’t be accountable, we are not going to do something coercive, contribute to call-out culture, or publicly shame them. We ask survivors, please don’t do a public take-down of this person; we’re not calling to cancel people. Instead, we might suggest that communities mute them or say they should not be platformed, but we ultimately want to draw people back into networks of trust. We want to direct resources and coaching to them so they are more capable of the change those around them know they need.”
Developing Muscle Memory in the Accountability Process
Accountability is a process, not an end point we arrive at. It requires acknowledging and taking responsibility for the harm that’s been caused, making amends however possible, and taking steps to change behavior so the harm does not continue. This requires that we develop skills in introspection, communication and sitting with discomfort. It requires us to ask, “What are the actions I can take to make things as right as possible, given that I can’t go back and undo what was done?”
Theoretically, these practices could transfer seamlessly into the psychedelic community. Is this a utopian vision, or is there hope for a lasting, truly just psychedelic movement that doesn’t self-destruct during its ascent? That depends on how committed we are to the process of change, first within ourselves and our immediate circles. Kelly offers up the long view:
“This rhythm of theory, action, and reflection has to be iterative and constantly evolving. What are we trying to do at a societal level if we can’t even figure it out in our own communities? These small exercises are maps and instructions for how we can reprogram things at a larger scale.
“Transformative justice doesn’t really make sense until you are involved in testing it out and applying it in the laboratory of your life. Testing it out in low-stake situations will help these concepts make sense. Then, when the going gets tough, you have muscle memory to handle more difficult scenarios.
“There’s a certain role that everyday facilitators and community organizers can play. Right now, that is where the gap is. So, how can we rise to the occasion ourselves to take these skills that seem professionalized and translate them into everyday skills? Transformative justice is not about running social services through non-profits and institutions. Those may be effective for other things, but there’s something else that can happen in a less codified way, in these intimate TJ settings, and that’s the change we’re trying to achieve.”
In other words, change begins at home. We’ve got to redefine justice on a personal level and learn to be accountable for ourselves and our immediate circles before we’re ready to make institutional change. Here are a few places to start:
Accountability: What Each Of Us Can Do Right Now
Invite mentors and elders into your life
Commit to a practice of brutally honest personal reflection
Get in touch with your body. Notice what comes up when you feel guilty, ashamed, threatened, accused, or misunderstood. Notice these emotions in minor situations and develop tools for managing them
Practice rupture and repair cycles in personal relationships
Learn how to apologize effectively
Develop capacity for uncomfortable conversations
Ask your peers for feedback
Create a culture of radical honesty & authenticity in your relationships
Practice following through on your commitments
Enlist a specific set of trusted “tough love” peers to be in close proximity and call you in when needed
How do we choose the right people to be our inner circle of accountability? Kelly lays out some considerations.
“It might not be your best friend. It might be your coworker, sibling, or neighbor. It’s more about the quality of the relationship than the quantity of people. Who do you share a depth of trust with? Where are the spaces in your life where you can receive direct feedback? The broken conditions of the world can feed into our ideas of victimization and defensiveness.
“When you’re activated, you may not be able to really hear critique. But who can, despite all of this, hang in there through the worst of the hurdles you put up; to have compassion for your human experience and essentially bear hug you into accountability? Who can say: ‘Yes, you can scream, cry, yell, etc. I’m able to hear your initial round of deflection and excuses. I may or may not validate them. But now that that’s off your chest, can you get to a place where you’re able to listen? It may be weeks or months later, but I’ll be here as a support person.’”
Healing For Our Descendants
The theory of transformation is one thing; the embodied, lived experience of it is something else entirely. As many of us can attest, the cosmic downloads we receive during a psychedelic experience may be profound, but the real magic happens as we integrate these insights into our lives. The same is true for accountability: Documentaries, books, and philosophy of change are solid starting points, but they carry with them a call to integrate this new knowledge meaningfully into our lives.
Integrity begins within ourselves, then expands into our relationships, our networks, and ultimately, as an extension, perhaps even the global community. Just as raindrops fill a stream, streams feed into rivers, and rivers become the ocean, it’s impossible to separate the individual from the collective.
How long might it take to really see a shift we envision? When will accountability, rather than punishment, be the norm?
“Realistically, we probably need another… fifty years of actively changing.” Esteban tells me. “Keep in mind, we don’t just suddenly ‘REACH SCALE’. Society changes through gradual, and sometimes speedy, transformation, but even that takes time to take root.”
Fifty years! In the psychedelic context, when we talk about the medicine of ancestral healing, we’re not just talking about healing backwards in time. We’re also healing for our descendants. We have the opportunity to pass along a heritage more healed and intact than what we’ve inherited. Healing our ancestral lines while we’re still living will likely take our whole lifetimes; this is a beautiful, fundamental expression of accountability. We are taking what we’ve been given, understanding its roots and working to transform it.
We not only need each other, we also need to trust and be trusted. We can acknowledge the windows of opportunity before us, but let’s commit to the long path and remind one another of the healing vision and our deep belonging when the noise gets too loud or our shadows come out to play.
Rebecca Martinez is a Xicana writer, parent and community organizer born and raised in Portland, Oregon. She is a co-founder of the Fruiting Bodies Collective, an advocacy group, podcast and multimedia platform addressing the intersections between healing justice and the psychedelics movement. Rebecca served as the Event & Volunteer Coordinator for the successful Measure 109 campaign, an unprecedented state initiative which creates a legal framework for psilocybin therapy in Oregon. She is also the author of Edge Play: Tales From a Quarter Life Crisis, a memoir about psychedelic healing after family trauma, spiritual abuse, and police violence. She serves on the Health Equity Subcommittee for Oregon’s Psilocybin Advisory Board as well as the Board of Advisors for the Plant Medicine Healing Alliance.
In this episode, Joe interviews co-founders of the charity, Veterans Exploring Treatment Solutions (VETS): Executive Director, Amber, and Chair of the board and former Navy SEAL, Marcus Capone.
They talk about Marcus’ transition back to normal life after 13 years in the service, and his “fizzling out,” depression, cognitive decline, and uneventful trips to brain clinics, followed by a life-changing experience with ibogaine and 5-MeO-DMT in a ceremony outside the US- something that, at the time, was very new and very scary but seen as a last resort. They talk about what he learned from his experience, the improvements they’ve seen in the people they’ve helped, why they call their grants “foundational healing grants,” and how the current psychedelic renaissance is missing a key element in the power of psychedelics: that maybe the issues we are working to try and heal (and their solutions) may be more physiological than we realize.
VETS has raised the money to provide grants to 300 veterans (and some spouses as well), and aims to do more, as they are currently working with the Stanford Brian Simulation Lab on a brain imaging study to investigate the potential physiological improvements from ibogaine.
Notable Quotes
“I was spending a lot of quiet time, just praying and thinking, and I remembered that one of our friends had gone outside of the US. And I didn’t even know what it was- I didn’t know anything about psychedelics, I didn’t know anything about ibogaine. I didn’t know anything other than someone we trusted was having a similar set of challenges and found relief through something crazy.” -Amber “I don’t think you can explain psychedelics, what it does. You’re opening your brain, really. You’re tapping into higher levels of consciousness that you just can’t explain to others unless you do it. And then the majority of people that do it [and] do it the correct way, they’re changed forever.” -Marcus
“It just creates this happiness that’s contagious, and it makes everyone else around them want to perform at that level as well. I know that I can say that for myself, and the shift in our family dynamic, and whether it’s our relationship with our kids, to our kids also setting goals and attaining them- that’s a real thing. There’s so much healing happening beyond just the veteran that we’re supporting.” -Amber “What we’ve come to realize, and what I personally feel, is that vulnerability is actually the greatest show of strength.” -Amber
“I feel like if we can really put our heads down and add to the body of research so that we can advocate for these therapies to be available inside the borders of the country that these veterans chose to defend, then we can not only help them in a more meaningful way, we can end the veteran suicide epidemic, and hopefully these therapies will be available to all Americans in due time, because they really are saving lives.” -Amber
When he was medically retired after 13 years and multiple combat deployments as a US Navy SEAL, Marcus Capone started experiencing an escalating myriad of challenges, including depression, isolation, cognitive impairment, excessive alcohol use, headaches, insomnia, and impulsivity. Marcus was diagnosed with PTSD, and later, TBI. When all hope seemed lost, his wife, Amber, learned of a new kind of treatment, and Marcus traveled outside of the US to receive treatment with Ibogaine and 5-MeO-DMT, to tremendous results.
This experience inspired them to co-found the non-profit, Veterans Exploring Treatment Solutions (VETS) in 2019, which has since provided grants for hundreds of US Special Forces veterans to receive psychedelic-assisted therapy treatment, as well as preparation and integration coaching. VETS believes that psychedelic therapy can lay the foundation for further healing. This “foundational healing” enables continued progress across a range of therapeutic modalities, and is supported by a robust coaching program, providing a holistic treatment solution for veterans.
What is “moral injury” and how might psychedelics help?
Moral injury refers to the biopsychosocial-spiritual suffering stemming from participating, witnessing, or learning about events that transgress one’s deeply held moral beliefs (Litz et al., 2009; Shay, 2004). Moral injury is not a new construct, and the idea of a “soul wound” has long been evident in the writings of Homer and Plato. However, over the past 15 to 20 years, the term moral injury has resurged as a focus within the field of clinical psychology and psychiatry. At the same time, psychedelics are similarly experiencing a renaissance. Is this mere coincidence or an indication of a deeper underlying process at play? How might psychedelics hold promise for healing moral injury?
Moral injury is not a psychiatric diagnosis (Farnsworth et al., 2017; Jinkerson, 2016), but it can include feelings of guilt, shame, anger, disgust, and sadness, thoughts of personal regret and systemic failures, and avoidance and self-handicapping behaviors (Ang, 2017). Considered to be more “syndromal” than “normative” moral pain, moral injury is associated with significant impairment in relational, health, and occupational functioning as demonstrated by poorer trajectories in these areas (e.g., Maguen et al., 2020; Purcell et al., 2016).
Although the two often co-exist, moral injury is distinct from post-traumatic stress disorder (PTSD). While PTSD is largely rooted in and characterized by fear-based conceptualizations (i.e., focus on life threat, victimization) and symptoms, moral injury is rooted in perpetration, complicity, and betrayal and characterized by moral emotions (guilt, shame, spiritual conflict). Largely studied in the context of military experiences (see Griffin et al., 2019 for review), researchers have bifurcated morally injurious events into transgressions (by others and self) and betrayal (Bryan et al., 2016; Nash et al. 2013). However, morally injurious events are not limited to certain people or contexts, but rather range widely (e.g., killing in combat, deciding which COVID-19 patient gets a ventilator in resource-poor settings, witnessing police violence against people of color, being ordered to break rules of engagement, institutional betrayal in sexual assault cases) (e.g., Badenes-Ribera et al., 2020; Smith & Freyd, 2013; Litam & Balkin, 2021).
In my professional experience, those who experience moral injury stemming from transgression they themselves committed (either through action or inaction) can often carry deeply painful thoughts of “being a monster” and often engage in various forms of self-punishment and isolation in order to “protect others from themselves.” Most often, self-forgiveness feels like “letting oneself off the hook” for what was done, which is unacceptable. This deep sense of accountability, of course, reflects the actual inherent goodness and strong moral compass within the individual. Those who have experienced betrayal and transgression by others may find it especially difficult to trust people, carrying deep existential wounds about the goodness of humanity. However, most often, those struggling with moral injury have experienced all three of these types of wounds to various extents.
Moral injury is in essence a social wound, predicated on the morals and values constructed and shaped by communities and society (Scheder, Mahapatra, and Miller, 1987; DePrince, & Gleaves, 2007; Litam & Balkin, 2021). But how does one heal a social wound? Evidence based treatments for post-traumatic stress disorder (PTSD), a related ailment, yield underwhelming efficacy especially in veterans, with up to 60% not experiencing meaningful improvement (Steenkamp, Litz, & Marmar, 2020). One reason for this may be that these approaches are not adequately addressing moral injuries within traumatic stress responses. Interestingly, the mental health field generally tries not to discuss morals, and yet it is clear that trauma and suffering are inextricable from morality. The false assumption of moral neutrality is deeply damaging and has allowed the mental health field to largely bypass the “moral” nature of trauma, war, and discrimination.
Relatively antithetical to current PTSD treatments, individuals struggling with moral injury need the moral violations acknowledged and held, rather than cognitively restructured away. Even in our approaches to healing, the Western mental health field places high value on the role of the individual as both the source of the problem and the solution, rather than the collective or society. In other words, it’s an individual’s “problem” and it’s on them to do the work to “heal themselves.” Much of current research is an exemplar of this through attempts to pinpoint just what’s wrong in the person’s biology, thinking, or feeling that leads them to be this way rather than searching for and acknowledging the larger truth that often trauma is a form of societal abandonment.
Thus, moral injury has been shied away from at least in part because it requires us to collectively acknowledge and take responsibility for the traumas that happen and their moral roots. Indeed, more often than not, those with transgression by self-related moral injury withhold these experiences from the therapist out of fear of moral judgment. People are often unsure if the person can confront and hold the truths of war and the dark side of humanity without restructuring it away. The same is often true for transgressions by others and betrayal related to racial trauma. However, to heal moral injury necessitates that we carry our share of the weight by confronting the social responsibility we have for each other. In other words, to move through moral injury, a society must actively incorporate and care for their individuals.
Individuals struggling with moral injury need the moral violations acknowledged and held, rather than cognitively restructured away.
Indeed, a recent groundbreaking study in warriors from Turkana, a non-Western, small-scale society, showed the robust buffering effects of having explicitly moral-affirming cultural norms, social responsibility, and integration (Zefferman & Matthew, 2021). This is in line with recent efforts to incorporate community healing ceremonies into treatment for veterans. For example, Cenkner, Yeomans, Antal, and Scott (2020) found a ceremony in which veterans shared testimony on their moral injury with the general public significantly decreased depression, and improved self-compassion, spiritual struggles, personal growth, and psychological functioning. These findings provide preliminary evidence of the healing potential of communitas for moral injury, which is where psychedelics come in.
Psychedelics may create the opportunity for individuals to connect with the prosocial sense of communitas inherent in us all. Psychedelic compounds including empathogens (e.g., MDMA), classic psychedelics (e.g., psilocybin, LSD, ayahuasca), and dissociatives (e.g., ketamine) may provide both the context and content needed to treat moral injury. Psychedelics have the ability to “reopen” critical windows to feelings, thoughts, perceptions, and sensations previously blocked by the ego’s well-intended presence (Brouwer & Carhart-Harris, 2020). Psychedelics induce interactive neural and neuromodular effects across whole brain systems (Carhart-Harris & Friston, 2019), which translate to a context in which rigid patterns of thinking, relating, and feeling are relaxed, allowing for more psychological flexibility (Davis, Barrett, & Griffiths, 2020).
Beyond providing the flexible ego-relaxed context, psychedelics may also “naturally” generate the content for treating moral injury and PTSD. Unlike evidence-based therapies, psychedelic-assisted therapies use non-directive approaches and although there is certainly preparation, there is no way to “enforce” what material is covered during dosing sessions. Despite this, evidence across numerous studies reveals psilocybin and other classic psychedelics consistently incline users toward confronting traumatic material and salient autobiographical memories, which relate self through past, present, and future (i.e., self-definition, expectations) (Camlin et al., 2018; Gasser et al., 2015; Malone et al., 2018; Watts et al., 2017). This is representative of the innate healing wisdom within each person. Much like how the body’s cells know what to do when a physical wound happens, the psyche on psychedelics appears to be naturally directed to the wound, toward confronting suppressed traumatic material, and limiting self-other concepts in need of healing.
There has been no empirical investigation to date into the use of empathogens (e.g., MDMA) or classic psychedelics as a treatment for moral injury. However, MDMA has been extensively studied as a treatment for PTSD, with very promising efficacy in reducing symptoms in combat veterans (Mithoefer et al., 2018). Announced this year, Drs. Amy Lehmer and Rachel Yehuda at the Bronx VA will be conducting a study using MDMA to treat moral injury in veterans (Lehmer & Yehuda, 2021). MDMA holds much promise for healing moral wounds in those who served, likely through its empathogenic qualities. Of particular relevance to military populations, MDMA may facilitate moral injury recovery through increases in self-other forgiveness and self-other compassion. It may help those suffering from moral injury disclose the experiences and get unblocked from beliefs about deserving to suffer and the unacceptability of forgiveness.
To elucidate this point, I spoke with John*, a Special Operation Forces post-9/11 veteran who deployed to Iraq and Afghanistan. John has also used psychedelics to treat his moral injury and PTSD.
John shared, “MDMA has allowed me to pull back from how I view the actions I took during war. I now see what I did as reactions to my environment based on the limited insights I had in a moment. The military created me, created my wolf mindset. I see now that I was just operating from how they made me. It’s given me the ability to see myself from a distanced perspective, and I can more accurately see cause and effect without judging myself. I used to view these experiences with just endless pits of guilt and shame, and now I see myself and what I did with much more compassion and forgiveness instead.”
Classic psychedelics may also provide unique benefit for moral injury through the opportunities of mystical experiences and ego-dissolution. Unlike MDMA (Holze et al., 2020), classic psychedelics can induce mystical and ego-dissolution experiences, which can include feelings of boundlessness, oneness with the larger world and reality, a sense of being eternal, and feelings of sacredness (Griffiths et al., 2008; James, Robershaw, Hoskisn, & Sessa, 2019). These experiences can foster a sense of personal meaning or purpose, often depleted in the wake of moral injury, and may offer an alternative felt sense to “feeling damaged or bad.”
The ego-relaxing effects of default mode network disruption may allow for the concept of self and others to be examined and redefined to integrate broader, more complex (e.g., “I’m a father, soldier, caretaker, friend”) versus singular organizations (e.g., “I’m a soldier”). Specific traumatic and morally injurious events can be “de-centered” or “de-weighted” from a person’s identity (Bernsten and Rubin, 2006); which could be considered akin to being able to do parts work (e.g., Jungian archetypes, Internal Family Systems). Relatedly, there is a strong body of evidence showing the effect of classic psychedelics on fostering prosocial affect and cognitions typically impoverished in moral injury such as self-other forgiveness, self-compassion, and connection (Carhart-Harris et al., 2016; MacLean et al., 2011; Pokorny et al., 2017; Preller et al., 2020; Wagner et al., 2017).
Classic psychedelic induced ego-dissolution and noetic experiences (e.g., oneness) may also aid in restructuring the “self” by highlighting our true connectedness with others, the natural world, and spirituality previously hidden by psychic pain. So often, those with moral injury report having lost their faith because what happened, or having their faith turn into solely a source of self-condemnation. Spirituality is often shied away from or at best, selectively present in the mental health field despite substantial ethical guidelines suggesting otherwise. The ubiquity of spirituality in psychedelic experiences will hopefully serve as a catalyst for the mental health field to fully incorporate this essential healing ingredient moving forward. Indeed, mystical and ego-dissolution experiences are consistently shown to be critical for positive treatment outcomes (e.g., Carhart-Harris et al., 2018; Griffiths et al., 2016; Haijen et al., 2018; Roseman, Nutt, & Carhart-Harris, 20118; Ross et al., 2016), suggesting the extent to which “I” can become “we” or “one/all” is important for alleviating psychiatric suffering. It also therefore stands to reason that both individual and group psychedelic-assisted therapies may be of particular benefit to moral injury. One could even imagine the therapeutic potential of complementing psychedelic assisted therapies with community liturgy approaches like those described above.
Consistent therapy and ritualistic medicine sessions with psychedelics has given me the ability to rise out of the grip that guilt and shame had on me. I no longer feel like I don’t deserve to have a good life.
Although there has been no investigation on moral injury to date, there is some converging supportive evidence for classic psychedelics. In gay-identified long-term AIDS survivors who had lived through many potentially morally injurious events in the 1980s and 1990s, psilocybin-assisted group therapy significantly reduced demoralization, a form of existential suffering characterized by loss of meaning, hopelessness, and poor coping (Anderson et al., 2020). Half of the sample reported reductions in demoralization of 50% or greater by the end of treatment. In people with substance misuse, psilocybin and ibogaine increase acceptance of past behavior and self-other forgiveness and reduce guilt, respectively (Bogenschutz et al., 2018; Heink, Katsikas, & Lange-Altman, 2017). Similarly, psilocybin induces realizations of being a “good person” in people with treatment resistant depression (Watts et al., 2017). These findings hint at the potential of classic psychedelics to change relationships to past wrongdoings and heal existential wounds, but experimental evidence is needed.
When asked about possible differences across types of psychedelics, John shared:
“I’ve used psilocybin, LSD, and ayahuasca for the strict purpose of working on myself. These medicines have allowed me to perceive myself, my actions/behaviors as part of the collective whole of humanity. They’ve created a sense of being a super-organism of humanity! When I got back from war, I didn’t belong. I didn’t know this world, I had been in war for five years, all of my adult life to date. I knew I wasn’t really welcome… people didn’t know what to do with what I had been through so I didn’t talk about any of it. I did go to therapy and got cognitive therapy. It helped, but honestly, it barely scratched the surface. There was a level of being blocked that I just couldn’t break through and I just couldn’t get past the shame. But, as I’ve continued to work with psychedelics, I’ve been able to experience my ego dissolve, I felt integrated with all others, even stretching beyond humanity and merging with all forms of life and matter. The lasting guilt and shame from the harm that I caused people because of my actions and inactions has shifted to a more understanding and forgiving stance. War still pops into my mind within the first minutes of waking every morning, but consistent therapy and ritualistic medicine sessions with psychedelics has given me the ability to rise out of the grip that guilt and shame had on me. I no longer feel like I don’t deserve to have a good life. I can see my badness, but I can see my goodness, too. I still have the number of harms I’ve done in my head, but I am focused now on living a full life, doing enough good helping others that maybe one day will balance out that number.”
The rising trend of both psychedelics and moral injury suggest a communitas evolution. The symbiotic renaissance is evidence that society is increasingly tiring of the false perception of individuality. Acknowledging the ineffable truth of our interconnectedness and interdependence on each other for safety and wellbeing is the path to healing—for moral injury and for all of us.
In sum, I leave you with these questions: If moral injury is a social wound, is depression not also a social wound? Is addiction not a social wound? How might reworking the current psychiatric model to legitimize the moral fallout of trauma change the way we understand and treat psychic pain?
*John is a pseudonym as the veteran wishes to remain anonymous.
*Even though this article speaks to the benefits of those with moral injury using psychedelics, it is no way advocated that such individuals should seek to self-medicate. In sharing his story, John* would like to make it clear that he is not advocating for others to self-experiment as he did, rather, his aim is to spark interest in researchers to find more data on this in hopes of providing relief for others.
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About the Author
Dr. Amanda Khan is a licensed clinical psychologist in private practice in California and researcher at the University of California, San Diego (UCSD). She specializes treating trauma, PTSD, and anxiety and depression and offers depth work, evidence-based treatments, and post-psychedelic integration. She has worked as an independent contractor on MAPS MDMA-enhanced psychotherapy for PTSD clinical trials for the past four years. Dr. Khan is trained ketamine-assisted psychotherapy and will serve as psilocybin therapist on the phantom limb UCSD clinical trial in the Fall. She is also currently enrolled in the MAPS MDMA Therapy Training Program. Dr. Khan serves as Chair for the Moral Injury special interest group for the International Society for Traumatic Stress Studies (ISTSS). She writes for Medium and Stress Points, and regularly gives talks and workshops on moral injury as well as working with gender and sexual orientation diverse people. In her spare time, she eats a questionable amount of tahini and enjoys hiking with her partner.
Taking a deep look at what Measure 110 did and didn’t do in Oregon, and speaking with one of the measure’s Chief Petitioners, Anthony Johnson, on the future of drug policy reform.
“There’s never been a better time to be a drug policy reform activist,” says Anthony Johnson, a Chief Petitioner of Oregon’s Measure 110. Amid a sea of despairing headlines, it’s refreshing to hear a streak of optimism, especially from someone who has been working in public service for over twenty years.
Measure 110, also known as DATRA (the Drug Abuse Treatment and Recovery Act), received 58% of the Oregon vote in November. Similar to Portugal’s drug approach, the measure decriminalized the personal use and possession of all drugs. In addition, it allocated cannabis tax dollars and prison savings to pay for expanded drug treatment and other vital services. This progressive policy was passed alongside Measure 109, which created a legal statewide psilocybin therapy program.
Measure 110 was implemented statewide on February 1st, 2021. Addiction recovery centers and services must be available in each of the state’s 16 coordinated care organization regions by October, 2021.
What Measure 110 Does:
Removes criminal penalties for low-level possession of drugs. The amounts are as follows:
Under 1 gram of heroin
Under 1 gram, or fewer than 5 pills, of MDMA
Under 2 grams of methamphetamine
Under 2 grams of cocaine
Under 40 units of LSD
Under 12 grams of psilocybin
Under 40 units of methadone
Fewer than 40 pills of oxycodone
Allocates $100 million in state funding to expand behavioral health, addiction, recovery, housing, peer support and harm reduction services and interventions.
Establishes an Oversight and Accountability Council, made up of people who have direct lived experience with addiction, along with service delivery experts.
Reduces the criminal penalty for larger amounts of drugs from a felony to a misdemeanor.
Replaces the misdemeanor charge for small possession (which held a maximum penalty of 1 year in prison and a $6,250 fine) with a fine of $100. This fine can be waived by completing a health screening within 45 day of receiving a citation.
Nearly eliminates racial disparities in drug arrests, according to an independent analysis.
The Measure Does Not:
Legalize or create a regulated supply of drugs.
Change the criminal code related to drug manufacture and sale.
Change the criminal code for other crimes which may be associated with drug use, such as theft and driving under the influence.
I spoke with John Lucy, a Portland-based attorney focused on cannabis and business law, to clarify. He explained that Measure 110 covers all controlled substances, Schedule I through IV. The defined amounts in the bill language were provided for the more well-known drugs. So in short, Measure 110 really does make simple small possession a Class E violation for most drugs (with some A misdemeanors for larger quantities of the drugs listed that don’t meet commercial drug offense guidelines).
To be more specific, substances such as GHB (Schedule I and III), 2C-B (Schedule I) and Fentanyl (Schedule II) are now all class E violations, subject to the new $100 citation.
Why Measure 110 Matters for Racial Justice
The Oregon Criminal Justice Commission (OCJC) is an independent government body which is responsible for research, policy development and planning. In 2020, the Secretary of State released a Racial and Ethnic Impact Report, which explored the potential impacts of Measure 110. The findings make it easier to understand why Oregonians voted overwhelmingly in favor of this measure.
According to analysts, Measure 110 is slated to:
Prevent 8,000 arrests.
Reduce drug convictions of Black and Indigenous Oregonians by a whopping 94%.
Save between $12 million to $48.6 million from ending arrests, jailings, and convictions.
Also noteworthy are the more systemic solutions that could come from this measure. According to the OCJC’s report:
“This drop in convictions will result in fewer collateral consequences stemming from criminal justice system involvement, which include difficulties in finding employment, loss of access to student loans for education, difficulties in obtaining housing, restrictions on professional licensing, and others,” the report says, adding: “Other disparities can exist at different stages of the criminal justice process, including inequities in police stops, jail bookings, bail, pretrial detention, prosecutorial decisions, and others.”
Q & A with Anthony Johnson on Current and Future Drug Policy Reform
The three chief petitioners of Oregon’s Measure 110. From left to right: Haven Wheelock, Janie Marsh Gullickson, and Anthony Johnson.
I spoke with Chief Petitioner of Measure 110, Anthony Johnson, about the treatment-not-jails approach and where he hopes the drug policy reform movement will go next.
Rebecca Martinez: It’s a little late, but congratulations on the passage of 110. What a huge accomplishment!
Anthony Johnson: It’s a step in the right direction. Oregon took a big sledgehammer to the failed drug war. But I would say there is still more work to be done around the criminal justice element, making sure that harm reduction, treatment, and recovery programs are fully funded. And there’s still more work to be done expunging past criminal offenses that people have suffered from.
RM: Do you foresee new organizations being formed under this measure, or will the funding go to expand existing ones?
AJ: Right off the bat, at least with the initial funds, it will go to groups like Central City Concern and Bridges to Change that set up sober housing living situations and want to expand their programs so they can help people find places to live, get job training and experience, and be able to move on with their lives. Programs like that can expand. There could be rural organizations that understand there are places in Oregon where people have to travel hours to receive drug treatment. Groups could get funding for mobile units and meet people where they are. And then we have organizations like Outside In, who may want to expand the ability to provide NarCan, or fentanyl-testing supplies so that lives can be saved.
So in the short term, it will be organizations that are already up and running, doing good work and have experience applying for these types of funding sources. Over time, I could see new organizations established based upon lessons learned and the needs of the community.
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RM: When it comes to drug testing [as in checking for purity, not to be confused with urine drug testing], is this something we currently have in some form, and if not, is it legal and allowed under this new program?
AJ: Right now, organizations can get funding to expand programs to test drug supplies. There are organizations working today in Oregon that provide test strips so people can test their own drugs and make sure they are not fentanyl. I’m unaware that this conflicts with federal law if a group is just supplying testing equipment. It’s a little different than say, a safe consumption site where there is a violation of federal law happening on site. It’s more like, “Here’s your kit,” and you’re on your way.
When we talk about the interplay and all these issues of impact, I want to highlight one point, and I believe we did this effectively during the campaign. I hope this can reverberate all throughout Oregon: When people talk about drug policy changes, ultimately it is not about the drugs. It is about the people. Our loved ones. No matter where you live, who you are, you have family members using drugs, most likely illegal drugs, but definitely legal drugs, be it alcohol, tobacco, or prescription drugs.
Knowing the truth about these drugs, treating them without stigma so that when people who do have an issue, they’re willing to come forward and there are resources available to them. Ultimately, what do you want for yourself or a loved one? How do you want to be treated? Do you want them arrested, put in jail, fired, given a scarlet letter “F” labeling them a felon for the rest of their lives so they can’t get certain housing opportunities? Or do you want them treated with dignity and provided resources if they need help. Remember that the majority of drug users actually don’t need help and can lead productive lives.
When mainstream media stories are written, headlines are going to be as inflammatory as possible. The photo’s gotta be needles and lines, razor blades, if they can they throw some guns in the picture too, but that’s not a realistic representation of life in America. As we move forward, we want to be compassionate, empathetic, end the stigma, and treat people how we want to be treated.
When people talk about drug policy changes, ultimately it is not about the drugs. It is about the people.
RM: I have two immediate family members who have been incarcerated. Is there a pathway to ending sentences for people who are serving time for substances that are no longer illegal? Or, is it: “What’s done is done”?
AJ: Something could be done about it, for sure. And we were able to accomplish some of this work with cannabis. We could have something passed that provides a study saying, “Who is in prison for these substances that are now decriminalized?” Or, “The offense was reduced from a felony to a misdemeanor and their prison time should be reduced and they should be let out.”
For whatever reason, there’s often some reluctance around that. I don’t quite understand it. The way I see it, when we legalize cannabis or drug possession, voters and society are recognizing that the state has made a mistake. Cannabis shouldn’t have been illegal in the first place. These small amounts of drugs should not be a felony or a misdemeanor. So, why are people in prison and why do people have criminal records when the state made the mistake?
It will take further legislative changes to accomplish this. We still have such a huge stigma around drugs. Cannabis has taken 25 years. It may be due to coronavirus and other concerns, but really there’s been no movement on further decriminalizing drug possession yet.
RM: What do you want to see moving forward?
AJ: What I want to see, what I’m working for and will continue advocating for, is automatically expunging old convictions. Automatically releasing people from prison. Following Measure 91 [Oregon’s Legal Marijuana initiative, on which Anthony was also Chief Petitioner], one of the most proud moments of my activist career was reading an article on OPB.org in which a man said he cried tears of joy because his cannabis delivery conviction could finally be expunged from his record, after following him for 30 years of his life.
Now, six years later, I am still proud of that, but I am struck that we didn’t go far enough. He was in a position to hire an attorney, pay the court fees, pay for the filing. [But] expunging your criminal record should not depend on your ability to hire an attorney. The law is the law. It should just be off everybody’s record. It should not be based on how much money you have or whether you know how to jump through legal hoops.
RM: Have you heard interest from people in other states who want to create models designed after 110? Given what you know now, what would be the dream model that you believe could be pushed through in more progressive states?
AJ: I have been in touch with people interested in enacting similar policies, and even city or countywide changes where statewide is not feasible. The cannabis movement did the same thing with local efforts. I definitely support anything that moves the issue forward. I became an activist over 20 years ago and I definitely see a key change in where we are and we are definitely going to move forward in other states. My dream model would be largely based in Oregon.
Now, the possession limits of what you decriminalize should be examined and should be realistic around peoples’ usage. One of the critiques I heard a lot from addiction doctors was that the possession limits we decriminalized in Measure 110 were, really, too low for a lot of users.
Even potentially, so long as someone is not selling, [general possession] could be decriminalized. Automatic expungements of past offenses and early prison release, and I think there should be funds allocated for treatment, harm reduction and recovery for those who need it.
This should be looked at as an extension of our healthcare needs. States should also be looking into studies into the medicinal benefits of various psychedelics, be it psilocybin mushrooms or MDMA. Slowly but surely, we are getting research moving forward at the federal level, but it is really up to the states to move these things forward.
In the future, something like 109 and 110 could be combined.
Explore the shadow side of psychedelics in this learn-at-your-own-pace course.
AJ: I support anything that moves the issue forward and educates people. My one caveat [about Decrim Nature and the Plant Medicine Healing Alliance] is I don’t want anybody to possess larger amounts of these drugs [in Oregon] than what Measure 110 allows, believing they are okay under state law because of a city resolution. A city cannot make something legal that the state has made illegal.
This is a problem with not having a city court, and this is something I look at when we are planning future drug policy reform measures. Cities that have their own city court, such as Columbia, Missouri where I went to undergrad and law school, can pass a measure and force the city prosecutor and police to keep that case within city courts and not send it to county or state [court], or refer it to the feds. So in these places, you can actually change the law [at the city level].
The city can’t make, say 28 grams of psilocybin mushrooms legal if the state says 12. It could be de facto legal, if the district attorney chose not to prosecute people, but DA’s change and it may not always be that way. [It’s then up to] local police discretion… it could be “lowest law enforcement priority,” but they could still arrest you.
RM: If it is on the discretion of the police, is it worth putting resources into these city-based resolutions? The last thing any of us wants is blood on our hands or anyone having a brush with the law because they thought they had legal protection when they didn’t.
It is imperative for all advocates to do what they can to be open. Lowest law enforcement priority measures are symbolic measures. If you are not actually changing the law, people can still be arrested and convicted. There could still be a lot of good out of that, but we need education that helps people realize this doesn’t actually change the criminal code. It’s up to advocates to make sure people know the truth of the matter. We don’t want to do harm. That said, if anything is moving the issue forward, I tend to support it. My focus is on changing the law, but I support anything that’s chipping away at the drug war. We should be honest about the pros and cons.
We want to let science, truth, and common sense guide us. We need to be truthful about what a lowest law enforcement priority measure does.
Expunging your criminal record should not depend on your ability to hire an attorney. The law is the law. It should just be off everybody’s record.
RM: What would you say to those who are pro-psychedelics who are new to the idea of broader drug policy reform?
This is something I’ve battled within cannabis legalization, which I’ve been involved in for over 20 years. Early on, and still to this day, there was cannabis exceptionalism. People had the attitude of, “Don’t arrest us [cannabis users]. Arrest these other people who use heroin, or meth, or these other drugs.” And now we’re seeing the same thing with psychedelics.
In the end, I believe people need to do their best to be empathetic to the situations people are born into, how they’re raised, the traumas they go through, and the drugs that are used. If you were born in a different city, state, whatever… you may have used different drugs than what you use today.
When I first told people in cannabis activism that I was working on 110, they were like, “You’re not going to decriminalize meth, right?”
Bottom line is: Arresting and convicting people, whatever the drug is… it’s counterproductive. Throwing someone in jail and taking away their education, housing and job opportunities is not good for them or society. We have to set aside our feelings about drugs because we believe some substances are better than others and that [certain] people should be treated better than others. We all have circumstances and hardships. No matter the drug of choice, arresting, criminalizing and stigmatizing them is a counterproductive policy.
We always need to come back to that. We need to appeal to people’s compassion and empathy. We cannot arrest and jail our way out of people using drugs.
RM: You make an important point. You’re touching on the question of: What does punishment do to us? Does it move us closer or further from the society we want to have?
We have to change the conversation. Imagine the headlines you’d see if other drugs caused the consequences we see with alcohol. Car accidents, death, abuse, other accidents, all these bad decisions people make… if that was another drug, just imagine the headlines, every day. People committing crimes, getting in wrecks with alcohol in our systems. But for better or worse, it is accepted in our society.
But if someone came to you and said they used alcohol and thought they needed help, that is [also] totally acceptable in society. And it should be. That’s where we want to get with all drugs. No matter the substance someone uses. If people seek help, they should get the help they need. Ultimately, we need to end the stigma. It’s difficult when even people within drug policy reform have their own stigmas around certain drugs. I’m a different advocate in 2021 than I was in 2000. Everyone has their own journey, but I definitely see the light at the end of the tunnel.
We got a strong majority of the vote [in Oregon]. Drug decriminalization got a higher percentage of the votes than Jeff Merkeley, who is a very popular senator! This is more popular than we think. We’ve got to thank Dr. Carl Hart, who is braver than most, for paving the way.
I believe in ten years, in this discussion around decriminalization, stigma and use, we’re going to be in a much better place than we are now. It’s not just electoral victories, it’s conversations we have publicly like this one, conversations with our friends and family, we can just chip away at it.
I’m actually very hopeful. Drug policy reform is two steps forward, one step back. But as scary and maddening and the world can be, I’ve never been more optimistic about what we can do. I’m proud that Oregon’s been playing our part and other states are following suit.
I believe in our lifetime we are going to end the drug war.
Rebecca Martinez is a Portland, Oregon-based writer, parent and community organizer. She is a co-founder of the Fruiting Bodies Collective, an advocacy group, podcast and multimedia platform exploring the intersections between healing justice and the psychedelics movement.
Taking a deep look at the trial’s Supplementary Appendix, the response from the psychedelic science community, and the choice to measure the results using the QIDS depression rating scale.
On April 15, 2021 the New England Journal of Medicine published a study comparing the efficacy of psilocybin-assisted therapy to a popular SSRI antidepressant, escitalopram (sold under the brand names Lexapro, Cipralex, and others): titled: Trial of Psilocybin versus Escitalopram for Depression. The landmark paper written by the team at Imperial College London’s Centre for Psychedelic Research, concluded that the “trial did not show a significant difference in antidepressant effects between psilocybin and escitalopram in a selected group of patients”, which caused a bit of an uproar in the psychedelic science community.
Reactions and questions came quickly on social media: Was the paper edited too heavily by the New England Journal of Medicine? Were appropriate rating scales used to judge the effectiveness of psilocybin? Are the “real” results hidden in the study’s appendix? As a participant in NYU’s study on psilocybin-assisted therapy for major depressive disorder in 2020 who received incredible benefits (my depression of five years went completely into remission and has remained there), I felt it was necessary to try and explain the latest results in more depth.
The study in question, under lead authors Robin Carhart-Harris, Ph.D, David Nutt, MD, Rosalind Watts, D.Clin.Psy and others, was a double-blind randomized trial with 59 participants for six weeks to compare the efficacy of psilocybin versus a leading antidepressant in treating depression. Each trial started with a psilocybin dose day; one group received a high dose of 25 mg, the other a negligible dose of 1 mg. Then, the high dose group proceeded to receive a daily placebo while the low dose group received 10 mg of escitalopram each day for the first three weeks. At three weeks, the psilocybin group received a second 25 mg dose of the magic mushroom compound and continued with the daily placebo. The SSRI group received a second placebo, 1 mg dose of psilocybin and also had their daily dose of escitalopram increased to 20 mg. Both groups received an equal amount of extensive psychotherapeutic support and counseling, totaling around 35 to 40 hours during the six week-trial using Watts’s ACE therapeutic model: Accept, Connect, Embody.
Prior to the start of the trial, both groups received multiple and extensive depression assessments, using four different depression rating scales; QIDS- SR-16, HAM-D-1A, BDI-17, and MADRS. Of the four depression inventories, QIDS-SR-16 is the newest, designed for convenience of use so patients can “self-rate” (that’s what the SR stands for), and crucially for this trial, it was the primary scale used to compare psilocybin and escitalopram’s efficacy in fighting depression. However, lead author Robin Carhart-Harris has now stated that should have been better considered because QIDS-SR-16 is the least established of the four scales used. There are several issues as to why it was not the best rating scale to use and its results should be viewed as less accurate, and we will explain those issues below, but first let’s review the trial results as published.
In the abstract, the NEJM concluded:
“On the basis of the change in depression scores on the QIDS-SR-16 at week 6, [the mean (±SE) changes in the scores from baseline to week 6 were −8.0±1.0 points in the psilocybin group and −6.0±1.0 in the escitalopram group, for a between-group difference of 2.0 points] this trial did not show a significant difference in antidepressant effects between psilocybin and escitalopram in a selected group of patients.”
This is an extremely conservative and staid summary for all the rating scales and secondary outcomes. Even so, in my opinion, this alone is phenomenal because they are stating that psilocybin, a psychedelic compound, is at least as effective as a leading SSRI for treating patients with major depressive disorder. But the real results are in the data contained within the appendices and tables, many published in the Supplementary Appendix rather than in the abstract or main study itself, so let’s examine them.
Analyzing the Supplementary Appendix
In clinical research, the two main items to track in depression scores are the “response” rates and the “remission (remitter)” rates. A response rate means there is an improvement in depression symptoms in at least 50% of patients. A remission rate means that a patient no longer has enough symptoms to qualify for a medical diagnosis of depression; for all intents and purposes, it’s effectively gone. So even when we look at the solely at QIDS scores for those two rates, the difference is striking:
“A QIDS-SR-16 response occurred in 70% of the patients in the psilocybin group and in 48% of those in the escitalopram group… QIDS-SR-16 remission occurred in 57% [psilocybin] and 28% [escitalopram]… Other secondary outcomes generally favored psilocybin over escitalopram, but the analyses were not corrected for multiple comparisons. The incidence of adverse events was similar in the trial groups.”
In both ratings for the QIDS scale we see psilocybin outperform escitalopram by nearly double with only two doses as opposed to six weeks of daily doses. But also notice the statement at the end about secondary outcomes favoring psilocybin and that adverse events were similar.
Honestly, these are significant understatements when you look at the secondary outcomes directly in the appendices and tables. Certainly, as a leading scientific journal it’s a far better position to conservatively report the outcome rather than promote the results, but consider the following: In the three other well-established depression inventories, HAM-D, BDI, and MADRS, the response rate for psilocybin at the 6-week mark was between 67.9 and 76.7% while for the SSRI it was only 20.7 to 41.4%. Even more striking are the remission rates, lying between 28.6 and 56.7% for psilocybin while the SSRI produced remission at 6 weeks in 6.9 to 20.7% of participants. (Check out the Supplementary Appendix, pg. 13 to see for yourself.)
As this is a two-dose study, there was a similar outperformance after the first psilocybin dose; in two scales (QIDS and BDI) 33.3 to 51.7% of participants no longer qualified as being depressed by the end of the first week. In my opinion, it can’t be overstated how miraculous these remission rates are; these are patients that have often been non-responsive to other treatments for depression, and have likely been through a gamut of approaches, including psychotherapy, exercise, other antidepressants, alternative therapies, and had yet to find relief, let alone remission after a single week.
When we look at secondary outcomes, there are even more revelations. In a score known as “wellbeing”, participants in the psilocybin group increased 15.8 points after six weeks while those in the SSRI group only improved 6.8 points. This not only shows a reduction in depression symptoms, but a marked improvement in patients’ happiness with their sense of self. This is similarly reflected in the “Flourishing Scale” which found the psilocybin group to improve 14.4 points while the SSRI group only improved by 8.9 points after six weeks.
Other similar secondary outcomes also demonstrated remarkable efficacy for psilocybin including reductions in suicidal ideation, trait anxiety, experiential avoidance, anhedonia (which has implications for chronic pain), emotional breakthrough inventory, psychotropic related sexual dysfunction, and others. A key line to take from the caption for Supplementary Table S1 that compares depression inventory rates across all six weeks is: “All contrasts favored psilocybin. None favored escitalopram.” These are well established depression inventories that are used as the standard of comparison in nearly every modern study testing efficacy against nearly any method or medication for relieving depression, but because they were not chosen as the primary scales, they were classified as secondary outcomes. But if all these scores had been corrected against each other, including the QIDS, psilocybin would have shown to be clearly superior.
So why was QIDS chosen as the primary evaluation instead of the much more frequently employed MADRS inventory? As someone who had to take the MADRS inventory repeatedly in order to qualify for NYU’s investigational study of psilocybin for major depressive disorder, I will tell you it is surprisingly precise and accurate, making it nearly impossible to hide the depths of your disease from yourself. As much as we may mask the symptoms of our disorder to others in order to function in our day to day lives, we may in fact find we mask the severity of our symptoms to an even greater degree to ourselves. According to Carhart-Harris, the choice to use QIDS was almost arbitrary and now considered ill-advised in hindsight. And other professionals on Twitter and elsewhere online are largely in agreement, arguing that QIDS was a scale not designed to measure depression so much as one designed for patient convenience and to measure response to classic SSRIs. For example, QIDS has no measure for wellbeing, emotional breakthrough, experiential avoidance or, dare we say, mystical experiences.
SSRIs modulate and downregulate distressing feelings, but do not generally resolve them, much like a daily salve that keeps negative emotions just under conscious awareness. Psilocybin not only goes to the heart of engaging the origin of troubling feelings, but due to its ability to induce neuroplasticity, it’s theorized that the psychedelic compound directly aids in a cortical reorganization of prior maladaptive circuits and strongly held associations that create the framework of a patient’s life experience and the events in it.
Evaluating the Choice to Use the QIDS Scale
Worth noting about the QIDS scale relative to the other inventories in the study is a concept in statistics known as a confidence interval or CI. When a study is performed, it’s obviously not done on the entire population but on a sample of the population. A confidence interval is a measure of how likely the mean average of the results in the study population would match the mean average of results in the general population. It’s also a measure of how likely those same results would occur if scientists were to repeat the test multiple times.
In a study like this one where two medications are being compared against each other for efficacy, their confidence intervals can be laid out on a table or graph known as a forest plot. When the CIs are displayed on a forest plot, they are shown as a range of most likely results (i.e. -2 to -15). This is key because that allows researchers to demonstrate their confidence that a given range of results would occur for 95% of the general population or in repeated studies. 95% is the agreed upon standard for proof of any statistical significance in patient response to medication for this type of study. However, if on a forest plot, your CI crosses zero (which is the midline between the two groups), there is a far greater likelihood that there is no difference in effect between the groups.
So recall now that Carhart-Harris said that choice of QIDS was arbitrary as the main depression scale for the study and that their team of researchers predicted no difference in effect size between the psilocybin and escitalopram when they submitted the pre-req application to run the study. For more than a week before the study was released, Carhart-Harris did a daily thread on Twitter describing effect size, how different measurements may in fact be measuring the same issue and could be condensed, that NEJM analysis of the results are extremely conservative, but most of all he “implored” readers to view the supplementary tables and appendices, and to particularly look at the confidence intervals for the main inventory and then the confidence intervals for the secondary outcomes.
Carhart-Harris made a very careful note that confidence intervals that do not cross zero are considered statistically significant and those that do cross zero are considered insignificant. He directed us to look at Figure S1 and Table S4 where you will see at the top that the only inventory that crosses zero is the QIDS scale, which strongly implies its result is a false negative in showing no difference in outcome between the SSRI and psilocybin, and we can be confident of that because of the redundancy of the other evaluations they also used. Every other inventory and measure shows psilocybin far out pacing escitalopram by nearly a two to one margin. You can take a look yourself by accessing the study’s Supplementary Appendix, and turning to Section S6. Supplemental Figure S4: Mean change for primary and secondary outcomes with confidence intervals (pg. 16).
Conclusion
Between the extraordinary results in the secondary outcomes, the fact that the QIDS scale was the only inventory to cross zero in the forest plot, and the strong likelihood that modern depression scales aren’t designed to capture the full range of positive personality change that underpin psilocybin’s cortical mechanisms, it’s hard to see how this is not an overwhelming win for psilocybin.
It would certainly be remiss for me to not once again state I was a participant in a very similar study myself who experienced full remission and know others who experienced the same. I would be equally remiss to not mention that for many who took the two doses, their depression returned after a few months—but not all of them. However, this is already the case with standard daily antidepressants. And with psilocybin, there are no sexual side effects, you can actually feel a full range of emotions, and the frequency of dosing is far less. But for people that have either found themselves unresponsive to standard SSRIs, or experience untenable daily side effects from antidepressant medication, psilocybin appears to offer an equal, if not superior, opportunity to recover their happiness and effectiveness in their daily lives.
About the Author
Court Wing has been a professional in the performance and rehab space for the last 30 years. Coming from a performing and martial arts background, Court served as a live-in apprentice to the US Chief Instructor for Ki-Aikido for five years, going on to win the gold medal for the International Competitors Division in Japan in 2000 and achieving the rank of 3rd degree black belt. In 2004, Court became the co-founder of New York’s largest and oldest crossfit gym, and has been featured in the New York Times, Sunday Routine, Men’s Fitness, and USA Today. He is also a certified Z-Health Master Trainer, using the latest interventions in applied neuro-physiology for remarkable improvements in pain, performance, and rehabilitation. You can find out more on his website: https://courtwing.com
In this week’s Solidarity Fridays episode, Kyle, Joe, and Michelle are joined by Tim Cools of PsychedelicExperience.net, a not-for-profit website that aims to be both an open data source for researchers, as well as a Trip Advisor/Yelp-style review site for retreat centers and facilitators that will actually allow negative reviews (something that’s oddly rare in similar sites). While the site is live now, they are having are-launch event on Saturday, streaming the documentary, “Psychedelia,” followed by a live panel discussion with “Psychedelia” director Pat Murphy, Cools, and David Luke.
The team first discusses a recent Forbes article that reported Beckley Psytech teaming up with Fluence (a psychedelic education organization that trains mental health providers) for the first 5-MeO-DMT training program, and how it felt like a press release that was both pushing 5-MeO-DMT while also ignoring many of its more important aspects.
They then move on to The New England Journal of Medicine’s recent “Trial of Psilocybin versus Escitalopram for Depression” study and the way it was reported, highlighted in a reaction blog by one of its authors: Dr. Robin Carhart-Harris. This leads to a discussion on how these studies (whether intentionally or not) so often bury important information deep within these papers, including study-related deaths. And they review responses from Katherine MacLean and Rosalind Watts that perfectly illustrate the importance of community, the efficacy of in-depth therapy, and the shortsightedness (and danger) of treating psychedelics as miracle cures.
Notable Quotes
“Learn to be aware of what you’re thinking. Learn to be aware of what your emotions are, what is in your body. This is more important because this is your real life. The psychedelic or the mystical experience is life-changing and it’s good to have once in a while, but you’re living in this moment. You’re living right now, and so it’s more important for [you] to be aware of what you have now than to chase the other psychedelic experience, one after each other.” -Tim Cools “We should have this open science to try to prove these things, but maybe the clinical model isn’t really where we need to be proving that this works. Maybe in the community model, we’re going to see more effective results. And we won’t be able to have that until it’s legal and therefore safe for everyone to participate in.” -Michelle
“I’m not totally against these capitalist groups, I’m just kind of against their fuckery and manipulation and hiding data, kind of lying in a way- selling us things but having a lot of lies hidden in the closet.” -Joe
“I think that tripping is a skill …and that you should practice that skill- build those muscles, and then maybe it can happen for you. But we shouldn’t sell it as: ‘You take a psychedelic, you have a mystical experience, you’re never depressed again.’ That doesn’t sit right. That doesn’t usually happen.” -Michelle
Tim is a conscious entrepreneur and psychedelic coach. After experiencing the profound transformational power of Ayahuasca in 2015, he realized his purpose is to advocate safe and responsible use of psychedelic plants and medicines: this is how Psychedelic Experience was born! He has over two decades of professional experience developing industrial-grade software in various industries, including smart homes, energy, payroll and logistics. In 2018, Tim re-trained himself as a psychedelic integration coach and guide, hosting legal psychedelic sessions and retreats in the Netherlands. Tim’s interests are software architecture, psychedelics and plant medicine, non-dualism, mindfulness, and helping people to reduce their suffering and improve their well-being.
Paradigm-shifting tools don’t fit into paradigmatically static ways of doing things
Psychedelics. Maybe you’ve heard. They’re having a bit of a moment right now. And for good reason. To name just a few examples, the Multidisciplinary Association of Psychedelic Studies (MAPS) is moving MDMA-assisted therapy for PTSD through the FDA approval process. Decriminalization of psychedelics, including LSD (!), is taking place at a breakneck pace. Psilocybin-assisted therapy was even legalized in Oregon during the 2020 election. And, multi-million dollar research institutions are also popping up left and right.
However, there’s an elephant in the room. The looming presence of large, for-profit companies swallowing up patents left and right and ostensibly becoming the primary option for psychedelic therapies of the future is becoming too big to ignore.
It’s beginning to get called out, for a start. More articles are popping up rightfully critiquing this situation as an issue. About a month ago, famous entrepreneur Tim Ferriss kicked off a question on his blog asking if there are any viable alternatives to for-profit psychedelic companies. In reply, Christian Angermayer, one of the main investors behind Compass Pathways, a for-profit psilocybin-assisted therapy company responsible for a large chunk of the patent grab, basically said, “Nope”.
This is disheartening to many in the psychedelic field, to say the least. Most of us didn’t become advocates for psychedelics because they promised to make our healthcare system a bit more effective and a few people a lot more rich. We became advocates for psychedelics because they offered a promise of a better way of doing things; not just for healing, but for the world.
Traditional for-profit companies that are seemingly dominating the space are a betrayal of that promise, especially when no viable, scalable alternative seems to be in sight. Luckily, I think there is a true paradigm-busting healing model that’s not only a proper fit for psychedelics, but has been worked on for years right under our glitter-speckled toenails. We just haven’t yet given it a name. But first, let’s address the elephant in the room: equity.
The Equity Elephant in the Room
I’d like to call this elephant in the room the “Equity Elephant” for two reasons. One is that this elephant is largely a product of private equity entering into the psychedelic space a few years ago. Think venture capital and angel investors. Another reason for deeming it the Equity Elephant is that the response to large, for-profit companies dominating the psychedelic space has largely been one of increasing equity in terms of fairness—or in other words—increasing access. This makes sense considering that most of the companies in question are derived from our healthcare system, which is not exactly the Cadillac of compassion and accessibility.
Thus, the question around what to do about the Equity Elephant has largely been around increasing access. There’s a problem with this, however. Much like how the old paradigm for mental health failed because it treated symptoms rather than causes, increasing access to a system that is inaccessible by design isn’t really going to do all that much good.
We became advocates for psychedelics because they offered a promise of a better way of doing things; not just for healing, but for the world.
Another issue is that we’ve only so far been using one half of the meaning of the word “equity”. Another important use of the word is equity as ownership. So far, asking who owns the future of psychedelic healing has been relatively off the table when it should really be on the tips of our tongues.
First, let’s dive into what ownership means a little more. Ownership is not just about who gets to keep the profits from something. This is another relic from the old paradigm. It’s also about who has the power to direct something’s future. It’s about stewardship, rather than just status. Equity as a term, defined as meaningful power over directing something, needs to be put to use yesterday in the psychedelic space.
The absence of discussing equity as ownership is, in my opinion, why the Equity Elephant in the room is so disheartening. It exemplifies a radical feeling of disempowerment by us in the psychedelic scene who’ve experienced profound healing benefits from these substances. When faced with these behemoths of capitalism making such large strides in the psychedelic space, it’s no wonder we feel outmatched. These organizations don’t strike us as stewards to the future we’re trying to bring about.
But fear not. Now that we know equity is about access and ownership, or fusing them together to increase access to ownership, I think some very promising alternatives will begin to emerge.
Before we go into what those are though, let’s take a quick look at who, in my opinion, actuallyowns the psychedelic future and why they’re charting its path forward: community-based psychedelic organizations.
Community-Based Psychedelic Healing
Perhaps I’m a bit biased. I have been leading the Brooklyn Psychedelic Society since 2016. But to me, what’s been taking place at psychedelic societies across the globe over the past years is muchmore headline worthy than a new multi-million dollar psychedelic company popping up overnight.
Psychedelic societies are self-organized, mutually supporting organizations that together form a grassroots movement of thousands of healers, seekers, organizers, artists, psychedelically curious, and many, many more that have been healing each other with little input from traditional therapeutic institutions. They’ve been doing this for years in ways that regular for-profit companies can only dream of, in an effective, decentralized, evenly distributed and accessible manner.
Why isn’t this getting any headlines? Well for one, twenty people gathering in a park for an integration session with a net yield of $8 and some palo santo sticks isn’t exactly click bait. It’s also because it’s emblematic of a pattern that took me many a psychedelic trips to realize: The most transformative changes aren’t in the headline-grabbing epiphanies (I’M GOD?!!), but in the little, subtle things that we integrate and adopt into our lives patiently and gradually over time (I really need to start painting again and be nicer to people). And that’s exactly the kind of transformation that psychedelic societies have been holding space for.
Because of this, a bonafide healing modality on its own has emerged: community-based healing. Besides just anecdotes from the hundreds of people I’ve met who’ve gotten healing through our community and other psychedelic societies around the world, there’s good ol’ science to back this up as well.
Much like how the old paradigm for mental health failed because it treated symptoms rather than causes, increasing access to a system that is inaccessible by design isn’t really going to do all that much good.
Mike Margolies, founder of Psychedelic Seminars, even came up with a nifty acronym to describe this approach: PEACH (Psychedelic Education and Community Healing) that I highly recommend reading. But, why is community-based healing its own approach altogether?
As mentioned earlier, the old mental health paradigm was failing because it treated symptoms rather than causes. We know that isolation and loneliness exacerbate some of the conditions psychedelics treat so effectively, such as addiction and depression. Thus, delivering psychedelic healing in environments that lack an authentic social component seems to repeat the same mistake of the old paradigm, albeit with better tools.
Of course, clinical modalities for psychedelic therapy should always be available and made as accessible as possible—if that’s what’s needed by the person seeking healing. I don’t think community-based healing will or should replace therapy altogether. But it does seem to be a genuine fourth context that goes beyond the clinical, retreat, and recreational settings, and should probably be the first place to go when someone is seeking a transformative experience.
Psychedelic Mutualism
While we are on a streak of trying to get to the root of things, I’d like to briefly outline what I think is the core philosophical difference between the community-based approach to psychedelic healing and those of the clinical models.
The difference is that community-based approaches take interdependence not just as a fact of life, but as a necessaryaspectof well-being and growth, especially when it comes to healing. This is called “mutualism” in biology and is something that ecologists have long been saying is key in order to awake from our anthropocentrism.
Therefore, psychedelic mutualism is the philosophy that emphasizes community, interdependence, and proactive peer support as centralto growth and flourishing on both an individual and societal level.
The clinical and retreat models contrast with this approach. These modalities are derived from an older philosophy: We are all atomized individuals with consciences that need to be preserved and kept secure. Hence the model: Go to a clinic and get your healing, and then go back to your private life, work and all the other dysfunctions of modern living included.
Sure, these settings might have some community components to them, such as check-ins with retreat members for a few weeks after the journey. But this is not core to their operating philosophy.
Psychedelic mutualism, and the healing modality in which it’s most exemplified, community-based healing or “PEACH”, puts community at its core. The psychedelic experience shows us this in spades by revealing our interdependence not only intellectually but viscerally, in our minds, bodies and hearts.
So how do we scale these modalities to not only increase access, but also increase ownership over them? In other words, how do we democratize the ownership of psychedelic healing?
The Cooperative Model of Ownership
Most traditional organizations are either non-profit or for-profit, with a board, an executive team, managers, employees, and then the people they serve (usually, the customers). While input is sometimes welcomed by other stakeholders within and outside the organization, the decisions are ultimately made by a small handful of people.
Using our definition of ownership as meaningful power and say over something’s future, these organizations are centrally owned. There is an alternative to this model called worker or member owned “cooperatives”.Cooperatives, or co-ops, work differently than the organizations previously mentioned. A cooperative is democratically owned (decentralized) and controlled by its members. Its members can be its workers, its consumers, a combination of both, or any number of different combinations depending on the needs of the community that it serves. Each member gets to vote on the direction of different parts of the organization’s future.
Thus, the key difference between co-ops and regular for-profit companies is that they’re owned by the people that produce and use their services. Put in another way, the profits made by cooperative organizations are in service to the community, not vice versa.
Cooperatives are social and equitable (in both the access and ownership sense) by design, rather than community being a nice byproduct. In other words, mutualism is baked into how they operate. One of the best accounts of this model specifically in a psychedelic context is Bennet Zelner’s Pollinator Model. In his article, Zelner contrasts “pollinator” organizations—those that contribute to the wellness of its members, surrounding communities and society—with “extractive” organizations that accrue value for its shareholders but don’t distribute that value to those they serve or are adjacent to.
Most of the companies that the psychedelic community is rightfully up in arms about are the latter variety. The co-op model is just the answer we’ve been waiting for, I believe. It just has to be applied.
Owning Our Future with Psychedelic Co-ops
You can’t fit a paradigm-busting tool, like psychedelics, into a paradigmatically-static context, like our healthcare systems and traditional for-profit companies. You also can’t use an old philosophy to help shoehorn it in. The settings and operant philosophy needed for psychedelic healing to scale in an authentic way must be at least as transformative as the tools and modalities they are provisioning.
So far, however, no viable and scalable alternatives have been presented. This is where cooperatives and psychedelic mutualism enter into the picture. Yes, large for-profit companies will be in the space. But they are not the end all be all. One day, I hope for-profit companies in the space will be the alternative to the default model: psychedelic co-ops.
Psychedelic co-ops would treat psychedelics and healing as they are meant to be treated: as a publicly accessible service that’s for the benefit of all, in the communities they serve. We have all the building blocks we need to not only construct our psychedelic future, but to own it. So all we need to do now is build. Together.
About the Author
Colin Pugh is the executive director of the Brooklyn Psychedelic Society (BPS), a MAPS-sponsored organization whose mission is to make psychedelic healing a publicly accessible good through community, education, democratic ownership, and advocacy.
Many in the Black community are weary of psychedelic therapy because of stigma rooted in the racist War on Drugs. But how do we begin to change that?
Last year I wrote an article entitled “Why Don’t More Black People Use Psychedelics?” I cited several reasons as to why we haven’t seen psychedelics embraced by Black people at the same rate as other groups. One of those reasons was that drug use has been highly stigmatized, especially in Black communities.
Another topic that has been heavily stigmatized within Black culture is therapy. As a result, many Black people are hesitant to try a treatment that involves both drugs and therapy.
Numerous research studies have shown that psychedelics can aid in the treatment of trauma, depression and PTSD. According to Medical News Today, “Depression is about as prevalent in Black communities as in white ones, but there are significant differences. Black people face different social pressures that may increase their risk of depression.”
These risks include but are not limited to:
Racial trauma
Difficult life experiences as a result of racism
Barriers and lack of access to mental health resources
Socioeconomic inequalities are another stressor that can increase poor mental health. In 2019, Black people represented 13.2% of the total population in the United States, but 23.8% of the poverty population. According to the organization Mental Health America: “Black and African American people living below poverty are twice as likely to report serious psychological distress than those living above the poverty level.”
Equity in psychedelics has been a popular topic of discussion. For those of us that are committed to equity in this space, what can we do to help destigmatize drugs in the Black community?
1. Normalize Drug Use
Society has led us to believe that illegal drugs are harmful while prescriptive drugs are useful.
This is not true.
We can end this harmful narrative by normalizing the use of drugs, all drugs.
In his latest book, Drug Use for Grown-Ups, Dr. Carl Hart writes about his experience with recreational heroin use. He shares that he uses heroin to unwind at the end of his day, the same way many of us turn to a glass of wine. Dr. Hart is not addicted. Instead, he says that his use of heroin has increased his overall life satisfaction. In order for our society to start to normalize drug use, we need to hear more of these stories.
2. Normalize Therapy in the Black Community
In the Black community, mental illness is a taboo topic and often, we’re labeled as “crazy” if we seek mental health services. Instead, we’re told to find solace in the church or prayer. In order to start to normalize therapy, we need to educate ourselves and each other about mental health. Part of that education needs to involve open and honest conversation about mental health in schools, churches and in the Black community.
3. More BIPOC Representation in the Media
Psychedelics have been portrayed in the media as a drug for white guys. We rarely see the portrayal of a Black man taking a trip on acid or psilocybin. Documentaries such as Hamilton’s Pharmacopeia and Psychonautics have helped to destigmatize psychedelic drug use, but not in Black communities. While I’m glad that these shows exist, they need to include faces that look like ours.
4. More Black Representation in Healthcare
Only 4% of all therapists in this country are Black. Finding any therapist you connect with can be hard. Finding a Black therapist can prove to be even more of a challenge. And if you’re in search of a Black psychedelic therapist, that can be nearly impossible. Just as we need to see faces that reflect ours in the media, we need to see that representation in the healthcare industry as well.
Our current healthcare system includes racial and ethnic biases which can impact the quality of care Black people receive. As a result, this may deter a person from the community to seek care. We need more Black therapists, trip sitters and educators in this space. We can start by seeking out future therapists and introducing them to these medicines and the benefits they offer.
For those in the Black community who want to pursue the path of becoming a therapist or healthcare professional, there needs to be adequate funding offered to support our education as well as our future research studies.
Conclusion
We can begin to normalize the stigma of psychedelics in the Black community by sharing information, having open conversations and seeing diverse representationin this space. The Black community has the added pressure of overcoming the stigma of both drug use and therapy, but the more we talk about these medicines and this work, the more normalized they will become.
Black people are traumatized. We not only live with current daily racial trauma, but the generational trauma endured by our ancestors as well. Psychedelics offer us a path to healing that exists outside of Western medicine. If we can begin to undo the stigma and shame associated with drugs and therapy, then as a community, we can finally begin to heal.
About the Author
Robin Divine is the founder of Black People Trip
Robin Divine is a writer, psychedelic advocate and the creator of Black People Trip, an online community with a mission to raise awareness, promote education, teach harm reduction, and create safe spaces for Black women interested in psychedelic use. If you’d like to support Robin in her mission to bring Black People Trip to more women of color, check out her Patreon or find @DivineRobin on Venmo.
In this episode, Joe interviews returning guest Richie Ogulnick, a facilitator/guide who has been helping clients through ibogaine experiences for 26 years.
Ogulnick talks about how ibogaine works, why he prefers working with the whole plant (iboga), why the flood doses he used to recommend weren’t as effective, and the importance of allowing his clients to spend as much time as they want on intention-setting before their session. And of course, he talks about the session itself, which usually tends to be a gradual slide into a 15 to 30-hour waking dream state of deep exploration, followed by the slow process of coming out of it, making sense of it, and starting to work towards integrating what was learned.
He also talks about LSD, the work of Bhagwan Shri Rajneesh (Osho), an instance of someone who had no experience with iboga (and why), methodologies and experience, and tells a story of a time in NYC, watching someone shoot up heroin while explaining their experience to him as a way for him to better understand addiction and an addict’s search for a feeling of peace.
Notable Quotes
“Very often, people ask me if they should bring a tape recorder with them, and I say, ‘Well, just make sure that it’s a voice-activated tape recorder, because you may say a few words and then 15 hours later, you may finish the sentence.’” “Unlike other psychoactives, it’s interesting- it’s almost like you’re introduced to a new language, and 6 months, 8 months later, people are sharing with me that their intentions have finally all been worked through and they’re maybe considering doing another session in 6 months or a year. Whereas, with other psychoactives, you can very comfortably do ayahuasca once a week, once a month, for months or years. People tend to do iboga maybe 2 to 4 times in a lifetime.”
“Psychedelics or iboga or meditation- methods won’t get us to that beneficence. What methods tend to do is allow us to crawl back to ourselves and say, ‘I’ve accumulated all of these experiences through this methodology, but I can’t go any further. I have to let go of this method’ and then the beneficence really happens. So it’s running at the arrogance of adulthood until you crawl back to yourself and you say, ‘I surrender.’” “The cool thing about setting intentions is not so much the content but the impetus. You create the pilgrimage to go deep within, irrespective of what you really explore.”
Richie Ogulnick is a long time Ibogaine provider and enthusiast Over the course of fifteen and a half years, he conducted about 750 sessions, including addiction-interruption treatments. He spent the next several years referring close to 1,000 more people to other ibogaine providers. During that time, he also trained doctors and ex-addicts who opened ibogaine centers throughout the world. Richie feels a pull to focus again on the more therapeutic and psycho-spiritual treatments where he is able to offer his expertise in ibogaine treatment along with his knowledge of reintegration with individuals who are looking to deepen and enrich their life experience.
Internal Family Systems therapy, or IFS, is an effective complement to psychedelic therapy and integration. But how does this therapeutic approach – best known for working with the many pieces of the psyche that comprise one’s personality, or “parts,” – work in conjunction with psychedelic medicines?
My own experiences with this modality enabled me to better understand how it works.
Navigating inner space is always a surprisingly visual journey for me. In one particular session, my eyes had been closed for a while. And this time, in a guided Internal Family Systems (IFS) therapy session, the powerful visual component was exactly the same.
There are many paths from which one can enter the inner world, known as “trailheads” in this detailed method of psychotherapy. Just taking a few breaths within this dark, introspective place, I could feel something churning like magma in my stomach. I saw and felt hot, crackling flames of anger percolating within my abdomen; painful memories of betrayal filtered through my consciousness.
Using this bodily trailhead as an entry point and working through the “parts” that hallmark the IFS approach, my therapist began to gently ask about it, as if the anger was a sentient presence.
“What would your anger do if it didn’t have to keep doing this job?” I heard from what now seemed like a far-off place.
“I don’t know,” I mumbled. “I like the anger. I know it’s here to protect me. We get along.”
It felt deeply familiar, like a well-worn sweatshirt that I couldn’t bring myself to let go of. It was safe. Or rather, it kept me safe. In the language of IFS, I had contacted a protective part of my psyche, which in this case, was a flaming cauldron of anger.
“Good. Let the anger know that you appreciate it. Really let it feel that… what does the anger have to say to you now?”
“That sometimes we lose people,” I sighed. “And that that’s OK.” These simple words gave way to a massive sense of release.
I felt the turbulent energy inside me suddenly transform into something which encompassed my entire awareness. The fiery magma of anger which coursed through my body a minute ago shifted into something that I can only describe as an emotionally expansive, all-inclusive moment of peace.
This space was familiar. I had felt it before, this wordless balance between bliss and sorrow which the thinking mind, or “ego”, seems to dissolve in.
Now, instead of feeling the flames inside me, I was inside the flame itself. I felt my entire body relax. My mind, a psychic battleground only moments before, was quiet.
I exhaled into a stillness which resonated throughout my cells. The immensity of all of life’s crushing beauty somatically flooded through my nervous system and inner vision. I felt my heart beat and my lungs expand as forgiveness flowed through my entire body. My mind relinquished control, letting the story behind this painful life chapter melt into the purifying, boundless flame I suddenly found myself engrossed in. I was deeply immersed in what IFS therapists call the energy of “the Self.”
The distant voice advised me to stay there as long as I could. And so I did, until time began to loosen its grip upon my consciousness.
As powerful as any psychedelic moment of healing, this visionary journey was facilitated by a therapist in my Internal Family Systems (IFS) therapy training program. After being guided through this modality, my suspicions around its potential for use in psychedelic therapy and integration were confirmed beyond a doubt.
What Is Internal Family Systems (IFS) Therapy?
Developed by Dr. Richard Schwartz in the late 1980’s, Internal Family Systems is a psychotherapy modality rapidly growing in popularity. As an outgrowth of his work studying family systems therapy and working with patients struggling with severe eating disorders, Schwartz noticed that his clients spoke about their inner conflict in terms of “parts” of themselves guiding their troubling behaviors and inner conflicts.
In what is ironically a radical act in many areas of the psychological establishment, Schwartz actually took his clients at their word.
Integrating his knowledge of family systems, as well as the work of Carl Jung and other psychotherapeutic pioneers, Schwartz created the IFS model which embraces the notion that our personalities are actually composed of a symphony of different parts, as well as a core, boundless source of energy that both Jung and Schwartz deemed “the Self.”
“There are times where you just can’t convince these protective parts to let us get to an exile and heal it. And a psychedelic session can expedite that pretty easily, it seems,” Schwartz told Psychedelics Today.
When asked about working with IFS and MDMA, Mithoefer said, “I have learned how well the spontaneous observations and experiences of our participants map onto IFS, including both parts and the Self… in my experience, people are hungry for this perspective. (Richard Schwartz) didn’t make it up – IFS taps into real phenomena.”
Schwartz says his experiences with psychedelics and the insights he gathered through substance work helped open his awareness to the “multiplicity of mind,” a core principle of IFS.
In the past, the field of psychology viewed subpersonalities with great skepticism, giving way to infamous diagnoses such as dissociative identity disorder (DID), formerly called multiple personality disorder (MPD). Yet IFS, a non-pathologizing form of psychotherapy, looks at the many subpersonalities, or parts, as natural facets of the psyche–aspects of ourselves which yearn to be known, understood, and healed.
As a depth psychotherapist, I was trained to suss out the unconscious and possibly archetypal aspects of a given dynamic or situation with my clients. Image and metaphor have long been the bread and butter of depth psychology, with myths and fairytales frequently providing the backdrop for some of this tradition’s most memorable texts. In other words, both depth psychology and IFS take to heart the notion that image and psyche are one and the same.
After slowly developing my own therapeutic style, which is influenced not only by human teachers, but psychedelic plant teachers as well, IFS felt like an immensely practical tool with which to weave this odd tapestry of animism, image, and archetypes.
After all, what is an archetype if not psychic energy crystallized into an image?
What are “Parts” in IFS?
For millennia, psychedelic medicines have been used by humans to invoke visions, as well as bring one into dialog with some larger presence: the Great Spirit, the spirits of teacher plants, animals, elements, or the ancestors. Especially with ayahuasca, DMT, and other tryptamine-containing substances, people report encountering beings or entities who often communicate detailed information that can be recalled after the effect itself has worn off.
Whether these entities are mere reflections, or personifications of psychic parts,is a valid, but different, discussion. The point is that when one goes deep enough into the mind, research and anecdotal evidence proves that it is not unusual to encounter presences that seem entirely other than one’s own self.
Instead of entities, beings, or spirits, IFS employs the language of partsto describe the psychic presences which collectively constitute one’s personality.
As a psychedelic integration therapist, IFS provided me with a systematized toolkit for working with people trying to make sense of the paradigm-bending moments that can often occur during a psychedelic journey.
For example: take the voice that suddenly tells you to quit your job; the sinking feeling in your stomach when you think about a memory from childhood; feelings of unworthiness that you’re doing it all wrong; or that suddenly you’re not safe, despite all evidence to the contrary. From the IFS perspective, these are most likely parts expressing themselves and asking for your attention. From a shamanic perspective, these messages might be coming from the spirit of the plant you just ingested, from the ancestors, or from something else entirely.
For psychedelic explorers who prefer not to think in terms of spiritsor entities, IFS can provide a useful method of conceptualizing and categorizing potentially confusing aspects of psychedelic experiences that might not fit within their worldview.
Defining “Self” in Internal Family Systems
Both IFS and psychedelics work by reconnecting one to an internal source of transpersonal energy, which Schwartz, taking a page from Carl Jung, calls “the Self.”
IFS has the potential to lead one into profoundly visionary and emotionally cathartic experiences. For me, IFS has been comparable to some of the most healing moments that I’ve experienced with psychedelic medicines.
IFS can provide both facilitators and participants a language by which to conceptualize and map an experience that would otherwise be, by its very nature, ineffable.
In describing the energy of the Self, Schwartz developed what he calls the “eight C’s”:
Compassion
Curiosity
Calm
Clarity
Courage
Connectedness
Confidence
Creativity
In IFS, it is the energy of the Self, not the therapist, that truly heals.
The good news here is that everyone, regardless of past trauma or experiences, has within them the boundless energy of Self. Thus, IFS believes that everyone has the capacity to heal.
The notion of the Selffirmly locates IFS therapy in the terrain of existential-humanistic, transpersonal, and depth psychology, all of which form the foundations of emerging and long-standing modalities of psychedelic psychotherapy (for examples, see Grof, 1975, Stolaroff, 1997, and Leary, Metzner & Alpert, 2007).
One could say that within the psychological establishment, the idea of the Selfis as radical a notion as LSD being used to heal. In many mental health agencies or governmental health services, both concepts would likely be given a sideways glance at best, mockery or early termination at worst.
In my own psychedelic experiences, I can recall moments of feeling immersed in many of the eight C’s.Formal research has yet to be conducted connecting the Jungian and IFS concept of the Selfwithin psychedelic experiences and its potential for healing, though the work of Stanislav Grof, as well as Griffith’s research mentioned above, comes close.
Perhaps the expansive, all-encompassing energy of the Self is what the famous Mazatec curandera, Maria Sabina was referring to when she said, “Heal yourself, with beautiful love, and always remember, you are the medicine.”
How Psychedelic Integration Could Employ IFS
After a psychedelic experience, my clients often share what can seem like a deluge of information, imagery, and questions. In addition to archetypal imagery, transpersonal, and shamanic perspectives, IFS provides me a detailed map for understanding and deeping into the integration process with clients. Often, there are recognizable themes or patterns that can emerge during a psychedelic experience – for good or ill.
Here are some core concepts in IFS therapy that I have found useful while facilitating integration work: “Unburdening,” “Polarization,” and “Blending.”
“Unburdening” in IFS
If one could distill IFS therapy down to a single sentence, it could be that it consists of helping certain parts of ourselves let go of outdated or inherited ways of being that cause us to suffer.
IFS calls this process “unburdening,” as it understands that certain parts take on “burdens” early in life which, as we grow, might become less and less helpful or healthy.
This unburdening is achieved by establishing a connection to the Self, so that the part can realize it doesn’t have to do it all by itself, that it’s not alone, and that its past experiences don’t dictate the future. Usually, these moments are profoundly cathartic and emotional. It can also take an immense amount of work to get there, which is why psychedelics can potentially play a helpful role in this therapeutic process.
From an IFS perspective, unburdening is often what happens in a positive psychedelic experience, and can be some of the most memorable moments of the journey. For example, metaphorically giving your anger to the fire; letting your grief float away into the ocean; or planting your sadness into earth. Such images are common in both IFS therapy sessions and psychedelic journeys.
Through the lens of IFS, our stories about who we are or how the world is might be a burden carried by a part. For instance, seeing oneself as a savior, victim, martyr, or outcast is a story that might be severely limiting one’s idea of who they really are and their self worth. Tendencies towards workaholism or scarcity fears, chronic shame, feelings of not being enough and needing to prove oneself, are all burdens that certain parts might carry for decades. Many burdens were placed upon us during childhood by family members, and in that sense are not true reflections of who we really are.
On an even deeper level, some burdens are inherited through our blood lineage and ancestry, or experienced through what author and psychotherapist Resmaa Menakem calls HIPP (historical, intergenerational, persistent institutional, and personal) trauma. These heavy burdens may inform every aspect of someone’s life, and are heartbreakingly real, but are still not accurate reflections of who they truly are.
Trauma twists someone’s story about who they are. Healing helps rewrite it.
“Polarization” in Internal Family Systems
Dealing with “polarization” between parts is a common occurrence in IFS therapy sessions. Through an IFS lens, challenging psychedelic experiences can often occur because these same polarized parts are amplified during a journey. Looping or confusion – a frequent element of a bad trip – might be seen as an extreme polarization.
Polarization is like an inner battle. A difficult psychedelic experience might occur because of this inner tension: one part wants to surrender, another part is terrified to do so. One part says to take a second dose, another part cautions against it. One part wants to lay down under a blanket, another wants to stand up, stretch, and go outside. Such conundrums can be viewed through IFS as polarized parts playing a psychic tug-of-war.
This can get exhausting. And usually, there is a much deeper process going on beneath. The IFS therapist’s job is to tend to the parts that arise with compassion, to witness them, help them unburden, and reconnect them to the energy of the Self.
“Blending” in IFS
We all have certain parts that become strong aspects of our personality. Many people who live outwardly successful lives might be plagued by a “manager” part which acts as a strict taskmaster, inwardly limiting their creative expression and spontaneity. High levels of anxiety, especially social anxiety, can be viewed through IFS as a “critical manager” or “worrisome exile” part which gains control in uncertain situations. Or someone struggling with a strong addiction, for example, can often revert to what’s called a “firefighter”–a reactive part that rushes in to dramatically protect the system when triggered, even though it ultimately sabotages that person’s wellbeing.
Such experiences are referred to in IFS as “blending.”
Fear of letting go, or becoming stuck in certain thought patterns is a basic example of being “blended” in a psychedelic state. The psychic energy being taken up by the part in question is inhibiting one from connecting to the body, the deep nervous system, and the Self, which is how healing most easily occurs.
Extreme examples of negative outcomes from psychedelics can often be seen through this idea of blending.
How many of us have experienced someone – possibly ourselves – fresh out of a psychedelic state convinced they are either some kind of messiah with a sacred mission, or at fault for some global catastrophe, disaster, or cosmic mishap?
Taken to the extremes, this is the stuff that psychedelic-induced psychosis is made of.
And almost guaranteed, there is a much deeper reason why the part in question took over. Likely, it is to protect the psyche from facing something incredibly scary or traumatic.
From a Jungian lens, one could view these extreme examples of blending as a type of “archetypal possession,” resulting from some form of inflation. During an archetypal possession, according to Jung, an archetype takes “hold of the psyche with a kind of primeval force and compels it to transgress the bounds of humanity. The consequence is a puffed-up attitude, loss of free will, delusion and enthusiasm for good and evil alike.
Interestingly, psychedelics can both inflate or deflate the ego, filling someone up with grandiose visions of spreading the “good news,” or reducing one into a fragile shell of themselves.
This is the critical role of integration: to recalibrate the ego with the Self, to witness and guide the vulnerable parts that need care, and to ground potentially expansive visions into a genuine path of tangible healing.
Using IFS to Navigate Psychedelic Journeys
Beyond integration, IFS can offer an immensely valuable toolkit for navigating psychedelic space as well. Speaking from personal experience, IFS has helped me to create more psychic spaciousness within a journey. Much like mindfulness, remembering my IFS training has helped me practice observing, rather than getting “hooked” into particular thoughts and feelings that might emerge during a psychedelic experience.
The basic premise of IFS is that the psyche is inhabited, and that we can learn to dialog with these presences or parts. Remembering this simple fact, I’ve been able to remain in a space of gentle curiosity when, for instance, I might fall into a thought pattern that could potentially send me down a critical, anxious, or confused internal loop during a journey.
Cultivating the ability to remain connected to Self, or any of the eight C’swhich characterize this energy, helps me to remain grounded and present within psychedelic space. Much like mindfulness, the goal is to create psychic flexibility, spaciousness, and literacy, so that we might more deeply be able to do “the work” that psychedelics inevitably ask of us.
Every IFS therapy session, like every psychedelic experience, can be worlds apart. Speaking from experiences both as a therapist and client, I am continually blown away by what this therapeutic modality has revealed to me and those I’ve been lucky enough to work with.
Internal Family Systems is not only an effective psychotherapy modality with an extraordinary capacity to heal trauma, demonstrated in a pilot study in which 92% of participants no longer qualified for a PTSD diagnosis, it is also a non-pathologizing, client-directed, and ultimately psycho-spiritual framework for guiding one on the potentially infinite road of inner work.
As every good navigator knows deep down, the map and territory will always remain two very different realms. Yet as far as a set of directions for charting the inner world, and for helping people integrate potentially life-altering psychedelic experiences, Internal Family Systems therapy presents a toolkit which can greatly benefit therapists and facilitators looking for a detailed, multifaceted, and truly psychedelic methodology for exploring the soul.
In this episode, Joe and Kyle interview Palo Alto-based Ph.D., author, clinical psychologist, and “integration specialist,” Kile Ortigo.
From what he’s learned at his time at the Grady Trauma Project, the National Center for PTSD, VA work, hospice work, and his own practice, he talks about the flaws of active intervention models of therapy and why what can be most healing for someone is often just letting them be and bearing witness to their experience. And he talks about burnout in healthcare, secondary trauma, common factors that help in all therapy techniques, Jung, “Altered States,” and what we might derive from the popularity of Marvel movies.
And he talks about his book,Beyond the Narrow Life: A Guide For Psychedelic Integration and Existential Exploration, and integration: what it actually means, the basics of how he works with clients, if it’d be possible to create some sort of integration measurement, the importance of being flexible when intention-setting, how the psychedelic journey relates to Campbells’ idea of the hero’s journey, and the importance of movies like “Joker.”
Notable Quotes
“I think that’s one of the downsides of working in any sort of big, large, complex system- is that the metrics that you’re being evaluated on are how many patients you’re seeing a day or a week, not necessarily: are they improving?”
“We need to loosen our attachments on active interventions sometimes and realize that just bearing witness- being present in a mental way can be what’s most healing.”
“Mythology is being created, I would say, at a very rapid pace these days, and it’s being communicated in a much higher scale. And that’s primarily through our science fiction, I think, because it’s previewing some of these challenges that are here right now and we knew they were coming, but we haven’t been paying attention to them and we need to. ‘Black Mirror’ is important.”
“There have always been multiple stories that need to be told, including counter stories to our dominant narratives (our hero’s journey). And that’s why a film like ‘Joker’ from last year was so incredibly important. We needed to hear the story of the shadow and why we need to pay attention to the shadow, and not from a place of judgment or antagonism, but of compassion.”
Kile M. Ortigo, Ph.D., is an award-winning clinical psychologist and founder of the Center for Existential Exploration, which supports people exploring profound questions about identity, meaning, life transitions, and psychospiritual development. He also serves on advisory boards of Psychedelic Support, an online training and clinician directory for legal, psychedelic-informed care, and Project New Day, a non-profit organization providing harm reduction resources for people using psychedelics in their addiction recovery process. He received his PhD from Emory University and is a certified psychedelic therapist trained at CIIS and mentored by Dr. Bill Richards (who wrote the foreword to his second book, Beyond the Narrow Life). For several years, Dr. Ortigo worked at the National Center for PTSD (NC-PTSD) where he collaborated on technology development and implementation projects, ranging from apps like Mindfulness Coach to online programs like webSTAIR. With colleagues at NC-PTSD, NYU, and Harvard, Dr. Ortigo coauthored Treating Survivors of Child Abuse & Interpersonal Trauma: STAIR Narrative Therapy (2nd Edition), which was released in June 2020.
Nine women of color who are working hard to ensure their communities have access and representation in the psychedelic movement
As interest in psychedelic medicine explodes, it is trailed by conversation about representation and access. From leaders, authors and filmmakers, to researchers and clinical study participants, one simple fact is clear: The psychedelic community is disproportionately white. The recent global focus on racial inequity and social justice has called us all to reflect on our impact and seek out tangible ways to show up for communities of color. Now, this conversation has reached the psychedelic community and called leaders to task. Are we ready to explore why the movement is so homogenous, and to learn from leaders of color who can help us shift and evolve?
While psychedelic press coverage focuses on hand-wringing over the privileged corporate takeover, there is a more hopeful subculture emerging. Around the world there are visionary and collaborative leaders who aren’t waiting for an invitation from the vanguard of psychedelic elites. We spoke with nine women of color who are shaping psychedelic culture at the grassroots level and helping to create more inclusive spaces within the movement for global healing.
Buki Fadipe, Founder Adventures in Om
Buki Fadipe is the founder of Adventures In Om
Buki Fadipe, founder of Adventures In Om, is a transformational guide, artist, and psychedelic practitioner in training based in London, England. Her work focuses on empowering individuals to take part in their own healing and consider all aspects of the self: emotional, physical, environmental, spiritual and psychological. “When we self-heal, we do so for our lineage, community, collective, Mother Earth and all living beings,” Fadipe says.
In the future of psychedelics, Fadipe hopes to see better representation and access.
“Accessibility is a big issue,” she says. “The way the industry is currently heading does not leave much room for focusing on marginalized groups. These medicines are being worked into a psychiatric framework, a system that is already incredibly dismissive of those from lower economic brackets who are often most in need.”
Fadipe’s goal is to positively disrupt the conversation, one which she says overemphasizes the clinical model and dependence on quick fixes, pharmaceutical medicines, and years of ineffective talk therapy.
“This is an emerging field,” she continues. “How can we map its scope without more diverse data coming from a realistic representation of society? I hope that the future will lead us to see more leadership from BIPOC and women who need representation across the industry, from clinical research and decriminalization to harm reduction, education and integration.”
Jenn So, Founder SO Searching Oneself
Jenn So is the founder of SO Searching Oneself
As a femme embodied person from a family of Viet-Khmer immigrant refugees, Jenn So, LCSW and founder of SO Searching Oneself in Washington, USA, is passionate about generational healing. So has worked as a professional social worker for the past 14 years, and her private practice specializes in racial trauma, adverse childhood experiences, and intimate partner violence. She first became intrigued about the healing potential of psychedelics after witnessing firsthand how psilocybin transformed her cousin’s life.
“Psychedelic-assisted therapy could help someone who has experienced trauma return to a specific moment in their memory and know they can be safely walked out of it,” So explains. She emphasizes the importance of trained professionals and safe environments.
“Western life is disconnected from the idea of things being passed down generation to generation. We don’t live with our elders. We don’t have opportunities to be closely involved with their lives and experiences the way traditional cultures do,” So says. She believes we are just beginning to appreciate the way trauma impacts the body and family lineage.
“These medicines are being worked into a psychiatric framework, a system that is already incredibly dismissive of those from lower economic brackets who are often most in need.”
–Buki Fadipe
Is the mental health community ready to take a serious look at the potential of psychedelic medicine? So isn’t sure.
“The stigma around psychedelics is largely because we don’t fully understand them,” she says. “We humans believe that what we know is all there is to know, so new information is met with skepticism and fear. The mental health community isn’t immune to these attitudes.”
So hopes to bridge the conversation and help mental health practitioners better understand psychedelic medicines.
Charlotte James, Co-Founder The Ancestor Project
Charlotte James is a co-founder of The Ancestor Project
When co-founders of The Ancestor Project (formerly The Sabina Project) Charlotte James and Dre Wright met, they connected over their shared experiences in white medicine spaces and the recognition of the need for BIPOC-centered healing environments. They launched The Ancestor Project (TAP) in 2019 with a focus on Baltimore-based events, then shifted online when the pandemic hit.
James outlines some tangible steps the psychedelic community can take to better support Black community members: “We invite White folx to buy our Psychedelic Anti-Racism workbook. To sit in their discomfort as they unravel privilege and find their role in the collective liberation movement.” James continues, “Also, recognize that racism causes trauma, [and so] treat Black and BIPOC folx with the same trauma-informed care you provide others.”
The mantle of leadership is heavy for a woman of color navigating her own healing path while working to further conversations about psychedelics as medicine. James emphasizes how important it is to slow down. “I really try to live my life in ceremony. I have a massive toolbox of practices and technologies that support me: sitting in ceremony, practicing Kemetic yoga with my partner, spending time in nature, dance, meditation, drinking lots of water, and building a healthy, shameless relationship with food. I would say though, when you’re walking in your purpose, the work is less draining–even when it is really intense.”
James shared about TAP’s recent name change, and the importance of modeling accountability:
“We have to walk the walk. We can’t be out here holding White folx accountable to their sh*t and not also reflecting on the ways that we have deeply internalized their ways of being to the point that the system becomes self-replicating. It’s okay to be vulnerable and admit when you have self-reflected and recognized a misstep. I’m grateful for the humans who support us as we do our own liberation work, and to the ancestors, spirit guides, and relatives who are the true geniuses and creators of this work.”
Elan Hagens, Co-Founder Fruiting Bodies Collective
Elan Hagens is a co-founder of the Fruiting Bodies Collective
Elan Hagens is the co-founder of the Fruiting Bodies Collectivein Oregon, USA, which was born out of a need for education, advocacy, and community within the state’s new psilocybin therapy program.
“Just inviting people of color into the scene or making options financially accessible isn’t enough,” Hagens explains. “We need to consider why communities of color aren’t as aware of or interested in psychedelics. We need to understand the history of the War on Drugs and what can happen if we invite people into vulnerable healing spaces and then they return to a world that can be dehumanizing.”
Hagens also explains the need to be mindful of the language we use. “When enthusiastic advocates talk about “magic mushrooms” and “tripping”, we can lose a lot of people due to stigma and cultural connotation. Instead, can we talk about these medicines with respect and in a new way that people from all walks of life can understand and relate to? Healing goes beyond one subculture. We all have hearts and souls and an innate ability to heal in the right conditions.”
“We have to walk the walk. We can’t be out here holding White folx accountable to their sh*t and not also reflecting on the ways that we have deeply internalized their ways of being to the point that the system becomes self-replicating. It’s okay to be vulnerable and admit when you have self-reflected and recognized a misstep.”
–Charlotte James
Ultimately, healing must go beyond the individual. The founders at Fruiting Bodies believe that individual healing and societal change are inseparable. Beyond helping shape Oregon’s program, their mission is to shift the narrative and destigmatize psychedelic medicine through relationship building and storytelling.
*Note: Elan Hagens is co-founders with Rebecca Martinez, who authored this article.
Robin Divine, Founder Black People Trip
Robin Divine is the founder of Black People Trip
Robin Divine is the founder of Black People Trip, an online community with a mission to raise awareness, destigmatize, teach harm reduction, and create safer spaces for Black women in psychedelics.
“There is such a stigma around drug use (as well as therapy) which makes the idea of psychedelic therapy taboo for many Black people,” Divine says. “We need to see the faces and hear the stories of people who look like us in order to begin to break down these outdated ways of thinking.”
Divine explains that Black communities are traumatized. She sees psychedelics as a way for people to take healing into their own hands, down a path to wellness that exists beyond Western medicine.
“I invite white community members to get involved. If you are truly committed to equity in psychedelics, then take action. If you have the resources, then donate money to organizations that are doing the work to create better access in Black communities. I’d also ask them to respect the idea that Black people need their own spaces to heal that don’t involve them. In short: take action, and honor our space.”
Jessika Lagarde & Tian Daphne, Co-Founders Women on Psychedelics
Jessika Lagarde is a co-founder of Women on Psychedelics
Jessika Lagarde and Tian Daphne are the co-founders of Women on Psychedelics (WOOP), which began organically during the COVID-19 lockdown while the two were volunteering for a mushroom-related initiative. “Having ourselves experienced the healing and transformative power of psychedelics, we saw a glaring need to not only normalize the talk around psychedelics, but to specifically work to end the stigmatization around women’s mental health and substance use,” Lagarde explains.
Tian Daphne is a co-founder of Women on Psychedelics
The promising research inspired them to become advocates. But as they dove deeper, they quickly noticed a lack of diversity in the psychedelic space. “Despite having disproportionately higher rates of trauma, people of color and women remain underrepresented in research amongst participants, as well as in underground psychedelic communities and the movement toward decriminalization and legalization,” Lagarde adds.
“Through Women on Psychedelics, we hope to connect women through social, creative, political, and educational content and activities. We truly believe that everyone should have the freedom and ability to access psychedelics for their own healing and growth.”
Mariah Makalapua, Founder the Medicine Collective
Mariah Makalapua is the founder of the Medicine Collective
Mariah Makalapua is a Hawaiian and mixed Native North American artist and mother who is the founder of the Medicine Collective in Oregon, USA. Since 2017, the Medicine Collective has combined art and medicine for the purpose of healing people and the planet. Makalapua’s mission is to provide safe and respectful healing experiences rooted in indigenous traditions.
Makalapua believes respect for indigenous rights and wisdom is an expression of an individual’s healing process. “Trauma healing has to do with diving into your upbringing, your ancestry, and ultimately, decolonizing and clearing your own lineage and understanding where you come from. We all have ancestors. No matter who you are, there is a reality of what colonialism and patriarchy did to your family.”
“We need to consider why communities of color aren’t as aware of or interested in psychedelics. We need to understand the history of the War on Drugs and what can happen if we invite people into vulnerable healing spaces and then they return to a world that can be dehumanizing.”
–Elan Hagens
If people understand these things, she says, we will no longer need to argue about cultural appropriation because we will develop a heart level-understanding of it. “You wouldn’t attend an ayahuasca ceremony and then think a medicine leadership role is yours to take. You just wouldn’t be having that jump. It’s not a healed or whole approach.”
In regards to Oregon’s legal psilocybin therapy program, Makalapua advocates for wisdom, accountability and intentionality.
“Historically, indigenous communities did not exist in a vacuum in their healing. The medicine was part of the larger culture and there was a collective consciousness around it. They understood: This work is terrifying, necessary, and we must go to the right people. But this collectivism has been lost from modern culture. We need support in watering the seeds planted during ceremony. It is deep, inner, relational work: making changes, making boundaries. It requires friendship, community, and at least a few close people who can support and guide you through that change.”
“The mushrooms are going to be mushrooms no matter what we do,” Makalapua continues. “I want to protect their sacredness. It’s like protecting your grandmother. You know she’s strong and a badass, but you’re not going to let her go and do something dangerous. It’s the same with the mushrooms; we should respect them, love them, and help carry their groceries, so to speak.”
Hanifa Nayo Washington, Founder One Village Healing
Hanifa Nayo Washington is the founder of One Village Healing Photo credit: Rachel Liu
Hanifa Nayo Washington is an award winning cultural artivist and sacred activist combining arts, healing, and activism for the last 20+ years. Based in Connecticut, USA, Washington is the founder and principal organizer of One Village Healing, cultivator of beloved community at the Fireside Project, director of community engagement for CEIO, and a founding member of several emerging psychedelic initiatives, including the Equity in Psychedelic Therapy Initiative.
In 2017 she released her third album, Mantras for the Revolution. In December 2018 Washington received a Phenomenal Women Arts Award from the Arts Council of Greater New Haven for her contributions and achievements in the arts. She is currently working on a storytelling project called Growing Wilder, which is expected in 2022.
Washington explains how her own healing experiences led her to the intersection of psychedelic medicines and social transformation:
“Going into ceremony and creating sacred spaces…helped me deconstruct the poisons of internalized systems of oppression. These allies, these plant medicines, have helped me to unhook these things from my body and mindset, and allow me to be in deeper relationship with myself and others in ways that are not poisoned,” she says.
What makes Washington’s leadership stand out is both her joy and her specificity. One vision many emerging leaders share within the psychedelic space is inclusion. Washington carries a torch into the unknown and helps to illuminate the “how” by shaping practical models with which to realize this shared vision. Equity and access are more than buzzwords at One Village Healing–they are the pillars that form the very structure and breath of the organization, which currently provides seven online wellness sessions for free to the community.
“Historically, indigenous communities did not exist in a vacuum in their healing. The medicine was part of the larger culture and there was a collective consciousness around it. They understood: This work is terrifying, necessary, and we must go to the right people.”
–Mariah Makalapua
The immense value of Fireside Project’s Psychedelic Peer Support Line is multiplied by their attention to “providing compassionate, accessible, and culturally responsive peer support, educating the public, and furthering psychedelic research, while embracing practices that increase equity, power sharing, and belonging within the psychedelic movement,” Washington says.
In order to create safer spaces and experiences for marginalized communities, Washington suggests a few practical steps:
Normalize and furthermore, require, inner work as a fundamental part of all psychedelic organizations, businesses, and institutions. “That means creating space and time within the work schedule for individual and collective learning, to practice and imagine ways of being that support healing from the trauma of oppressive systems.”
Within this process, trust and invest in affinity integration spaces.
Listen to, fund, and invest in individuals, businesses, projects, and initiatives led by people who have been impacted the most by systems of oppression.
“Without representation in leadership,” she says, “I’m pretty convinced that these aforementioned aspects will not happen.”
Conclusion
The common threads that come through these interviews help weave together a larger story. It’s a vision for global healing that doesn’t stop at getting over depression or healing family trauma. It’s a call to recognize our interconnectedness with one another and the Earth, and to commit to the work which enables psychedelic insights to transform us into more engaged, justice-focused citizens. Because of their intersectional identities, women of color offer the presence, leadership and perspective which are essential to the integrity of the psychedelics movement. We have endless opportunities to lift them up and learn from them as we grow and heal together in the years to come. Let’s begin today.
About the Author
Rebecca Martinez is a Portland, Oregon-based writer, parent and community organizer. She is a co-founder of the Fruiting Bodies Collective, an advocacy group, podcast and multimedia platform exploring the intersections between healing justice and the psychedelics movement.
In this episode, Joe interviews Dena Justice, who uses her unprecedented 4th appearance on Psychedelics Today to not talk a whole lot about neuro-linguistic programming or ways to beat anxiety. Instead, she blasts out of the psychedelic closet and opens up like few guests have before, taking us on the harrowing and life-changing journey of the last 6 years of her growth.
She talks about how her first MDMA experience made her realize how many limiting beliefs, insecurities, and issues with never feeling safe all came from childhood abuse and could be traced back to one specific morning. She discusses the “ages and stages of Dena,” and getting to know her childhood self, Little Dena, and how Little Dena, her 15-year-old self, and her future self influence her today. And she talks about the breakthroughs and realizations from each subsequent experience (MDMA, LSD, and ayahuasca), and how each was just another step leading to her year of “energy and life cleanup,” culminating in the most profound psychedelic experience of her life, where she found the frequency of safety she’d been seeking her whole life.
The first few minutes of this episode feel tense and you may be cautious to continue, but stick with it- like many beneficial psychedelic experiences, you may have to go through some rough stuff to get to the gold, but in the end, it’s worth it. This one’s pretty powerful.
Notable Quotes
“This whole morning as a 4-year-old is ingrained in my memory. I remember what I was wearing, I remember the way my Mom looked, I remember the sunlight streaming into the living room through our front windows. …And I’m standing at the top of the flight of the stairs, screaming at her and sobbing because she’s not hearing me. And in that moment, I created an entire set of beliefs that literally ran my show until 3 months ago.”
“I look at what I’ve done since I started really utilizing psychedelics intentionally, and my whole life changed. In the last 5 years, my whole life is completely different than where I was in November of 2015, and I don’t look at the person in the mirror and recognize her anymore the way I was familiar with myself before. I’m like, ‘Where did this woman come from? She’s pretty amazing.’”
“I literally saw all of this energy moving and I traveled up one thread of this energy to a point of light, and I articulated it so clearly- I said, ‘Wow. I found the frequency of safety. I can see it and I can feel it in my entire being, and this is what I’ve been seeking my entire life.‘”
“Everybody who has trauma should be able to experience this kind of healing. Everybody should get to feel this free from the past that has tormented them.”
Dena’s training as a facilitator, educator, trainer, mentor, and coach started at age 7 when she took her first social-emotional training program. That started years of training in conflict management and mediation, leadership, communication, facilitation, and more. By 15, she was facilitating personal development courses.
In this episode, Joe interviews the most guests he’s ever had on at once- 5 people from the Entheo Society of Washington: Leo Russell (Executive Director), Monique Bridges (Head of the Female Battalion and Head Guardian of the Santo Daime Ayahuasca Church), Malika Lamont (Director of VOCAL Washington), Tatiana (Executive committee member, DNS), and Solana Booth (promoter and teacher of traditional Native American healing techniques and modalities).
The Entheo Society of Washington is a 501c3 organization that is working to create community and treatment centers and eventually a movie about the underground psychedelic culture in the Pacific Northwest. Their larger, more socially-focused goals are to encourage people to reconnect to the earth, accept our emotions more, hold space for healing and encourage others to do the same, see the economy around legal cannabis and psychedelics become much fairer, and their biggest goals: to help the most marginalized people receive care without being criminalized, and to dismantle the very systems of power that keep marginalizing them.
They are a sister organization to Decriminalize Nature Seattle, which is yet another chapter of the Decriminalize Nature movement making legal waves across the US.
Notable Quotes
“I consider the first wave of the psychedelic movement to be very masculine-oriented. So for me, just my personal opinion- the second wave just feels much more diverse, and I see a lot more women leading, and I’m excited about these women. I have lots of curiosity about them. …how they’ve come up and how they found their voice. We’ve never seen women before lead in grassroots psychedelic political efforts. We’ve never seen that in human history. So I just want to celebrate these women. I want to help the ones that are behind a mountain and lift them up.” -Leo Russell
“What is extremely attractive about decriminalization of psychedelics is that we know that the most potential is there to be able to help people heal from the issues that have impacted them through systemic violence. However, we can’t stop there, because just to heal somebody to throw them back into a harmful system is not enough. We need to dismantle the systems.” -Malika Lamont
“I do believe that there’s also a shift in general towards not criminalizing people for any kind of substance use. I think that that is a very real, attainable goal. It’s coming, and I really believe that.” -Tatiana “I really don’t like it when people say ‘use psychedelics’ when they’re talking about mushrooms or talking about plant medicines, because we don’t use people. Like, I’m not going to ‘use’ my sister Leo when I’m in a conversation with her. I’m going to partner with her and listen and look at her face (if I can see her) and be with her in that moment. So, I’m not going to use any plants; I’m going to go into the medicine, I’m going to ask permission.” -Solana Booth
“With all of the talk of being gentle and reaching higher consciousness and being cognizant of the healing properties of these plants, I think that we also cannot lose focus that trauma out of context can look like culture. Trauma out of context can look like personality or be perceived as weakness.” -Malika Lamont
Traditional entheogens (natural plant and fungi medicines) can dramatically improve human health and happiness—transforming our ability to care for ourselves and one another. The Entheo Society of Washington educates the public about the healing value of entheogens and seeks to destigmatize and decriminalize their use. Their community believes the use of entheogens reinforces our connection with nature and is an inherent personal, therapeutic, and spiritual right.
Could taking and integrating ketamine in groups make psychedelic therapy more accessible?
As psychedelic-assisted therapy continues marching into the mainstream, the issue of how absurdly expensive the treatment is continues to present countless difficulties. Of the strategies practitioners are taking to circumvent this problem, one of the most promising—and underreported—approaches is offering psychedelic-assisted group therapy.
Despite promising preliminary research using psilocybin in small groups to treat depression in cancer patients and MDMA-assisted therapy for couples where one partner has PTSD—and ignoring the fact that psilocybin-containing mushrooms are traditionally taken in group ceremonies in Mexico—ketamine is the only psychedelic medicine that’s already legally used in psychedelic-assisted therapy. Let’s take a look at the emerging world of group ketamine-assisted psychotherapy, its benefits as well as drawbacks.
Group Ketamine-Assisted Psychotherapy
Though traditionally used as an anesthetic, ketamine, an Essential Medicine of the World Health Organization, is now widely being prescribed off-label by qualified practitioners to treat a host of mental health diagnoses, including depression, addiction, PTSD, and chronic pain.
Ketamine-assisted psychotherapy—“KAP” for short—is a growing mental health treatment option for people who meet diagnostic criteria. In line with most psychedelic therapy protocols, KAP involves a sequence of medicine sessions, in which clients take the substance with the mental health professional present, and sober therapy sessions referred to as “preparation” and “integration.” Through KAP, many people are finding healing where prevailing mental health treatments have fallen short.
Also in line with most psychedelic therapy protocols, KAP is really freaking expensive.
Though ketamine’s effects are relatively short-acting compared to MDMA and psilocybin, therefore requiring fewer therapist hours to pay for, sessions still cost several hundred dollars. Ongoing treatment can quickly climb into the thousands.
Even ketamine “infusion centers,” which involve no therapy, tend to charge $400-$600 for each intravenous infusion—and they typically make it clear that lasting symptom relief only occurs after several rounds. At such centers, folks may receive infusions in group rooms, but oftentimes it’s more akin to the way you’d find yourself sitting on a sterile lab chair next to some stranger at a plasma donation center, while someone who doesn’t want to hear about your problems sticks a needle in your vein and leaves. While this might help some folks, costs remain abundant.
Group ketamine-assisted psychotherapy is different. Though there is currently no published research on group KAP’s efficacy, ketamine’s legality via prescription allows therapists to smoothly translate the modality into groups. As group members can then split the price of the therapist’s time—the largest contributor to high costs of treatment—the overall cost decreases significantly.
Raquel Bennett, Psy.D., is a psychotherapist and researcher who specializes in ketamine-assisted psychotherapy, who also teaches our masterclass on ketamine ethics as part of our Navigating Psychedelics for Clinicians and Therapists course. She practices in Berkeley, CA, where she runs the KRIYA Ketamine Research Institute. Bennett has been studying the therapeutic properties of ketamine since 2002, when a personal encounter with the medicine sparked her awareness of its powerful antidepressant properties. That was over a decade before infusion centers started popping up, well before “ketamine-assisted psychotherapy” was a term.
“I was studying this long before it was cool,” Bennett tells Psychedelics Today with a laugh.
Motivated by a desire to lower cost and increase accessibility, Bennett began facilitating ketamine groups with her medical partners in 2016. The same motivation also prompted the Wholeness Center, a leading ketamine therapy clinic and psychedelic research site in Colorado, to offer ketamine therapy groups as well. Scott Shannon, M.D., who founded Wholeness in 2010, teamed with colleague Sandra Fortson, LCSW, to offer the clinic’s first ketamine therapy group last year.
“One of the most prominent reasons why I endorse and am exploring group therapy is that it solves one of the greatest drawbacks of the psychedelic model right now, which is that psychedelic therapy is a treatment of the affluent,” Shannon tells Psychedelics Today. “Instead of offering KAP for three or four hundred dollars a session, group therapy brings the cost down closer to a hundred dollars a session, which is a big difference.”
Fortson elaborates on how significant that difference can be: “Clients are looking at a savings of almost 50% for a 5-week KAP group curriculum—including medical clearance, intake, 3 experiential sessions and final integration session.”
At the time of writing, Shannon and Fortson have facilitated two groups, each spanning five sessions. They are currently planning for a third and foresee group KAP as an important option in the Wholeness Center’s future psychedelic therapy offerings.
What Group Ketamine Therapy Looks Like
Bennett breaks down the process of ketamine-assisted psychotherapy into four essential steps:
Patient selection
Patient preparation
The medicine session
Follow-up care
At the preliminary level of patient selection, legal concerns must be taken seriously. “In order to participate in a ketamine group, you still have to fully meet the criteria for a clinically necessary treatment,” Bennett explains. “It’s currently not legally defensible for a person to participate in a group just because they want a ketamine experience.”
Both Wholeness and KRIYA use a cohort model where the same participants come together at scheduled times, and their series of sessions begins and ends together. Throughout that process, the group engages in both ketamine and non-ketamine sessions together, the latter of which involves working through their challenges and implementing insights into their lives with the support of the therapist(s) and fellow group members.
Shannon and Fortson have limited their cohorts to four people due to COVID-19 restrictions and social distancing protocols. Going forward, Shannon envisions groups of eight participants, which would require two therapists present. At KRIYA, Bennett has found that five or six participants with two clinicians is an optimal ratio.
At the Wholeness Center, participants sit on bean bag chairs in socially-distanced corners of a large room. During the ketamine sessions, members are given eyeshades along with their measured doses. Specifically-curated music plays through speakers, and Shannon and Fortson remain present in the space, supporting as needed and facilitating conversation if appropriate—and if possible, for at higher doses of ketamine, folks often temporarily lose their capacity to form words with their abruptly-nonexistent mouths.
There are three primary routes of administration in ketamine-assisted psychotherapy:
Lozenges (held in the mouth)
Intravenous (IV) administration
Intramuscular (IM) injection
All three require an MD’s prescription, and the latter two require a nurse or doctor for administration. Dose ranges vary significantly in each route—though low-dose sessions are often orally administered, while high-dose sessions typically come through IV or IM.
Each route yields a unique experience in terms of onset, depth, length, and intensity. Different routes of administration and doses are associated with the treatment of different conditions—in individual KAP, for example, high-dose IM treatment is often regarded as uniquely effective for suicidality. At KRIYA, doses and routes of administration are determined based on individual and group assessments.
“As providers, we need to be clear about what effects we are going for, and then make our dose recommendations based on that,” says Bennett. “That varies depending on the needs of the group and what we’re trying to accomplish.”
Regardless of dose and route of administration, ketamine sessions at KRIYA follow a consistent protocol. “Our ketamine groups include an opening ritual, time for sharing, the ketamine administration, quiet rest, and a potluck meal, with more time for sharing,” Bennett explains.
The frequency of group sessions at KRIYA varies. “For some cohorts, the participants come once per month for four consecutive months. In other cohorts, the participants come once per quarter, four times in a year,” describes Bennett.
A capacity for fluidity and openness is called for on the part of the therapists, along with a willingness to learn from the groups and attune to the members’ needs.
“Sometimes, we ask people to share something that feels heavy on their heart, and that usually opens a conversation,” Bennett says. “Then, we move to something they feel grateful for—it’s very helpful to invite people to enter a positive mindset as the medicine is wearing off, because that then seems to linger. Other times, we are quiet and simply hold the space as people spontaneously work on what they need to work on.”
At the Wholeness Center, ketamine groups have thus far followed fixed, five-session structures. Shannon details the process:
“We start with a prep session, where we get to know each other and build rapport. The second session is a low-dose oral experience, which doesn’t put people in a full, dissociated state. It reduces their inhibitions, opens up their heart; what we find is that people actually bond very well during that session. They feel safe and secure. In the third session, which is a moderate-to-higher-dose oral session, they begin to have deeper, fuller psychedelic experiences. We really encourage people and give them the instruction that they can come in and out at will. If they want to come into more consensual reality, they can talk with us, connect with us, or their peers even—or they can go inside if they’re feeling pulled to explore.
“That third session begins to give them the taste of the more full-fledged psychedelic experience,” Shannon continues. “In the fourth session, they have a high-dose IM experience, where they’re going to fully dissociate and go into their personal inner space. People reenter the group space at various times as they’re ready and able, and come back and process it. Then, the fifth session is an integration session.”
Unlike the varied frequencies of KRIYA’s groups, the Wholeness Center’s groups meet once a week. Shannon is not attached to that model and expresses that future groups may follow different formats. Likewise, Bennett remains open to new possibilities. Even after all her years of ketamine research, she reflects, “We are always learning and trying things to find the most effective strategies.”
How to Establish a Safe Group Culture
For an effective group, a culture of safety and trust must be established. One way of doing that is to create “homogenous” groups, where all members share common struggles, such as depression or anxiety. The Wholeness Center, for instance, is in the process of creating a KAP group to treat PTSD experienced by COVID first responders, as well as a group for alcohol addictions.
At KRIYA, Bennett is not attached to homogeneity as a necessity, yet she recognizes that disregard for commonality among group members can be detrimental to the group’s safety, and therefore efficacy.
“It is possible to have somebody in the group who is on such a different page than the other folks that it really puts the group out of balance,” she explains. “We try not to do that.”
Bennett circumvents issues related to group imbalances by focusing on preliminary assessment. She describes the assessment process as an under-regarded component of psychedelic healing, the “magic for helping people to get better in the fastest and most cost-effective way.” If therapists take a first come, first serve approach to their groups, imbalances are bound to emerge, negatively impacting trust and safety.
“Not everyone is a good candidate for group treatment,” Bennett candidly states. “Ketamine is a fickle medicine. People need to feel physically and emotionally safe in order to have big and beautiful and expansive experiences. They need time to relax into the space and develop trust with us.”
For example, Bennett has found that people with complex trauma are better suited for individual work, noting that these folks “are often better served by having the individual attention of the therapist.”
Shannon underscores the necessity of a detailed intake process to ensure safety. When group safety and assessment are sufficiently prioritized, however, he has found that ketamine presents very little risk to individuals or groups in a therapeutic context.
“People are screened ahead of time for concerning medical or psychiatric issues,” Shannon says. “We haven’t seen any safety issues in our groups so far. I think that reflects our experience with KAP in general—that it’s a low-risk, quite safe medical process.”
For folks who have been properly screened and assessed, Shannon has found that the drop in individual attention from the therapist that groups entail does not negatively affect the healing process.
“I think we overrate the value of having an expert in the room, and we underrate the importance of connection and community in our current mental health paradigm,” he reflects. “My observation is that although the attention of the practitioner is more divided in a group, that is more than enhanced by the sense of community and safety and support that comes with it.”
Healing in Community
On top of assessment, non-ketamine preparation sessions help establish the safe and supportive group environment.
“People spend time getting to know each other in the preparation sessions before the medicine is introduced,” Bennett explains. “We’re not just throwing people in and shooting them up. That would be totally unethical.”
The cohort model contributes to participants’ sense of safety through rapport and consistency. When safety is established, Bennett has found that groups are not only consistently effective, but offer a host of benefits she did not anticipate.
“In individual treatment, people often felt very alone, that they were the only person on earth dealing with whatever problem they were living with,” she explains. “In the group, people quickly found that there were other people who had similar issues and challenges. That in itself is healing.”
Shannon and Fortson have observed the same trend. Fortson shares, “While it is difficult to explain, there is something about the sense of connection and support that is fostered in a group environment, specifically as it pertains to KAP, that seems to greatly expand the therapeutic benefit experienced by participants.”
Shannon notes this “enhanced response” is influenced by participants’ magnified expectation of hope, as well as something more primordial.
“With the pandemic, and really just in modern society, one of the major plagues we’re facing is a sense of disconnection, isolation, and removal from our social roots as herd animals,” he reflects. “A primary reason I like group therapy so much is that it really makes use of the power of community and group process.”
This unmeasurable component of community healing is emerging as a trend of group psychedelic therapy. The Forbes article linked in the introduction indicated that the cancer patients who receive psilocybin treatments together “frequently develop a sense of community and mutual support that can enhance their recovery and overall well-being.”
Implications of Ceremony in the West
An intriguing argument sometimes leveraged on behalf of group psychedelic therapy hinges on its potential correlation to group entheogenic healing ceremonies practiced by countless cultures for millennia. While it would be imprudent to propose a generalized, catch-all comparison between the two, given drastic differences in cultural context, traditional plant medicine healing ceremonies testify to both the safety and the power of group psychedelic journeying when held in an intentional and meaningful container. Base-level similarities between these processes—i.e. community healing through visionary journeys—suggest the possibility of a ceremonial, rite-of-passage element to group psychedelic-assisted psychotherapy.
Now, I am not advocating for psychedelic therapists to buy rattles and drums and chant songs from other cultures they do not understand. That would be very bad. My suggestion—which I am not the first to make—is that outside the boundaries of important issues related to appropriation, there are archetypal processes of ceremonial rites of passage that have factored prominently into countless cultures through the ages, and their general lack of existence in Western society may have some connection to the rampant isolation, existential confusion, and struggles of purpose and maturity afflicting so many people in this hyper-individualized capitalist paradigm.
It strikes me as significant that countless Western people are traveling to distant countries to experience sacred plant medicine ceremonies of cultures about which they know nothing, seeking a kind of spiritual healing and renewed sense of meaning their lives lack. Could group psychedelic therapy play a role in patterning these forsaken archetypal ceremonial processes into Western culture?
What kinds of ceremonies could fit into and emerge out of a Western therapeutic context? Can such rituals respectfully incorporate wisdom shared by other traditions, while establishing a unique and authentic identity? How might ceremonial rites of passage, held in a safe therapeutic container, help heal the complex, multitudinous mental health struggles unique to our techno-capitalist world?
These questions are way too massive to attempt to answer here. The fact that group psychedelic therapy raises them, however, highlights an added layer of its potential significance.
Diversifying the Psychedelic Space
The decrease in cost has the obvious benefit of making the treatment accessible to more people. A hope is that such increased access will invite more diversity to the space of psychedelic healing, which remains strikingly un-diverse. In 2018, Dr. Monnica T. Williams and her co-authors demonstrated that between 1993 and 2017, 82.3% of participants in psychedelic therapy trials were white. While no research has been conducted on diversity in the practice of ketamine-assisted therapy, it is unlikely that results would be much different.
It would be erroneous, however, to suggest this lack of diversity is related exclusively to cost and implicit bias among practitioners. It’s also about safety. In my recent interview with MAPS-trained therapist Dr. Joseph McCowan, McCowan reflected, “People of color desire to do what is safe prior to contributing to research or science, or even healing themselves. Right now, psychedelic spaces, due to their illegality and the stigma they carry, are not safe.”
While offering more affordable treatments is a great start, white therapists must educate themselves on unique struggles and barriers related to mental health in communities of color, as well as the socio-political factors—i.e. the ramifications of the War on Drugs—that keep these barriers standing. Further, they must use that education to create more safety. Only then can the decreased cost offered by modalities such as group KAP really help diversify the landscape of psychedelic healing.
Training and Ethical Considerations for Group Ketamine Therapy
As the field currently stands, there are no regulated training requirements for clinicians to facilitate ketamine-assisted psychotherapy. Theoretically, so long as an M.D. prescribes the medicine to the client, any therapist can offer ketamine-assisted psychotherapy. Many are disturbed by this lack of regulation, and an increasing chorus of voices is calling for higher ethical standards for ketamine therapy practitioners to abide.
Bennett is a leading voice on the ethical front. She recently authored this article on ethical guidelines for ketamine clinicians that was published in the Journal of Psychedelic Psychiatry, which establishes the importance of assessment, medical safety, preparation, training, and maintaining professional conduct for providers.
As with other psychedelics, ketamine should not be taken lightly or offered carelessly. It is a powerful substance that can consistently facilitate healing experiences when offered with care; at the same time, it can have destructive consequences when handled carelessly. If facilitators are unprepared to work with deep and painful unconscious content that can unexpectedly erupt in clients under its influence, they are putting clients at risk of retraumatization that could leave them in a far worse state than before. At a broader level, reports of such egregious harms could do significant damage to the still-vulnerable field of psychedelic therapy in general.
Many practitioners advise therapists who intend to offer KAP to experience the medicine themselves. Both KRIYA and Wholeness have run groups for mental health professionals who meet specific criteria; Bennett shares that KRIYA’s professional participants “reported that their direct experiences with ketamine vastly increased their understanding of how to use this tool with their own clients.”
If therapists do not meet criteria to experience ketamine therapy themselves, a number of trainings in KAP now exist, many of which involve an experiential component. Shannon and Fortson, for instance, helped found the Psychedelic Research and Training Institute (PRATI), a nonprofit organization that currently offers several KAP trainings each year. Over the course of the three-day intensive, therapists are given the opportunity to experience both a low-dose and high-dose ketamine session while dyad partners practice skills in the facilitator role.
“For clinicians who want to do group work with ketamine, it is strongly recommended that they get specialized training,” Bennett emphasized. KRIYA has compiled a list of reputable trainings for those interested in learning more.
Group Ketamine-Assisted Therapy: Summarizing the Journey
In the new mental health frontier of psychedelic-assisted therapy, group psychedelic therapy represents an even newer frontier. With its potential to lower cost and invite the healing power of community into psychedelic therapy, group ketamine-assisted therapy calls for more attention in both research and ethically-minded practice. It will not be for everyone, and it is far from a panacea, but the modality holds tremendous promise to help people with a whole lot more than lowering their bill.
And even if a lowered bill proves to be the sole benefit, that’s still a huge accomplishment for the current landscape of psychedelic therapy.
About the Author
Sean Lawlor is a writer, certified personal trainer, and Masters student in Transpersonal Counseling at Naropa University, in pursuit of a career in psychedelic journalism, research, and therapy. His interest in consciousness and non-ordinary states owes great debt to Aldous Huxley, Ken Kesey, and Hunter S. Thompson, and his passion for film, literature, and dreaming draws endless inspiration from Carl Jung, David Lynch, and J.K. Rowling. For more information or to get in touch, head to seanplawlor.com, or connect on Instagram @seanplawlor.
In this episode, Joe interviews the founder and CEO of MindMed, JR Rahn.
This one’s a bit different and plays out perhaps unsurprisingly, as Joe’s well-established talking points against the drug war and DEA, legalize-everything stance, and all-inclusive focus on the many branches of drug-use (medical/therapeutic use, religious use, celebration/partying, inner work and exploration, and creative problem-solving) meet a businessman whose life was saved by psychedelics and who doesn’t want to talk about the battle but instead wants to push forward, all-in on the method he thinks will get people in need the medicine that could save them the fastest: not putting so much effort towards state-by-state decriminalization and demonizing the DEA, but instead, working with them towards medicalization, and telling them what we want by passing measures that allocate more capital and resources towards infrastructure that will help people.
Rahn talks about what MindMed is working on: the first approved commercial drug trial studying the effects of microdosing LSD on adult ADHD, and their more long-term plan, developing a trip-neutralizing drug that would be a safer option than Xanax for ending a challenging trip and getting people back to stability. He also discusses the importance of scalability and lowering healthcare costs, changing anecdotal evidence into real science, and his life-saving (and cheaper) hope of patients being able to work with therapists in their homes rather than in expensive, anxiety-increasing medical environments.
Notable Quotes
“As a society, we need to prioritize treatment and we don’t. …It’s just completely illogical to me that, as a society, we stare it in its face every day and we blame the opioid crisis and we blame drug addiction for our crime and all these things, yet, as a society, we don’t allocate the resources necessary to solve it.” “I think there’s that Forbes article where I was like, ‘Oh, I want nothing to do with the decrim people.’ I definitely said that, but that’s not really what I meant. What I meant was: if we’re going to make psychedelics into a medicine, and we’re going to make it scalable and accessible, I think we should be having a federal conversation about it, and to me, the most efficient pathway to do that is the FDA. And I’m concerned that we’re going to go through this process of state-by-state legalization that happened in the cannabis days and we’re going to get some pretty unsavory people involved in this community …and I’m just concerned that, if it happens in that manner, it becomes a political battle, and it doesn’t become: How do we help people? How do we get medicine to folks that are in need?”
“If we’re going to get people willing to healing themselves and get over the stigma, I think it’s important to have the feature of: ‘Look, we have the emergency stop button. Your therapist can press it if they need to when they feel that you’ve reached a point that is not good anymore.’ And I think that, ultimately (and we’ll have to study this), it might make the experience even more therapeutic. …They should be walking into a cocoon and we’re taking care of them. They should not be walking into [a room] or sitting on their couch, going, ‘Holy shit, am I going to die?’” “I’d love to get to the point where we have destigmatized these substances enough in society that people value them for what they are, and I think we will be a much better society when we get to that point, but I don’t think we can do it all at once. People tried that- didn’t work. I would just hate to watch the potential for so many people that are actually suffering from mental health and addiction [to] not get access to this treatment because we went too fast.”
“Psychedelicstoday.com: best podcast in psychedelics.”
JR is a former Silicon Valley tech executive who realized that transformational solutions to mental illness and addiction might lie in psychedelic medicines. He spent 2 years researching and began personally investing in psychedelic research through his investment company. JR partnered with drug development veteran Stephen Hurst to start MindMed in 2019, assembling a leading clinical drug discovery and development team with vast experience conducting clinical trials and research on drug candidates derived from psychedelics. Before starting MindMed, JR worked in market expansion and operations at Uber.
Could 18-MC, a synthetic derivative of Ibogaine, make treatment safer without the psychedelic trip?
With COVID-19 still spreading, mutating, and killing, it’s easy to forget the other health crises ravaging the country. One of the most concerning of these is drug overdose deaths, with opioids representing a large share of such casualties. From 1999 through 2018, nearly 450,000 people fatally overdosed on opioids in the US. While slight decreases in 2018 buoyed hopes that we were past the peak, even then, overdose deaths were four times greater than in 1999. In 2019, such optimism was dashed as the number of opioid overdose deaths climbed to 50,042, an increase of nearly 7 percent over the previous year. But, are there viable treatment options that are overlooked by the medical community and general public?
In the psychedelic community, many would argue yes, and highlight the potential of ibogaine, a psychedelic compound found in the West African shrub, Tabernanthe iboga. But ibogaine comes with more possible health risks than other psychedelic plants and substances that we’ll explore below, and of course, there remains a lingering bias in some parts of the medical establishment against psychedelics. And so, a non-psychoactive alternative, 18-Methoxycoronaridine (18-MC) was developed in the 1990s and is now advancing through the FDA’s drug development process at a steady clip, while research into ibogaine remains virtually frozen. However, the question remains: are the concerns about ibogaine’s risks valid enough to explain the differing fates of these chemical cousins, or are other factors at play?
What is Ibogaine?
Ibogaine is a plant-derived alkaloid with unique psychoactive properties distinct from those of classic psychedelics, such as LSD, psilocybin-producing mushrooms, or DMT. One of its effects is panoramic recall, often described by patients as watching a movie of their life playing in their head. Sometimes called a dissociative psychedelic, Geoff Noller, a medical anthropologist with a doctorate from the University of Otago’s Department of Psychological Medicine, prefers the term “oneiric” (pronounced ō-ˈnī-rik), which is defined as, “dream-inducing.”
This description of the ibogaine experience was seconded by Dr. Bruno Rasmussen, a physician and researcher based in Brazil who provides ibogaine therapy. “Ibogaine doesn’t make you hallucinate; Ibogaine makes you dream, but you are awake when you are dreaming,” Rasmussen said. “If you do an EKG during the effect of ibogaine, the lines will be like they are in a REM state, the rapid eye movements state, the dream state.”
How Does Ibogaine Work?
The unique, psychedelic qualities of ibogaine are not the only way it differs from more familiar hallucinogens. Psilocybin, LSD, and DMT all act in a more focused manner on the brain’s serotonin receptors. And while ibogaine does act on serotonin levels in the brain, it also acts on numerous other neural systems. Noller compares its relatively blunt mode of action to cannabis, which also acts on many different receptor sites, and contrasts it with more targeted designer medicines like Prozac.
While the exact neural systems ibogaine engages are not fully understood yet, studies show it can reduce opioid withdrawal symptoms and help control cravings. This offers a window of opportunity for patients to make changes in their life that would otherwise be more difficult due to the pain, anhedonia, and other symptoms of withdrawal. Once they have weathered this storm, the reduction in cravings increases their likelihood of not relapsing.
Furthermore, studies have shown that ibogaine reduces the amount of drugs, like cocaine, alcohol, and nicotine, that animals self-administer, despite the fact that each of these drugs has their own distinct way of influencing neural chemistry. This ultimately suggests that ibogaine acts on multiple regions of the brain. Studying this broad function could lead to new insights into the physiological underpinnings of addiction, which makes the relative dearth of research on ibogaine all the more curious — until you consider its potential hazards.
Ibogaine Risks
The benefits of ibogaine must be weighed against its potential dangers. An article in the Journal of Forensic Science examined 19 deaths that occurred following ibogaine treatments given between 1990 and 2008. Post-mortem testing revealed that at least 11 of these patients had other drugs in their systems, such as benzodiazepines, cocaine, opiates, and methadone, all of which are known to be dangerous when mixed with ibogaine.
Prior to treatment, however, a dozen of the patients who died also had one or more comorbidities known to pose risks when using ibogaine, such as obesity, brain neoplasm, and a range of diseases affecting the liver, heart, and other organs.
Although ibogaine research in the US stalled in the late ‘90s, it continued abroad. Thomas Kingsley Brown, a California-based anthropologist, worked with the Multidisciplinary Association for Psychedelic Studies (MAPS) for a 2017 study in Mexico, where ibogaine treatment is not specifically outlawed. Thirty people with opioid dependence received ibogaine treatment and were evaluated over the following year. After one month, half of the research subjects stated they had not used opioids since their ibogaine session. Further follow-ups showed sustained anti-addictive effects.
“To address the first question of whether or not ibogaine can be used safely and effectively, my short answer is yes,” Brown said. “There are going to be risks with that, but you can also minimize the risk.”
In addition to screening patients for potentially dangerous comorbidities and identifying contraindications, such as the presence of drugs that could cause harmful interactions, Brown explained that genetic tests can determine how quickly people’s bodies break down ibogaine into noribogaine. This helps those administering the treatment determine whether it’s safe for a patient to move forward with ibogaine and how to calculate an optimal dosage.
Noller also worked with MAPS on an ibogaine study, though this one was based in New Zealand, where Medsafe (the country’s equivalent of the FDA) made such treatment legally available as a non-approved medication in 2010. According to Noller, this classification gives doctors the ability to write a prescription for a drug or treatment even if it hasn’t gone through a three-phase trial testing period.
He points out that ibogaine’s mortality rate is comparable to methadone. A 2008 paper in the Journal of Ethnopharmacology reported 11 ibogaine-related deaths from 1990 to 2006 out of the 3,414 people estimated to have taken it — a mortality rate of 0.32 percent. A 2007 paper in the Drug and Alcohol Review found 283 methadone-related deaths in Australia between the years of 2000-2003 out of an estimated 102,615 episodes of treatment, which yields a mortality of 0.27 percent.
But Rasmussen believes it can still be safer, attributing the majority of ibogaine-related deaths to preventable failures on the part of caregivers, such as not having qualified doctors present, forgoing the use of cardiac monitors, and passing on testing patients for drugs that could cause harmful interactions. His strongest piece of evidence for the ability to safely use ibogaine is that none of his roughly 2,000 patients have died due to or during treatment. In fact, he hasn’t even had a subject develop complications, like severe heart arrhythmia. In Brazil, doctors can legally prescribe ibogaine therapy in hospital settings, a model Rasmussen champions.
“I think that the trick here is to face it as a little surgery,” Rasmussen explained. “We make some pre-surgical examinations, lab tests, blood tests, and EKGs. We do it in a big hospital with the emergency team aware that there is an ibogaine patient in the hospital. For anything we could need, we are backed up, but we never needed the emergency team because we do the lab tests, so we can usually prevent the complications.”
18-MC: The Non-Psychedelic Alternative to Ibogaine
Concerns about ibogaine’s psychoactive effects and potential risks led to the development of 18-MC in the 1990s. Dr. Kenneth Alper, a professor of psychiatry and neurology at New York University School of Medicine, explained that 18-MC is a structural analog of ibogaine, meaning they share a common molecular base, in this case the ibogamine ring system. At the microscopic level, even small variations can lead to big changes.
The general consensus seems to be that 18-MC is not psychoactive or oneiric, though Alper speculated that it could potentially be hallucinogenic at higher doses. 18-MC also does not seem to carry the same cardiovascular risks. MindMed, a new Canadian pharmaceutical company focused on psychedelic and psychedelic-inspired medicines, obtained the patent for 18-MC in 2019 when it acquired the biopharma startup, Savant HWP, for an undisclosed sum. MindMed recently completed Phase I testing on 18-MC. The company declined to share information about their 18-MC trials or comment for this story.
18-MC Patent and the Halting of Ibogaine Research
Karen Szumlinski, a neuropharmacologist, neuroscientist, and professor at the University of California Santa Barbara, worked on animal studies for both ibogaine and 18-MC from the mid to late ‘90s—long before Savant HWP or MindMed existed. 18-MC was first developed in 1996 by a group of scientists, one of which served as Szumlinski’s research mentor. Based on her observations, Szumlinski believes 18-MC is not psychoactive. But the bias against psychoactive compounds combined with 18-MC’s minimal cardiovascular risks are likely the reasons why ibogaine research in the US halted when it did.
Another reason ibogaine studies in the US stopped is due to profitability. Ibogaine is a natural product not eligible for a patent, according to Brown. Patenting molecules is how companies make big profits. Somewhat confusingly though, Howard Lotsof, the person credited with discovering ibogaine’s anti-addictive properties, was able to patent the use of ibogaine and related molecules in doses ranging from 1 mg/kg to 60 mg/kg given orally or rectally for treating poly-drug dependency in 1990. The patent covered addiction to one or more of the following: alcohol, heroin, methadone, cocaine, caffeine, amphetamine, desoxyephedrine, and nicotine. However, it’s the patents held by companies like MindMed that cause Rasmussen to express concerns.
“Big pharma, they like molecules that they can register as their intellectual property and make more money on,” Rasmussen said. “So, I think that’s the reason that there’s a lot of money for 18-MC and there’s no money for ibogaine research.”
Is the Ibogaine Experience a Crucial Part of the Treatment?
Ibogaine’s effectiveness for treating substance abuse disorders and addiction is established in human trials and supported by numerous first-person testimonials. We were unable to find data showing the same for 18-MC, likely because the results of clinical research don’t exist on the molecule yet. But when such information is available, it may offer additional insights into whether the consciousness-altering properties of ibogaine are essential to its effectiveness for treating various SUDs.
Alper suspects the new data will be consistent with what is shown in the existing research. “In terms of ibogaine and its effects on self-administration and withdrawal, the animal model and human experience appear to align pretty well,” Alper said. “Effects on reduced drug self-administration following treatment with ibogaine or 18-MC are not likely to be based on the processing of the content of psychoactive experience.”
In other words, Alper doesn’t think that the reduced consumption of addictive substances by lab animals is caused by psychedelic epiphanies. Rather, he believes it’s the physiologic processes induced by ibogaine. He suspects the same is true for humans, though he also accepts that the psychedelic experience could be a useful aid for patients undergoing psychotherapy.
Other researchers were less optimistic about 18-MC’s relative prospects in human trials. “I think that at least in some cases—not the majority of them maybe, but in a significant number of situations—the psychedelic experience is a key to solving the problem,” Rasmussen explained. “It’s not that I think that 18-MC will not work, but I really don’t understand how it would work as well as ibogaine does without the psychedelic experience.”
Instead of viewing the question as a zero-sum game that promotes one treatment at the expense of the other, the true win-win scenario for patients would be that both medicines become safely available. After all, the need for more effective therapies is paramount. COVID-19 and the policies put in place to contain it have only exacerbated the risks posed by SUDs. The Lancet reports that as of July 2020, drug overdose deaths in the US increased by 13 percent, with rates in some states up by over 30 percent.
If the end goal is to reduce harm and save lives over the long haul—and not pump up stock prices in the short term—then it’s up to those within the psychedelic movement to continue their decades-long struggle to end the criminalization of these potentially life-saving medicines. Otherwise, the fate of these powerful and potentially transformative substances will be decided by supporters of the failed policies of criminalization and the corporatization of psychedelics.
About the Author
Jeff Kronenfeld is an independent journalist and fiction writer based out of Phoenix, Arizona. His articles have been published in Vice, Overture Global Magazine, and other outlets. His fiction has been published by the Kurt Vonnegut Memorial Library, Four Chambers Press, and other presses.
In this episode, Joe interviews Dr. Anne Wagner: Toronto-based clinical psychologist, founder of Remedy (a mental health clinic combining therapy with research through their corresponding Remedy Institute), investigator on the MAPS-sponsored trial on cognitive behavioral conjoint therapy for PTSD, and current lead investigator on MAPS’ trial of cognitive processing therapy + MDMA for PTSD.
She talks about working with Candice Monson in 2013, having her first MDMA therapy session with Michael and Annie Mithoefer a year later, her first couples study on PTSD using MDMA, her MAPS training (she’s now a trainer in-training), her passion for relational healing, Remedy and what she hopes to accomplish there, and what she’d like to do next: a larger MDMA couples therapy study with hopes of proving its efficacy towards relationship satisfaction improvement to the point of running a study without PTSD being a factor, and a new protocol combining mindfulness-based work with psilocybin.
They also talk about the idea of personal optimization and how it relates to community, speaking at psychedelic conferences, behavioral accommodation, psychology’s struggles with being accepted in a scientific data world, how to measure what makes a therapist good, and the importance of clinicians-in-training going through extremely in-depth training and doing their own work.
Notable Quotes
On trying MDMA with MAPS: “[I] went and had that therapeutic experience for myself, and was convinced in that moment that this is really, really worth pursuing. And it honestly shifted not only the course of my research, but of my career, my personal life, everything.”
On MDMA being used in therapy: “We saw 6 couples go through this protocol, and it was very compelling. Really, as someone who works with PTSD all the time in my clinical practice and in many different trials over the years, it is the thing that’s excited me the most as a clinician and a researcher, and I feel so much hope for the potential future clients who might get to access this.”
“The advice I really give to people is to try to be an expert in something, and it doesn’t have to be psychedelics. …So, it could be that you are going to be a therapist. Fantastic. Become an amazing therapist. You could be a statistician. We’re going to need those. Become an amazing statistician. We’re going to need great lawyers, or great people who understand policy- all of these things. I really believe in this model of: become an expert in a skillset, and then apply it to psychedelics.”
“Right now, everything’s focused on the drug- this pharma model of: ‘Is it the drug or the placebo? Which one has more effect?’ When really, I think the question needs to be: ‘Should it be the therapy, or the therapy plus the drug? …Is it the process, or the process amplified?’”
Dr. Anne Wagner, C.Psych., is the founder of Remedy, a mental health innovation community, and is the lead investigator of the pilot trial of Cognitive Processing Therapy (CPT) for PTSD + MDMA and the upcoming randomized trial of Cognitive Behavioral Conjoint Therapy for PTSD (CBCT) + MDMA. This work and collaboration builds on the MAPS-sponsored pilot CBCT+MDMA trial she ran with colleagues Michael Mithoefer, MD, Annie Mithoefer, BSN, and Candice Monson, PhD. Anne is deeply committed to bridging the worlds of psychotherapy and non-ordinary states of consciousness, and has a passion for its use for relational healing. She is committed to supporting and protecting traditional and Indigenous wisdom with sacred medicines and consciousness expansion, and uplifting the voices of women in the psychedelic world. She is an Adjunct Professor in the Department of Psychology and an Associate Member of the Yeates School of Graduate Studies at Ryerson University. She is also certified in Mindfulness-Based Cognitive Therapy, and is engaged in learning and practice of somatic, emotion-focused and transpersonal methods of healing. She is the Past-Chair of the Traumatic Stress Section of the Canadian Psychological Association, is a Global Ambassador for the International Society of Traumatic Stress Studies, and sits on the Board of Directors of Casey House (Toronto’s HIV/AIDS Hospital).
In this episode, Kyle interviews psychologist and licensed marriage and family therapist, Veronika Gold, and author and clinical psychologist, Harvey Schwartz. They are co-founders (and Gold is the CEO) of Polaris Insight Center in San Francisco, which offers ketamine-assisted psychotherapy. Together, they work as co-therapists, as trainers on ketamine-assisted psychotherapy through Polaris Insight Center, and as investigators in MAPS’ Phase 3 MDMA-assisted psychotherapy clinical trial for the treatment of PTSD.
They talk about their training model, the benefits of co-therapy and how a leader/apprentice co-therapy model is likely the future of therapy training, the importance of doing your own work as a therapist, the arguments for therapists not taking drugs, the subtle hierarchal and approval-seeking games uncovered in training, how working with ketamine today is like raising a teenager, the “mystery and mastery” in therapy, medicine, and psychedelics, and the casualties of the mental health care system and the importance of de-programming patients from the effects of its abuses.
Notable Quotes
“We almost need to create a culture. That’s what we’re trying to do in our training- to create a culture of courage and [fearlessness], honesty about ourselves and about the work, and humility and vulnerability, and to have as much of an egalitarian approach to our patients and clients as possible- for many reasons, but one of the main ones is to, in a way, undo the damage that many of them have had by being in the mental health system for as long as they’ve been in the mental health system, because so much gets laid down in terms of programming about worthlessness or failure or ‘it’s their fault.’ So, I feel like a big part of this model is not just giving the medicine and doing the protocol, but kind of imbuing the person with a whole new worldview about what their struggle means and what their struggle is about. …It’s almost like de-programming them from the mental health systems’ long-term effect on their sense of self and their identity.” -Harvey Schwartz
“Mastery and mystery both have risks, both have shadows. And I think teaching that is really important so that everybody learns about humility by walking down the center path between these possible errors that we could all make- being too rigid, or being too loosey-goosey.” -Harvey Schwartz
“The clients do report different experiences, even with the same doses of the medicine. And is it just the set and setting, or is it just the music, or is it really the space that we hold that allows the patient’s psyche to go deeper, to go to the inner-healing intelligence, to access things that will be safely held in that space? That maybe this inner-healing intelligence knows that if that something was not welcome or supported, it’s not going to bring it out because it would be re-traumatizing for them?” -Veronika Gold “Psilocybin’s been on the planet for thousands of years. Iboga, thousands of years. Ayahuasca. These medicines, I feel like, have thousands of interdimensional spiritual support systems between ancestors, and it’s been going on for a long time. Ketamine is like a teenager in the spirit world, I feel like. And so, in a sense, we are really having a chance to impact the morphogenetic field in a greater level than these other things which have been around so long. So all the things we do, every session we have, I think of this. And all of our trainings, we’re kind of adding into this, helping this teenage form of therapy grow up and steward it in the way that we think it should be stewarded from the point of view of serving in the best possible ways, the safest possible ways, and the most expansive possible ways. So it’s kind of exciting to be raising a teenager.” -Harvey Schwartz
Veronika Gold, a psychologist from the Czech Republic and a licensed Marriage and Family Therapist in California, has expertise in the treatment of anxiety, depression, and PTSD. She is a co-founder and CEO of Polaris Insight Center in San Francisco, clinic providing Ketamine Assisted Psychotherapy treatment for depression, anxiety, PTSD, and other mental health issues. She is also a lead trainer in the Ketamine Assisted Psychotherapy Training offered by Polaris Insight Center. She is a sub-investigator and a co-therapist at San Francisco Insight and Integration Center, site participating in Phase 3 MDMA-Assisted Psychotherapy clinical trial for the treatment of PTSD sponsored by MAPS, and she is an associate supervisor for Phase 2 trial in Europe. Veronika Gold is as well EMDR therapist, consultant, and volunteer facilitator for the EMDR Humanitarian Assistance Program. She is a certified Somatic Experiencing Practitioner and a Realization Process Teacher. Veronika provides Psychedelic Integration Therapy and serves as an article writer, consultant, trainer, and presenter on Psychedelic Assisted Therapies.Dr. Harvey Schwartz
About Dr. Harvey Schwartz
Harvey Schwartz has worked as a licensed Clinical Psychologist in private practice in San Francisco since 1985, and is Co-founder of Polaris Insight Center. He received his Ph.D. in clinical psychology from Emory University, Atlanta, GA. in 1982. He has specialized in treating complex PTSD, severe dissociative disorders, survivors of organized abuse experiences, and individuals working on psycho-spiritual development. Harvey has undergone training in psychedelic psychotherapy with the Multidisciplinary Association of Psychedelic Studies (MAPS) and the Ketamine Training Center (KTC), and served as a trainer in two KTC trainings, and currently served as a Sub-Investigator and co-therapist on the MAPS MDMA-Assisted Psychotherapy Phase 2/3 Clinical Trials for treatment-resistant PTSD. Harvey is an associate supervisor for the MAPS sponsored clinical trials in Europe.
In today’s Solidarity Fridays episode, Kyle and Joe have a discussion about spirituality and spiritual development.
Joe was rubbed the wrong way by a podcast he recently listened to where a previously very psychedelic-oriented Qabalist said that psychedelics didn’t really help with spiritual growth. This leads to a discussion built on many questions: what is spiritual development? What is enlightenment? Does drug-taking always need a set intention based on growth? Do “I need a break from bullshit” or “I want to have fun with my friends” count as intentions? And who are we worried will discredit or judge us for having those be our intentions or keys to spiritual development?
They also touch on religion and their embedded spiritual goals, the importance and power of the communal aspect of some of these experiences, the community that church brings to people and what’s changing as more people move away from religion, hypnosis and the dangers of inaccurate or entirely fabricated “memories,” the importance of diversifying your tools for growth, the trouble in trying to define shamanism, the problems with therapists and facilitators bringing their own frameworks into sessions rather than letting clients define their own experience, and the unfortunate passing of the Fungi Academy’s Oliver Merivee (fundraiser link below).
Lastly, they remind us that there are only a few spots left for the upcoming Navigating Psychedelics for Clinicians and Therapists class, which begins on January 7th. If you’ve been considering taking the class, what better time than the new year to take that step? Time to leave 2020 behind and step into 2021 with purpose! Happy New Year!
Notable Quotes
“The thing that had me keep coming back to breathwork is that sense of community. And I think a lot of people start to find their community in these medicine spaces and ayahuasca circles and whatnot, because you’re having an experience together and being able to explore and share that, and sometimes these are so vulnerable and so deep experiences- you’re together with a bunch of strangers and you feel like you just shared things or experienced things that you never really experienced with the closest people in your life. And somehow, that creates a sense of meaning or connection that is hard to find elsewhere. It’s interesting to really kind of view the community or community aspect as part of spirituality, in a sense.” -Kyle
“It’s interesting to hear people have these experiences and then have a facilitator say, ‘Yes, that’s what happened to you.’ How do you know? I don’t know. I’ve had plenty of these past life experiences and I have no idea if that was actually real.” -Kyle “Of course this is a complicated topic, and really messy. We wouldn’t have this many episodes of the podcast if it wasn’t.” -Joe
In this episode, Joe interviews Medical Director of the Kuya Institute for Transformational Medicine, consultant to Onnit Labs, consultant to several international treatment centers, and author of one of Joe’s most referenced books, The Concussion Repair Manual, Dr. Dan Engle.
Engle is quite knowledgeable when it comes to concussions and traumatic brain injuries and the brain’s ability to heal. He specializes in psychiatry, neurology, peak performance methods, and healing through regenerative and plant medicines. He talks about the sadly very different stories of his siblings, the factors that affect neurological resiliency, the need for establishing neurological performance baselines for athletes, the science behind CBD being a neuro-protectant, the safety and efficacy of psilocybin, how scaling research can dilute data, the importance of dipping one’s toes into non-ordinary states of consciousness before trying psychedelics, how we seem to have hit a new phase of learning more about preparation, and how not trying to achieve transcendence is suppressing a biological need.
Notable Quotes
“It’s fascinating that, in the midst of this medical movement, we’re seeing both of these fields of medicine, in parallel, gain more and more traction- this being the psychedelic medical arena, which is more psychological-based in nature, and then you have the neurologic concussion repair arena [that’s] more hardware, brain-tissue based. So you’ve got, now, software and hardware technologies in two parallel medical paths, both accelerating at the same time, with this intermediary bridge between those two fields, which is the psychedelics.” “There’s a lot of interest, there’s a huge demand, the data’s very good, and when done well, there can be a pretty significant profit margin. And so, it still comes down to: the primary focus has to be client care and client outcome, not a profit-driven model.” “When you prepare people well, for sure, you see this magnificent improvement in rates of response, recovery, whether you’re going for healing something like one of those epidemics I mentioned, or just optimization and fulfillment and the radical remembering of our awesomeness and what we’ve come to be a part of. At that point, the whole game has changed. The whole game of life just has changed from scarcity to abundance, from ‘what I have to’ to ‘what I get to,’ from the ‘me, mine and I,’ to the ‘us, the we, and the all.’ This is a shift in consciousness. It’s a shift at the level of the psyche, and psyche means soul, so this is a process where we reconnect with the deeper aspect of our inherent humanity, and no agent on the planet is as consistently predictive to support that process than psychedelics. Near-death experience can do that, but it’s not as easy to control that process.” “We’re always evolving, individually and collectively, and these psychedelic medicines, when done well- these are sparks. They’re ignitors. They’re catalysts of consciousness.”
Dr. Dan Engle is a psychiatrist with a clinical practice that combines aspects of regenerative medicine, psychedelic research, integrative spirituality, and peak performance. His medical degree is from the University of Texas at San Antonio. His psychiatry residency degree is from the University of Colorado in Denver, and his child and adolescent psychiatry fellowship degree is from Oregon Health & Science University. Dr. Engle is an international consultant to several global healing centers facilitating the use of long-standing indigenous plant medicines for healing and awakening. He is the Founder and Medical Director of Kuya Institute for Transformational Medicine in Austin, Texas; Full Spectrum Medicine, a psychedelic integration and educational platform; and Thank You Life, a non-profit funding stream supporting access to psychedelic therapies. Dr. Engle is the author of The Concussion Repair Manual: A Practical Guide to Recovering from Traumatic Brain Injuries, as well as his new book, A Dose of Hope: A Story of MDMA-Assisted Psychotherapy.
Disclaimer
The information provided in this podcast is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical recommendation, diagnosis, or treatment. The use of information in this podcast is at one’s own discretion, and is not an endorsement of use given the complexity inherent in these medicines, and the current variable widespread illegality of their usage.
In this episode, Joe interviews Dr. Naveen Thomas of Clarity Psychiatry in Boulder, Colorado.
Naveen first discusses what he initially looks for in patients (low-lying fruit like a vitamin D deficiency or poor diet) and what he recommends for boosting immunity and improving overall health, then this becomes a bit of an “everything you ever wanted to know about ketamine and ketamine-assisted therapy” podcast.
He talks about the range in treatment methods across conventional models and what you could expect to experience in relation to dose, experience, and price, and how he likes to use ketamine in his practice. And he talks about the dependence that can come from more conventional “get dripped” methods, the variation of doses and subsequent effects on most people vs. more sensitive people, ways to calibrate a patient to give them the best (and safest) possible experience, the missed opportunities of models that don’t spend as much time on the experience and integration, why he believes so strongly in the efficacy and safety of ketamine (especially when compared to other psychedelics), and why how he’d like to see breathwork be used more in conjunction with both psychedelic and traditional therapies.
Notable Quotes
“In the worldview of the way I was trained, the whole point of ketamine therapy is not to get somebody hooked on ketamine for the rest of their life. It’s to give them enough corrective expanded experiences of healing and of their own inherent wholeness that they don’t need the ketamine- that whatever was off-balance is coming right.” “I’d like to maybe reframe the word ‘dissociative.’ With ketamine, chemically, in the ketamine state, we are becoming less and less in tune with outside sensory input. We are dissociating with ourselves as a body, temporarily, to some degree. And we are associating with ourselves as something other than body. And there’s some real- I’m just going to go ahead and use the word- there’s some real magic in that possibly. There’s some real healing potential.”
“One of the final common pathways, shall we say, of any medicine or technique that can induce a non-ordinary state is temporarily softening the ruminative negative self-narrative that’s so characteristic of human suffering and mental illness. And how you achieve that state, in some ways, is potentially not even that important. …Holotropic breathwork, or what I call journey breathwork, in any of its forms, absolutely can soften that egoic function and give people access to the parts of themselves that are bigger than that negative self-narrative, and just to bask in the juiciness of what’s possible when that happens. …And I think from a pragmatic standpoint, if we were to use breathwork as [an] interim integration tool between sessions, could we get away with maybe slightly decreasing the frequency of the more expensive psychedelic sessions? Might there be societal value in that while still retaining the efficacy and the self-learning and the insights and all the good stuff that goes along with that?”
Dr. Thomas graduated from Emory University in Atlanta, Georgia. He completed his medical school training at Emory University School of Medicine. He then went on to complete his post graduate psychiatric residency training at the University of North Carolina in Chapel Hill.
In this episode, Joe interviews writer, director, and producer of the recent documentary, “The Way of the Psychonaut: Stanislav Grof’s Journey of Consciousness,” Susan Hess Logeais.
The film, which we streamed and presented a panel for back in October, was co-produced by Stan Grof himself, and tells of his journey from his youth in Nazi-occupied Prague to Esalen to today, with much of Logeais and her theory-affirming life story mixed in. It features interviews with many big names, including Fritjof Capra and Rupert Sheldrake, and full-length interviews can now be found on the film’s website; 2 of which are conversations between Grof and legends we’ve lost recently: Ralph Metzner and Michael Harner. It is Joe’s favorite film on Grof and his work.
Logeais talks about making the movie and meeting such big names in the field, wonders how differently children might grow up if quantum physics and a respectful agreement with nature were taught in school, discusses cesarian births and the differences they could create in fear or stress response in comparison to kids born traditionally, and talks about the power of breathwork and its enormous influence on psychedelic-assisted therapy.
Notable Quotes
“When I met Stan and heard him speak and heard what he spoke about- tantric science, mythology, Eastern spiritual traditions, even quantum physics, Shamanic journeywork- there were so many things that he spoke about that I had explored on my own before I met him. And then in the course of making the movie, I realized that he had introduced many of those concepts during his 14 years at Esalen. And so I was resonating with him on a level– it’s like he was impacting my life before I met him.”
On using MDMA with psychedelics: “Perhaps as an introduction to a psychedelic experience, especially for people who are older, it might not be a bad idea. I know the anxiety that I had occasionally when something was going really fast and very deep. But I agree with you in that the depth and that anxiety passes, and it’s in the learning to get past that anxiety that we develop capacity for reflection and to move away from reactivity. So I think maybe for the first trip, just to say, ‘Ok, this is what you’re in for, and next time we’re not going to do this.’”
“I just want to say how valuable I think Stan’s contribution is, and how proud I am, or how, I guess, grateful I am to have worked with him in the creation of this film. And I’m so glad that you enjoyed it because I wanted to take his theories, his discoveries, his contributions, and make them accessible and interesting so that people could watch it and come away with an understanding that would hopefully inspire them to then go and do the deep work. And I hope people come to the website and visit the live stream archive page so that they can gain a deeper understanding of all these amazing concepts that Stan participated in sharing during his time at Esalen and his ITA conferences.”
Susan holds a demonstrated history of working in the entertainment industry. She is skilled in Music Videos, Film, Documentaries, Commercials, and Theatre. She demonstrates strong entrepreneurship professional with a Interdisciplinary Degree focused in Transformational Entertainment and Human Consciousness from Marylhurst University. She is an actress and producer, known for Gone (2012), Not Dead Yet (2009) and The Way of the Psychonaut: Stanislav Grof’s Journey of Consciousness (2020).
In today’s Solidarity Fridays episode, the typical Solidarity Fridays format is switched up again, this time with Joe interviewing podcast host and psychiatrist specializing in ketamine-assisted psychotherapy, Craig Heacock.
Will Hall’s 2 recent SF episodes spurred a lot of conversation, and led to Heacock reaching out to Psychedelics Today to counter some of Hall’s points, and stand up a bit on behalf of psychiatry. He feels that while psychiatry isn’t perfect, saying to replace it isn’t helpful, and doesn’t feel that anyone in psychiatry is saying a pill will fix anything, but rather, that if psychedelics can help people get in touch with buried trauma (something that typically takes a lot of time and relationship/trust-building and often still doesn’t work), then shouldn’t we not only be treating them like medicine, but also learning as much as we possibly can about them?
He points out some of the most obvious flaws with our model of psychiatry (and how we deal with mental health in general), discusses the barriers stopping physicians from learning more about ketamine, looks at the “spiritual emergency vs. psychotic break” argument from a different perspective, talks about what he sees in his practice and how much ketamine has helped his clients, and really brings home one of Will Hall’s main points from a different perspective- while Hall talked about how science isn’t always the answer because of how much nuance there is from person to person, he points out the amount of nuance in how mental health physicians treat clients, how clients arrived at their mental state in the first place, and how differently they respond, both with or without psychedelics.
Whether you felt Will Hall brought a lot of interesting ideas to the table or hated those episodes, this is the yin to those episodes’ yang.
Notable Quotes
“I think a lot of psychiatrists are just trying to keep their head above water, which, I think, they would much more enjoyably keep their head above water if they would use ketamine in their practices.”
“We may never understand the mind-brain connection fully, but don’t we want to try?”
“We’re finding with ayahuasca work (a lot of psychedelic work) that some people are going to these sessions and their conscious brain is saying ‘oh yea, there’s no trauma,’ and we’re finding out that there’s some serious trauma that’s just underneath the surface. And again, if we don’t know that, how can we get to the roots of anything? …Almost like we use a CT scan to see what’s happening in your innermost self, it’d be interesting to think of using psychedelics as sort of a psychological diagnostic tool to say: ‘Is there trauma in there?’” “When Will is saying, ‘Why are we trying to address trauma with a pill?’ I don’t think any of us are. I don’t think anybody on the MAPS study or I don’t know, people in the psilocybin studies- I really don’t think anybody is thinking, ‘Ooo we’re going to fix PTSD with psilocybin!’ or ‘We’re going to fix trauma with this 150 mg MDMA capsule!’ Nobody’s thinking that. What we’re thinking is: this is a catalyst, [and] resources are limited. …We need to get in there quickly and get working on this, and that’s what’s so exciting to me about psychedelics coming online with mental health, is that we can get down to business quickly and not have to spend so much time trying to get past these defenses.”
“Capitalism is messy and psychiatry is messy and psychedelics are messy and people are messy, and isn’t that ok? Can’t we just accept that and not default to this sort of pan-negativism and finger-pointing and blaming? Because, again, we’re all on the same team. We want the same thing. We want people to thrive and we want to dial down psychological despair as much as we can.”
Working in psychotherapy with substances such as LSD, MDMA, and psilocybin in order to help heal depression, post-traumatic stress, or to overcome death anxiety has been the subject of many publications. Some authors, such as Stanislav Grof, have even gone so far as to establish new stages in human development. Just as Freud in his time conceived of psychopathology on the basis of trauma in the oral, anal, or genital stages, Grof postulates that certain behavioral disorders stem from suffering encountered in one of the four perinatal stages. In conjunction, both older (James Fadiman, Michael Mithoefer) and more recent authors (Benny Shannon, Eric Vermetten) have modeled psychotherapy settings that use work under psychedelic substance.
Our aim today is not to question these different approaches and their possible transferability to countries where the law prohibits such practices. Indeed, what are the implications regarding the relationship with therapists when working in a framework outside the law, which imposes secrecy towards the environment? What does this induce in therapy?
In France, the law prohibits the use of substances in psychotherapy. However, in our therapists’ offices, we receive people who have gone abroad to other continents to have psychedelic experiences (whether conducted according to traditional practices or not) or even to nearby countries where foreign shamans come to perform ceremonies. The people who come to consult in this context have either had a “bad trip” that still disturbs them, or are no longer able to reintegrate socially after a strong mystical experience, or, still further, want to understand and integrate what they have lived through.
This is “afterthought” process work that differs from what a therapeutic framework would have involved, with preparation prior to the experience, specific therapeutic support during the experience, and an integration (the phase where meaning is given, where the experience is symbolized) and assimilation (the phase when we are able to link this experience to all our past experiences and our history, enabling us to visit prior beliefs) of the elements that emerged during the experience. Indeed, the psychedelic experience induces a shock by opening up hitherto unknown spaces which the psyche does not know what to do with, or, if it does, it will literally cling to the visions that have arisen during the experience, even if this means being out of step with daily reality.
These people come knocking at our door because they know that in addition to our training as a psychologist and psychotherapist, we have been initiated into shamanic practices. As such, we are supposed to know all about this, or, at least, are willing to hear non-ordinary stories without limiting our diagnosis to psychopathology. Through this approach, we are asked to hear these accounts not as pure madness, but to take care of their experience as a salient moment in their lives, even if a painful one.
In doing so, the experiencers come to challenge our own reference grids and our anthropology. Applying a single theoretical reference frame as we usually do in therapy has the risk of greatly reducing our understanding of the experience, even if this frame of reference was based on the transpersonal current. From our point of view, Grof’s perinatal stages or the archetypes of Carl Jung or Gilbert Durand cannot, by themselves, sufficiently support the elaboration work required by our patients. We believe that elements emerging during a psychedelic experiment are polysemic. They must be looked at on several levels: symbolic, metaphorical, transcendental, processual, as well as on the ego and somatic levels. Each level can, in itself, feature several interpretations.
For example, if I see myself as a warrior killing the dragon to free the princess:
-This may symbolize a problem in my married life which is very difficult to solve (we talk about symbolism at this point, because in our culture, references to the warrior and the princess speak of couples, as seen in children’s tales).
-At the level of the ego, it may question my desire to be recognized by my wife, or manifest my need to be seen as a powerful man.
-At the transcendental level, I may be envisaging the influence of superior, and even very ancient archetypal forces impacting my life as a couple.
-On a metaphorical level, it could be interpreted as the work I have to do to channel masculine strength and liberate the feminine dimension of my being.
-On the somatic level, during this experience, I may have felt a lot of energy inside, which could point towards the fact that I have a lot of inner energy at my disposal to obtain what I desire.
-On a process level, if I follow through with my vision, it has me view my wife as a weak person in need of rescue. Maybe this reveals my thoughts on male/female relationships.
-And at the transgenerational level, it may evoke how one of my ancestors forced a marriage upon his family against their advice.
The symbolic and metaphorical levels can overlap, and it’s often a very fine line to distinguish between them, and not necessarily always useful to do so. However, it is essential for therapists to keep these different levels in mind so that interpretations can be broken down and not rushed through too quickly, for the sake of an immediate ‘aha’ moment that would obscure and eliminate all other possibilities.
At the same time, a single level of interpretation may contain several meanings. For example, at the symbolic level, seeing oneself locked in a dark cave from which no escape is possible can represent how my current life is functioning now, just as it can symbolize the overwhelming constraints which I am confronted with in my environment, or my inability to see my situation clearly, etc.
To shed light on our way of working, we offer below three very different clinical cases.
Marc is a 38-year-old man. He lives alone without any children. His mother died when he was 20, and he sees his father quite regularly. He has little contact with his brother, who lives far away. Marc has been to South America, where he tried mushrooms, peyote, and ayahuasca. During his experiences, he was given a highly spiritual task: to attain spiritual enlightenment and guide his fellow citizens on this path. He saw himself as having high spiritual potential and became convinced that this was his destiny. Unfortunately, his return home to France was not as smooth as expected. There were no followers to be found. His speeches were met with irony. He didn’t make a good Messiah. Disheartened and still convinced by the visions he experienced deep inside, he isolated himself and drifted into a state of depression.
When we meet him for the first time and ask him about the faith he has in his own visions, he answers that his mother had the gift of clairvoyance and that she spoke “The language,” implying the language used by Christ. So there was no doubt that he had to continue the work of his lineage, being himself, like his mother, a person different from others.
From a psychological viewpoint, we could make the hypothesis of narcissistic disorder, eased by an extraordinary ideal. This defense mechanism against narcissistic collapse, however, is undermined by the lack of disciples. The depressive movement is the reason for his consulting us, and not his psychedelic experiences, which he believes to have understood sufficiently well.
Initially, no attempt was made to deconstruct his defense mechanism. We looked at his mission and more precisely how he had come to this conclusion. Based on his visions where he had sensed divine power within and where he had seen himself conveying it to others, we came up with several other interpretations for each of the levels previously evoked.
For example, divine power was seen as a spark of life shared by every human being (transcendental level). It was no longer a superpower that he possessed and that made him into an exceptional being. Together, we worked on his representation of the visible and invisible worlds, and the beliefs attached to these representations; namely, whether every human being had a mission, who assigned it, and whether we all had some degree of freedom with regard to this mission.
We also looked to see if this mission could stand as a metaphor for the way his family functioned, in which one person was the leader of all. We explored his family lineages. Was this “gift” already present over several generations? He thought his maternal grandmother had it, but wasn’t sure. He could only confirm that this particular trait was not recognized by those around him. Rather, it caused exclusion. This was a form of transgenerational recurrence. He thus was able to see exclusion as something to be avoided and discontinued. We did not go any further on that level.
Next, we addressed the level of ego, in this case, the desire to be recognized, admired, loved, and to be able to guide others. Through this inquiry, he was able to let go of his feeling of being all-powerful. It reintroduced a notion of intersubjectivity that he was overriding. It was also a way of looking at his limits and of accepting his shortcomings, thus allowing acceptance of a sufficient level of frustration (in the psychoanalytical sense) to live in society.
We suggested to him to let his vision unfold to the maximum (on the imaginary level), push it to the limit, and see how that would be for him, and what he would learn from it. This is the process level. When we go to the very end of the rationale of “I have something divine that I must share with others,” it most often leads to a crazy, untenable position. In this situation, it could well lead to becoming a new Christ. Pushed to this extreme, he felt that it was not right.
During these experiences, he had felt full of energy. He told himself that it would be forever present in him and that he could rely on it for his new life projects. Working on the different interpretation levels allowed him to let go of the initial conclusion that had stuck him in an unbearable pattern. Working on his ego, he resumed humility, which, in turn, helped him find a job in nature that he easily adapted to.
Exploring the transcendental level through how he viewed the visible and invisible worlds set him back on a spiritual path that did not split him off from the people he knew. In this case, we can speak of a shock or intrusion that caused spiritual trauma. If psychedelics have been shown to open up a spiritual space that is helpful for the person, they can just as easily cause a form of trauma, because the experience cannot be integrated, thus locking the individual into an alienating dynamic.
This example shows us once again the regrettable absence of a containing setting when using psychedelics. Such experiments proposed in a different cultural context, with codes often unknown to us Westerners, do not allow the experimenters to integrate the contents of their experience.
The second situation refers to a person who underwent a bad experience using psychedelics with a sitter in a supposedly therapeutic context.
Simon had taken LSD. After marveling at the fantastic images and colorful music, he had found himself locked in a kind of hell with viscous, crooked, suffering beings. Some of them were obsessed with sex. Disgusted, Simon could see in these beings all the darkness of their souls. A voice sounded in his ears: “You’re just like them, just as bad… You’ll never get away with it… You’re doomed to stay here…”
In fact, until the end of his psychedelic experience, Simon would not leave this space. Very affected and upset by his experience, he shared it with his sitter, whose answer was: “The medicine knows what is good for you… Let this experience take you through.”
A state of depression ensued. Simon couldn’t bear to see this hideous evil forever lodged in the depths of his soul. He saw no way out of this condemnation. The darkness of the images he had seen on that trip had left a deep impression on him. He imagined he’d be stuck there even after his death. This state lasted more than three months without his sitter being able to help him any further. She was always evasive during their phone calls, probably overwhelmed by the situation herself.
It was at this point that Simon began work to heal his depression. We invited him to delve into the darkness he evoked and see how it was inscribed within. Through our elaborations, differentiation was made between his cowardice in everyday life, the fears that triggered aggression, the frustrations generating anger, and the possessive, predatory nature of his sex drive.
The darkness he witnessed during the journey was no longer a shapeless, slimy magma. In fact, each element of this hell could metaphorically represent an aspect of Simon’s personality. Viewed in this way, it provided a perspective to work with. By unfolding each element, we were able to extract him from the suffocating magma he couldn’t shake free from before.
This “bad trip” can be construed as an attack on the ego. The ego seeing itself in its darkest aspects with no hope of breaking out triggered the depressive episode. The attack on the ego also contributed to taking a good look at the reverse polarity: “Who do you think you are, to imagine you’d be free from negativity?” The process allowed Simon to identify his quest for an idealized self (being a good person in all respects), which cut him off from a whole part of his being.
His spiritual quest, as he practiced it, let him off from confronting his shadow areas. In fact, it really supported a cheap narcissism. However, it was actually through this soul-searching initiative that he finally was able to take into account the shadows perceived during his journey. He saw them as constitutive of all human beings, i.e. elements that everyone had to work on.
This transcendental perspective made him accept his shadow areas and brought him out of his self-condemnation that had frozen his being. Having to improve on these negative areas, as with any human being, brought movement back into his life. It also gave him more compassion for others and for their shortcomings.
At the process level, this experience was analyzed on two levels:
-The form of idealization that he held for his sitter was shattered. Through this idealization, Simon was looking for a knowledgeable figure who would pass on their knowledge to him. From the pupil being taught special knowledge, he became the grown man making the effort to search for himself. The fact that the sitter had failed to be of help forced him to give up his search for a master and to discover himself.
-The second level of the process consisted of pursuing his vision to the end, i.e. remaining locked up in this hell. Simon then asked himself who held such a power to condemn? Could God condemn a human being to such a degree?
Several hypotheses were offered to Simon on the basis of his spiritual beliefs:
-Christ (Simon had been raised as a Catholic) is a God of love and forgiveness. This is what He preaches. Simon could not see Him condemn in this way.
-Reincarnation makes us consider death a passage and not a prison.
-Returning to the original source is not what he had seen either.
Simon concluded that the only one who could condemn him to this hell was himself. He had to learn to forgive and have compassion for himself, which was quite different from a narcissistic drive.
At the same time, he had also associated the image of hell with what his father had endured during the war. This episode was never talked about in the family, and, as Simon saw it, everything about that war was censored in his family. Through his vision, it was as if that hushed-up part of family history was finally revealed. That’s how Simon interpreted it. Without talking about closer ties between father and son, Simon understood and accepted more of his father’s silence. It also opened up a whole new set of questions about his transgenerational legacies.
Working this way on the different levels enabled Simon to move out of his depressive state. This example shows that the medicine does not do the work on its own, contrary to what is sometimes claimed by some counselors. The qualification of the counselor/sitter is fundamental.
The third example tells us about a defaulting set and setting.
Elizabeth had been experimenting with a friend, Birgit. One day, Birgit suggested she should work with an LSD specialist she knew and admired highly. Elizabeth agreed, but some time before the experience, she got into an argument with Birgit.
On the day of her experience, Elizabeth was greeted very coldly by her friend, who quickly introduced her to the specialist before she left. After taking LSD, Elizabeth was shown into a small room, with a stained bed and deafening music. She remarked on the lack of cleanliness of the sheets, but at the insistence of the sitter, she moved in with resignation and disgust. After some time, Elizabeth got up and asked to move to a chair in another room. A power struggle immediately ensued. The sitter refused and, in a rage, Elizabeth physically grabbed her. Frightened, the sitter gave in. Shortly thereafter, Birgit reappeared. Elizabeth was beginning to come to her senses. Confused by the tense atmosphere, she decided to go home against Birgit’s advice.
This experience left Elizabeth in a deep state of unease and she severed contact with both her friend and the sitter. She thought things over without really understanding what had happened. Guilt took over.
A few months later, she signed up for a trip to swim with dolphins. Two striking events followed: a mother dolphin and her baby dolphin came to swim with her. Then, a hummingbird landed on her while she was lying on the sailboat in the open sea. These two events caused a shockwave. The discomfort disappeared and gave way to an old childhood memory of being in communion with animals. She had rediscovered the simple joy and wonder of her childhood nature.
Looking back with Elizabeth on what had happened, she saw these moments as signs of healing that her soul had granted her- an interpretation based on her spiritual approach strongly anchored in shamanism. This interpretation, based on a transcendental perspective, but also on a childhood experience, had reconciled her with life through connection to the animal world.
Yet there were further developments to the session. Her relationship with her friend Birgit changed. From a relationship of dependence, she went through a period of anger, sadness, and then detachment. She came to see how the emotional bond was tied in with a form of submission. This issue, playing out on the level of the ego, concerned all three persons involved. Each one was playing their part in the game (loyalty, displacement of the bond, and roles).
How the framework is set and how the setting (physical conditions) is organized will have a strong impact on the experience, since it conditions mindset and the inner security with which the experience is met: many psychic contents will be colored by those factors. It also underlines the importance of the sitters/caretakers overcoming personal issues in order to avoid feeding them back unconsciously into their work environment.
Thus the framework, which had become violent due to the climate of disagreement (above and beyond the mere dirtiness of the sheets and the intensity of the music), had, in turn, summoned Elizabeth’s physical violence. Realizing how everyone had participated in the unfolding of this session, Elizabeth was able to refrain from taking on all the guilt and to see what recurring patterns were at play in her relationships.
Curiously, Elizabeth had few memories of what she saw during her trip, other than her strong desire to admire the beauty of spring outside, from the vantage of a clean and quiet environment. It was as if the most important part of the experience revolved around what happened between these three people. In this situation, the process level stood out clearly. This episode also echoed on the metaphorical level for Elizabeth. It highlighted how the people who needed to take care of her had failed to do so, and how nature had made up for it.
The multiple levels summoned in the integration work (and their scope) require of the therapist a real freedom and skill in wielding the whole keyboard of interpretive planes, i.e. a vast opening to numerous therapeutic, symbolic, emotional, processual, transgenerational, and spiritual meanings, in the face of the infinite psychic contents unveiled in these experiences.
Through these three clinical vignettes, we propose a structured intervention framework quite different from what is applied in traditional therapies, and that we use when assisting clients with such painful experiences or “bad trips.” We insist on the polysemic nature of each vision and on the different levels to be explored:
-The symbolic level -The level of ego -The transcendental level -The somatic level -The process level -The transgenerational level
Of course, when exploring all these levels, some may not be relevant to the person’s experience. Yet we ought not be satisfied with the first insight singled out, which would lead to an overlooking of the other equally relevant possibilities. We have often noticed that by focusing on a first interpretation, one failed to question the ego level, thus avoiding an awkward challenge.
In fact, this type of work unfolds in time. Integration and assimilation cannot happen in the span of a few rare sessions following the stressful experience. Indeed, these bad experiences often confront our clients with hidden elements of their functioning, beliefs, or history, i.e. elements which they were not ready to face, hence the importance of in-depth support.
About the Authors
Denis Dubouchet: A clinical psychologist for 35 years, psychotherapist, and Gestalt therapist, he trained at Michael Harner’s Foundation for Shamanic Studies, and he has worked with shamans and participated in ceremonies in their countries. He is the author of Etats de Conscience Elargie, Psychothérapie et Chamanisme (Ed. Dervy, 2017). You can reach him at denis.dubouchet@gmail.com.
Rosine Fiévet: A Gestalt therapist and coach for over 20 years, Rosine first discovered shamanism in 1981 with the women of Okinawa. She now regularly travels to North and Latin America to explore the traditions of the First Nations people to support her practice in ancestral healing. She has completed a full course in shamanism with the Sacred Trust in England. You can reach her at rosine.fievet@orange.fr.
In today’s Solidarity Fridays episode, Joe and Kyle continue their conversation from last week with Will Hall: therapist, host of the Madness Radio podcast, author of Outside Mental Health: Voices and Visions of Madness, and previous psychiatric patient diagnosed with schizophrenia.
This week, Hall compares how the medical industry treats those seeking therapy and growth vs. how they treat the homeless and victims of sexual abuse, how the framework for mental disorders disrespects the individual, neoliberalism and why capitalism and the free market shouldn’t be the answer for everything, Grof’s focus on etiology and why his model of spiritual emergence is problematic, the future of psychedelic advertising in a world where anything that can be sold will be sold, and the 3 biggest factors towards successful therapy.
And he focuses a lot on what we should be doing: creating and promoting individualized medicines and healing techniques over mass-produced Band-aid medicine, not reducing a difficult psychedelic experience to biology and instead focusing on getting to the root of what is causing the issue and working through it, not solely researching the effects of drugs, and most importantly, researching how people have bettered themselves without drugs- if the long-lasting effects of psychedelics and integration work are the catalyst for change, how can we get to those effects and integrations without the drug?
Notable Quotes
“Drugs are drugs. I don’t believe in psychedelic exceptionalism. I don’t believe in psychiatric drug exceptionalism. Drugs are drugs. There’s no exceptionalism for drugs. If they change your consciousness, they’re getting you high in one way or another, and that is what is either beneficial or nonbeneficial to you, based on your experience.”
“The people who are having successful treatment with MDMA psychotherapy- they aren’t just reporting ‘oh, my depression is down;’ they’re reporting all these wonderful benefits of MDMA. Why should we wait until you have a diagnosis of PTSD to give access to MDMA [to someone] if they want to experience those benefits as well? The people who are having the experiences of psychedelics are not having the experiences of disease-treatment, they’re having the experiences of psychedelics, which can be, for many people, very positive. So why are we gate-keeping the access? And if we don’t gate-keep the access, then we have to admit that, actually, it’s not a disease treatment; it’s actually something that many people find beneficial and some people don’t.”
“What is the commitment? Is the commitment to get psychedelic drugs accessible at all costs? And we’re going to lie, cheat, and steal our way to get there? Or is the commitment to trust that truth is the way? And if we just stick with the truth, that is how we change society?”
“I think you’re onto it. I mean, this is the key thing- psychedelics, in the best of contexts, is the pathway towards that. So why not study that? Why not research that? Why not invest the resources to exploring how we can create contexts for that which you’ve just described- create more spaces in society for successful encounters and engagements with openness, deeper relatedness, developing more trust, learning to communicate better, learning to form better community bonds, learning to develop our loyalties for each other, overcome our traumas together, tell our stories, overcome our shame, find ways that we can accept each other and support each other? That’s what we should be researching. That’s what we should be investigating, not psychedelic treatments that might have the effect of this, because this is what we’re really after.”
Will is a counselor and facilitator working with individuals, couples, families and groups via phone and web video (Zoom). He has taught and consulted on mental health, trauma, psychosis, medications, domestic violence, conflict resolution, and organizational development in more than 30 countries, and has been widely featured in the media for his advocacy efforts around mental health care. His work and learning arose from his experiences of recovery from madness, and today he is passionate about new visions of mind and what it means to be human.
In this episode, Kyle interviews Doctor of Psychology, faculty member at Esalen Institute, Fellow at the Institute of Noetic Sciences, Dharma teacher, and former Buddhist monk, Dr. Michael Sapiro.
Sapiro talks about his recent travel pilgrimage to the northeast US, living in a camper with his dog and spending a lot of time in the woods working on himself and his connection with others. He talks about the “ways of knowing” that is taught at Esalen Institute, where people ask their cognitive brain about an important decision, then ask their body, their intuition, and even their ancestors and/or spirit guides, paying attention to their reaction to each interaction. He talks about methods to deal with body reactions, breathwork, the importance of self-talk, metaphors, cutting karma so you aren’t perpetuating old ancestral wounds, the concept of post-traumatic growth, the difference between selfishness and self-focus, and knowing when to be passively working on yourself or actively engaging with and helping others.
They discuss how to fuse your normal self with your mystical self and make the mystical ordinary- through action, being self-aware, staying calm, staying open-hearted, and always thinking of what can be done next to improve yourself and the health of others. This is a bit of a feel-good episode: in a hectic, stressful time, it’s a reminder of the importance of checking in with yourself, taking care of yourself, and allowing yourself to just be.
Notable Quotes
“One of the things nature and the mystery taught me in my retreat, was to slow down and feel the presence of the mystery in a strand of a spider web. And I’m not being hyperbolic- I would slow down on a walk and see this spider web and just be with it for a while. What can I learn? What can I soak in? How can I be with it? And then I would take that into conversations when I met people. So that’s one practical way of bringing the wisdom of the forest into our daily lives.”
“How beautiful that we have this access to deep knowledge of the universe through us, but we have to be quiet. We have to be quiet to hear the whispers of the heart. And when you become quiet, the whispers of the heart become louder and they start filling you in. Then you have to start believing it.”
“What I learned in the forest and when I was doing my own healing work, is that the mystical states are actually ordinary- profoundly ordinary states of greeting the world [presently]- through my eyes, through my being, through being quiet when I’m agitated. …Making the mystical states ordinary is a verb. It’s turning mysticism into an action, and that comes out through our speech, eye-gazing, through the way we listen, [and] the way we show up for ourselves and other people.”
“Selfishness is doing a behavior that negatively impacts other people on purpose. …Being self-focused is different. It’s ok that we have time being self-focused. …You have to discern the difference. Because it’s not selfish to take care of the vessel that your consciousness is housed in. It’s important so you have good health to contribute to others’ health. It’s important because you’re precious and you matter. You don’t have to be selfish to take care of yourself, so let yourself off a little bit. Because a lot of people say ‘I feel selfish when I take care of myself.’ That’s not fair actually. That’s not fair. If you’re being selfish, call yourself out on it and change your behavior. If you’re just taking care of yourself out of self-love, because you know your health will positively impact other people’s (because we’re interdependent), then it’s really important you do take time to be self-focused.”
Michael Sapiro, PsyD is a clinical psychologist, Dharma teacher, meditation researcher, writer, workshop and retreat leader, and former Buddhist monk. He is on faculty at Esalen Institute and is a Fellow at the Institute of Noetic Sciences where he engages in research on meditation, transformation, and consciousness. He completed his postdoctoral fellowship in advanced psychology at the Boise VA Medical Center where he specialized in rural health, PTSD, and combat trauma. Dr. Sapiro teaches nationally on the art and science of transformation, expanded human capabilities, self-care, and meditation for personal and community growth. He is the founding teacher of Maitri Sangha Boise, an integrated Buddhist community, and director of Maitri House Yoga, LLC, serving the community through integrating meditation practices, psychology, noetic sciences, and social justice. He can be found at michaelsapiro.com.
In this episode, Joe speaks with Doctor of Osteopathic Medicine, Psychiatrist (specializing in the treatment of OCD), and Psychedelics Today Advisory Board member, Dr. Matt Brown.
Brown talks about osteopathic medicine and his thoughts on energy: how the principle of osteopathic medicine is that “mind, body, spirit” and the things we interact with contribute to what makes up a person, and by shifting things within each body system (neurological or respiratory, for example), change can be made, just like the way small postural shifts can lead to a decrease in pain or anxiety and how smiling can fool your brain into feeling happier. With bodywork emerging as such a powerful tool and breathwork facilitators learning interventions to help clients work through stuck energy, there is clearly a huge connection between the different energies in our bodies and how they affect us, but how much do we really perceive these shifts, and how do we measure these energies and create usable data out of it all?
They also discuss other new methods of psychedelic healing, like the Integratron, light machines like the Lucia Lucia N°03, and Soren Peterson’s sound table, and what it might look like if people used these and other non-drug methods in addition to a small amount of psychedelics- could that take away a lot of people’s fear? And they talk about Stan Grof, Dr. Christopher M. Bache’s LSD and the Mind of the Universe, Elon Musk’s Neuralink, and why people should watch and read more sci-fi.
Notable Quotes
“We’re talking about the study of consciousness, which I am fully confident we are not going to find out way past my death. But that’s ok, and actually, I find that somewhat exciting, because this is a really hard problem that humanity has been working on forever, and if we can even push the ripple of the movement in a slightly different direction for a positive change, that’s an amazing feat when you think about the totality of the universe and how huge it is and how small we are.”
“I think that what we might do, is, over time, try to figure out ways of having very, very specific, reliably repeatable experiences mediated through the combination of [a] psychedelic and some sort of a technology, that neither the drug by itself would cause, nor the technology by itself would cause, but if you combined the two, you could have something. What that would be, I don’t know, but it kind of feels a little bit like Total Recall. And then on the opposite side of that, with more the natural medicines, there’s this constant exploration of like, ‘ok, well, what is this broader universe all about and how is nature interconnected with everything else?’ And so, they’d be used for different purposes. So then when you think about it, when you’re talking about the ‘medicines coming from the earth’ so to speak, vs. like, the synthesized version, it’s like, ‘Do you want the blue pill or the red pill?’”
“He [Dr. Christopher M. Bache] does have that eye about him, of people that have gone really, really deep. …There’s just a thing- I don’t know how to explain it- it’s like a different twinkle in the eye, that you can just see in folks that have seen more than, I don’t know, what we’re supposed to see.”
“This is very much a global psychedelic experience going on right now. We are on the biggest trip that we’ve ever had, ever. And this is not going to be fast. …I’m not sure if we’ve gotten to the point where all the other traumas that we get to be able to be introduced to have all been shown to us yet. I think we’ve gotten some glimpses with that, with the whole George Floyd situation, but I’m not sure what’s still on the horizon before this whole thing ends. And hopefully, just like a psychedelic experience, there’s going to be a dramatic healing and growth that comes out of this. We’ll all find out together, whenever that happens.”
Dr. Brown Specializes in whole health psychiatry. This approach differs from many other practitioners who more and more practice symptomatic management when it comes to mental health. Dr. Brown takes the perspective that the body has the ability to heal itself, but from time to time may need assistance through balancing the things that are important for physical health that are also important from mental health. These include, sleep, diet, exercise, meditative/spiritual practice and cultivating positive social relationships. Dr. Brown also has a strong command of how to balance vital nutrients in our body with the aid of supplementation to augment traditional psychopharmacological therapies. Dr. Brown’s method is aimed primarily at the treatment of Depression and Anxiety as well as other mood disorders and ADHD. Dr. Brown is a specialist in the treatment of OCD specifically and is board certified by the ABPN in both adult as well as child and adolescent psychiatry.
The role of therapy in psychedelic therapy has been underexplored in mainstream articles that focus more on neuropharmacology and the psychedelic medicine experience. Without therapy, however, results from clinical trials would be no more significant than if the substance was studied in a recreational setting, and the fact that there is such a difference is central to the growing appeal.
As our companion article on psychedelic therapy explained, numerous therapeutic approaches used in psychedelic therapy converge on an inner-directed, relational approach. In psychedelic sessions themselves, therapists take more of a back-seat role, encouraging clients to focus inward and engage in an authentic process facilitated by their “inner healer” and refraining from interpretation. Still, complications can arise in psychedelic sessions, such as an upsurge of trauma, and if therapists lack the skills to respond, they risk leaving clients stuck and unresolved, potentially re-traumatized from improper care in a vulnerable state.
While therapeutic training is essential in case overwhelming content arises, the bulk of therapy work occurs during preparation and integration sessions. Across numerous clinical trials and clinics offering ketamine and cannabis-assisted psychotherapy, psychedelic therapists are using many therapeutic approaches to help their clients heal. Here are some of the most common.
Internal Family Systems
One of the most consistently referenced models used in psychedelic therapy is internal family systems (IFS). Developed by Richard Schwartz in the 1980s, IFS views the psyche as an amalgamation of interrelated personalities, or “parts” that often conflict with one another. IFS brings clients’ attention toward three main parts of the psyche: Exiles, Managers, and Firefighters. When these parts are in conflict, they prevent people from grounding in their core Self.
Exiles are related to psychological trauma, often from early childhood. They are the parts that have been cast away- buried beneath shame, fear, or pain that has not been expressed or accepted. In psychoanalytic terminology, they have been “repressed.” Managers keep the Exiles in control, relegating them to their shadowy domain so they do not disrupt overall function. Still, Exiles sometimes break through Managers’ control, at which point Firefighters take over, putting the system on high alert and inciting reactive behaviors to avoid encountering the Exiles. All of these parts create the “internal family,” and IFS helps clients center in the Self, which transcends all the parts, to create a loving inner container for intrapsychic balance and communication.
“The goal of IFS is to first acknowledge these protected and wounded parts within a person, and then to foster this reconnection with the higher Self,” explained Jason Sienknecht, who practices ketamine-assisted psychotherapy in Fort Collins, CO. “Ultimately, the Self is put into a position of a manager so the other parts can fall in line behind the Self’s guidance, instead of monopolizing a person’s consciousness. We want the Self to monopolize the person’s consciousness.”
Sienknecht is a MAPS-trained MDMA-assisted psychotherapist and a lead trainer for ketamine-assisted psychotherapy through the Psychedelic Research and Training Institute (PRATI). In his psychedelic therapy work, Sienknecht regularly uses IFS. “The reason I gravitate toward IFS is because ketamine aligns the client with their higher Self, or innerhealer, very naturally,” Sienknecht said. “The Self doesn’t need development- it’s the root of love and wisdom within each of us. Some people have lost sight of the Self through years of identifying with the protected or wounded parts of themselves.”
Sienknecht added that clients’ subpersonalities also naturally arise under the influence of ketamine, and IFS helps them make sense of the confusing content. As such, it is more a framework of integration than an intervention used in psychedelic sessions. “When you’re engaged in dialogue in a medicine session, you don’t want to give your client linear, logical reflections that their left brain can attach to,” Sienknecht said. “You want to encourage their non-linear state of consciousness to continue, rather than connecting them back to their thinking mind. I generally don’t bring my understanding of IFS into the dialogue of a medicine session.”
As a tool for psychedelic integration, IFS provides a powerful means to restructure one’s relationship to one’s inner reality for lasting healing to occur.
Gestalt Therapy
Gestalt therapy preceded internal family systems as a predominant modality focused on internal parts. Created and developed by Fritz and Laura Perls in the 1940s and 1950s, Gestalt therapy helps clients enhance their present moment awareness through acute sensitivity to internal responses to stimuli. “Gestalt is a way to identify inner polarities within a person, or inner parts, and encourage dialogue between those opposing parts or beliefs,” explained Sienknecht.
Those dialogues can take the form of the “empty chair technique,” in which clients converse with a part of themselves as if that part is sitting in the empty chair beside them. Clients are encouraged to feel and express the emotions that arise. Through the process, therapists help them expand their self-awareness and take more responsibility over their way of being in the world.
Sienknecht recently facilitated ketamine therapy for a man suffering from alcoholism. A part of this man wanted to stay in a comfort zone and keep emotional pain at bay, which he did through binge drinking, while another part wanted to free himself from that addiction. Sienknecht helped him become aware of the polarity between these opposing parts, and from that awareness, the client could move toward resolving the conflict.
Psychedelics can enhance clients’ awareness of the relationships and dichotomies between internal parts of themselves. Therapists have found that models based on accepting and balancing those parts can significantly enhance the healing potential from that newfound awareness.
Somatic Therapy
Somatic therapy refers to body-focused psychotherapy. Somatic therapy is a relatively recent development without much research on its efficacy, yet it has still recently come to be regarded as one of the most effective approaches for healing trauma. Its foundational premise is that trauma is stored in the nervous system, and listening to the body’s messages is the ideal inlet to healing trauma’s lasting effects.
The two most prevalent somatic methods are sensorimotor psychotherapy and somatic experiencing. Rafael Lancelotta, a psychedelic therapist and researcher practicing in Denver, CO, helped elucidate the differences. “Somatic experiencing is highly relational and has a ton of emphasis on resourcing,” he said. “Sensorimotor is more based on movement. It’s a little less relational; more let’s go into your body and see where these incomplete movements are. It’s more physical in nature.”
The somatic style used by Innate Path, a psychedelic therapy clinic where Lancelotta worked for two years, is called trauma dynamics. Trauma dynamics uses elements of both approaches but focuses more on challenging clients outside of their window of tolerance. Lancelotta explained that while challenging clients can be effective, sometimes it can be too challenging and push clients too far outside their comfort zone. “I’ve found it most helpful to use pieces of all of these to find something that can be more fluid from one person to the next,” he explained.
Since somatic therapy involves focusing on the body, it can be a helpful intervention in psychedelic sessions themselves. If therapists notice that clients appear stuck in their processing, they can invite the client to focus on their body and notice what arises. From there, new content can become conscious, allowing the client to move toward the point of stuckness and continue processing through it.
Cognitive-Behavioral Therapy
Many psychedelic therapists reject the efficacy of cognitive-behavioral therapy (CBT) and claim it does not lend itself well to psychedelic work. Nevertheless, one of Johns Hopkins University’s most significant psilocybin studies to date uses a framework of CBT- a study using psilocybin-assisted psychotherapy for smoking cessation.
Dr. Matthew Johnson is the study’s principal investigator. While he explained that the psilocybin sessions themselves (which typically involve the synthetic equivalent of a Terence McKenna “heroic dose”) proceed with a non-directive, supportive approach, the many weeks of preparation and integration are CBT-focused.
“In terms of the CBT, my thinking is that any number of empirically validated forms of therapy can be brought to bear here,” Johnson said. “If a tool tends to work for the disorder of focus, my bet is we can combine it with psychedelics and make it work. When you’re talking about smoking cessation, most of the programs and a lot of empirical support are based in CBT.”
CBT is among the most widely practiced therapies; used for depression, anxiety, PTSD, and addiction. Therapists help clients identify distorted thought patterns and then replace these cognitive distortions with new, healthier thought patterns, which correspond to better emotional regulation and healthier behavioral patterns. CBT has no interest in psychoanalysis and the unconscious mind. It is an action-oriented, solution-focused approach, and Johnson has found it particularly effective during the “afterglow” of a psychedelic experience.
“We have a lot to figure out [about] what that afterglow is, but there’s probably some neuroplasticity lingering- this window of increased agency,” Johnson said. “If we then establish a new normal with boring, bread-and-butter techniques like CBT, it’s probably going to help.”
In the study’s ongoing second iteration, 59% of participants who received psilocybin were confirmed as abstinent from smoking in the one-year follow-up, as compared with 27% who received a nicotine patch. Such powerful results suggest that even modalities unconcerned with psychological depth can enhance psychedelics’ healing properties.
Mindfulness-Based Approaches
Mindfulness involves directing one’s open attention to present moment awareness. While this may seem like a given in therapy, many therapeutic approaches encourage interpretation and recounting of past experiences, both of which can impede awareness of the present. Mindfulness-based approaches to therapy, such as mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction, foster present-moment awareness as a path to healing.
Sienknecht has found that mindfulness-based approaches align well with ketamine-assisted psychotherapy. “Ketamine quickly and effectively helps someone transition from the thinking self to the observing self,” he explained. “It just so happens that meditation does the exact same thing. Meditation mimics the activity of the higher Self, which some people refer to as the eternal witness. You’re not walking down the street, you’re aware of yourself walking down the street. It’s one step back from the ego. Mindfulness-based psychotherapy can help teach the skills needed to move more fully into this observing self.”
In order for people to move more fully into the witnessing Self, both inside and outside the psychedelic session, it is important they develop a daily mindfulness practice. “I find that people who practice daily throughout the course of a two-month ketamine treatment program are more able to move in the natural direction of the medicine as it moves you away from your thoughts and into an observing self,” Sienknecht explained.
A daily mindfulness practice does not have to be seated meditation. The practice can involve journaling, painting, exercising, or simply walking through the woods, as long as it is intentional time taken to practice awareness and receptivity to what arises within and without.
Learn more about our course on Psychedelics and The Shadow
The Hakomi Method
The Hakomi Method is a mindfulness-based somatic approach that is often discussed alongside psychedelic therapy. Developed by Ron Kurtz in the 1970s, Hakomi focuses clients on their present-moment experience and understands that the body is the harbinger of messages from one’s inner workings. Hakomi clients are encouraged to focus on mental content that arises alongside embodied sensations, such as images and memories.
Hakomi therapists use “probes” to gather information on a client’s internal process. These probes often aim at clients’ core beliefs that structure their relationships to their self and their world. For instance, a hakomi therapist might encourage a client to close their eyes, focus on their breath, and notice what arises as they say, “You are lovable exactly as you are.” It does not matter whether a client experiences elation and lightness, or bitter, self-defeating thoughts and constriction of the stomach- what matters is that the client notices what happens, because the response contains all the information needed to then work with the core content.
Psychedelic sessions can cast new light on core stories while also showing clients that other stories are possible. Skilled Hakomi therapists help clients restructure and heal those stories’ ongoing impact on their present moment experience.
Experiential Therapy
Another present-focused approach is experiential therapy. Sara Reed spoke to the approach’s efficacy in her work with ketamine-assisted psychotherapy at the Behavioral Wellness Clinic in Connecticut, as well as her work in MAPS’ Phase II trials for MDMA-assisted psychotherapy for PTSD. “What that therapy is about is really focusing on what’s happening in the here and now,” Reed explained. “Often clients come in flooded with a lot of different things, and experiential therapy can help clients slow down and be present with what’s happening in the here and now.”
Experiential therapy can take many forms; those forms are united in that therapists involve clients in real, present-focused processes to gain insight into their thoughts, feelings, and emotional responses. Examples include art therapy, animal-assisted therapy, adventure therapy, and psychodrama.
Michelle Hobart, a specialist in psychedelic integration, uses psychodrama with her clients. She described psychodrama as “an embodied enactment of certain scenes from life,” thereby allowing clients to engage creatively with their experience. “Creativity is a really important way of working with the material that arises,” Hobart explained. She often helps clients work with their psychedelic experiences as if they were dreams, focusing less on analytical processing than on “embodiment and active imagination.” This approach becomes especially important when psychedelic experiences cannot be rationalized or interpreted at all.
Transpersonal Psychology and Spiritual Emergence
While transpersonal (meaning “beyond the personal”) psychology is not a modality, it is a broad wave of western psychology that embraces the validity of non-ordinary states of consciousness and understands humans as inherently spiritual. Academic programs in transpersonal psychology, such as those offered at Naropa University and Sofia University, are among the most popular programs for students interested in working with psychedelics. Understanding the expansive frameworks through which it views people can help therapists support clients through their most challenging internal experiences.
An important topic within transpersonal psychology is “spiritual emergence.” Developed by Stan and Christina Grof, spiritual emergence refers to experiences in which individuals suddenly expand far beyond their established understandings of themselves into a broader perspective on the universe. When this process becomes too overwhelming, it can incite a “spiritual emergency,” which the western diagnostic model can misinterpret as psychosis.
“Spiritual emergency is when something comes up that’s so expansive that it’s not able to be metabolized or integrated,” explained Hobart, who specializes in spiritual emergence in her integration work with clients. “Sometimes that opening is very ecstatic and blissful, and sometimes it’s terrifying and devastating. If we don’t have a framework for how to work with and hold spiritual emergence and emergency, then when that process happens; whether it’s catalyzed by medicines or happens spontaneously as through kundalini awakening or near-death experience, people may think it’s a mental illness or psychosis. Then people get sent into hospitalization, thrown into the pathology paradigm and forcibly medicated, and it’s not understood as what is actually happening.”
In honoring clients’ overwhelming experiences, Hobart helps clients integrate those experiences and adjust into a society that does not understand or appreciate their profound transpersonal expansion. “I hold it in terms of awakening to spiritual gifts,” she explained.
Hobart also suggested that the potential for spiritual emergency in a psychedelic session heightens the need for therapists to be highly skilled and trauma-informed. “Some people who have been activated into these states have not been held properly in medicine spaces,” she said. “To be able to hold spiritual emergence and emergency, and for that matter, entheogenic work, people need to have attunement and the capacity to hold emotional and energetic space. And they need to be trauma-informed. That’s a huge piece.”
Conclusion
If anyone told you that being a psychedelic therapist is easy, that person lied to you. While specific regulations and training requirements are sometimes hazy and differ between medicines, psychedelic therapy calls for both responsibility and a diverse skill set for therapists to bring out optimal healing potential for their clients.
These therapeutic approaches and frameworks do not comprise a complete picture of the approaches currently being practiced in psychedelic therapy. As Johnson suggested, it is possible, if not likely, that psychedelics can enhance any therapeutic specialty. Regardless, a robust therapeutic tool kit will help any psychedelic therapist meet clients’ specific needs. There is always more to learn, and psychedelic work has never been about staying within an established pattern or comfort zone.
About the Author
Sean Lawlor is a writer, certified personal trainer, and Masters student in transpersonal counseling at Naropa University, in pursuit of a career in psychedelic journalism, research, and therapy. His interest in consciousness and non-ordinary states owes a great debt to Aldous Huxley, Ken Kesey, and Hunter S. Thompson, and his passion for film, literature, and dreaming draws endless inspiration from Carl Jung, David Lynch, and J.K. Rowling. For more information or to get in touch, head to seanplawlor.com, or connect on Instagram @seanplawlor.
In this episode, Joe and Kyle interview Sara Reed, MS, LMFT, CEO and cofounder of Mind’s iHealth Solutions, and Director of Psychedelic Services at the Behavioral Wellness Clinic in Connecticut.
Reed talks about her path to psychedelics- from graduating with a masters in emerging family therapy and wanting to do research specifically with black Americans, to working with Dr. Monica Williams and eventually MAPS, to being selected as one of the therapists for a phase 3 MDMA-assisted psychotherapy trial (which focused on people of color), to making the transition from practicing with MDMA to ketamine based mostly on one woman with racial trauma and her amazing transformation through ketamine-assisted therapy.
They talk about her process and practice, from the screening process to building relationships and rapport, trying to determine if ketamine is the right path, what dosing she prefers, and setting expectations; to the post-session check-ins and integration, how she practices everything through a cultural lens and personalizes treatment based on her level of connection, how important it is to know when to intervene and when to be a silent partner, stories of purging and the meaning behind it, the significance of dreams clients have around sessions, and her concerns surrounding emerging online ketamine therapy.
Sara Reed will be giving a presentation on chacruna.net on September 3rd concerning culturally responsible care with ketamine therapy.
Notable Quotes
“Just as much as we want to emphasize how transformative ketamine can be used as an adjunct to psychotherapy, I think it’s equally as important to emphasize the integration. Because you can have these insights all day long in psychedelic-assisted sessions, but it’s really integrating those experiences and those insights into real practice where I see a lot of the therapeutic work coming in, and the importance of the therapeutic work is to really integrate those insights into practice.”
“Isn’t that so interesting how, even as therapists, we’re still, in these moments, trying to control the outcome of what happens? I think these moments definitely remind me that I’ve got the skills, and I’ve got the training, and that I also must surrender to the process and check myself about my own process as a therapist.”
“This idea that we have around the healing process- that healing has to be this painful, ‘no pain, no gain’ kind of healing that you have to go through (which, I think in some aspects- absolutely, healing can be painful. It can be challenging). But, joy can also be an important process of healing. And experiencing love can be an important process of healing, or experiencing relief.”
“I’m not trying to be the spokesperson for people of color- for black people, around what diversity, equity and inclusion looks like in this work. And I’m even trying to be mindful about how many talks I do accept, and I’m always trying to refer other folks who have equally valuable perspectives and input around this work within this field to elevate other voices too, because I also think it’s important to value other perspectives. We can’t just be the only folks talking about it, because we’ve got our blind spots too.”
Sara received her undergraduate degree in Bioethics and Philosophy from the University of Louisville in Kentucky, and her M.S. in Marriage and Family Therapy from Valdosta State University in Georgia. Prior to her move to Connecticut, she worked as a licensed marriage and family therapist associate at the Behavioral Wellness Clinic in Louisville. Sara Reed is a Marriage and Family Therapist at Behavioral Wellness Clinic in Tolland, CT. She is also a Study Therapist on the Psilocybin-Assisted Therapy research study for Major Depression at Yale University. As a socially-minded therapist, Sara works to advance health equity and upward social mobility for Black Americans.
Is Salvia divinorum more than just a crazy trip? And what would salvia therapy or spirituality even look like?
Like many teens in the mid-2000s, I took a bong rip of Salvia divinorum extract in a group of laughing friends, and didn’t feel the need to touch the plant again. The 5 to 10-minute trip completely took me out of my mind, body, and surroundings in what I’d still, to this day, categorize as one of the most intense psychedelic experiences of my life. In the dreamlike state, I was walking on clouds and then found myself stuck in a cave where I had to move boulders aside to escape. As the cave slowly faded away and I drifted back to reality, I found that I was on my hands and knees in the corner of my best friend’s room, moving scissors and other art supplies around. I looked back to see my wide-eyed friends still sitting on the bed, bong in hand, staring at me, simultaneously giggling and relieved to see that I had returned.
When Psychedelics Today co-founder, Joe Moore, asked me to look into salvia for my next article nearly 15 years later, I laughed out loud, recalling that cave and the thrashing, ripping-apart-of-the-body feeling that salvia can give in high doses, and said something along the lines of “that shit is crazy.” But through researching this piece and talking to experts, I’ve learned there’s so much more to Salvia divinorum than smoking that weird black extract that was easier to get than booze or weed when I was 17- that there are people both in indigenous communities in Mexico and psychedelic societies in San Francisco who are developing deep and healing relationships with this purple flowering plant that contains the strongest naturally occurring psychedelic on our planet.
Indigenous Salvia Ceremony and Practices
The oldest standing Salvia divinorum tradition is held by the same indigenous community that still practices magic mushroom ceremonies, the Mazatec of Oaxaca, Mexico. “For us Mazatecs, salvia is very sacred,” says Inti Garcia Flores, Mazatec professor and archivist. Over WhatsApp, he explains to me the Mazatec legend of the origin of Salvia divinorum, or “La Pastora” (Spanish for “the shepherdess”) as he refers to it during our conversation. Essentially, salvia was one of the first three plants in existence. Tobacco was the first plant, who is a male spirit and the father. Then came salvia, who is a female spirit and the mother. Lastly, the mushrooms were born, who are the children.
Oaxaca highlighted in map of Mexico
To prepare for such a powerful encounter, part of the Mazatec tradition is a 40-day cleansing period before the actual ceremony. When it’s time for the ceremonial encounter with La Pastora, prayers are said while leaves are picked from salvia plants that grow around the Sierra Mazateca mountain range. Notably, it’s the only region in the world where this psychedelic strain of sage grows, and it has likely been propagated by indigenous people of the land for hundreds of years and possibly longer.
Salvia Divinorum
Salvia is consumed in ceremonies which are held at night, in the home of a curandero (Spanish for “healer”), and in front of an altar that typically faces the west. Then, the leaves are either chewed and swallowed in pairs, or drunk in a kind of salvia mash tea, but the plant is never smoked. Mushrooms are also consumed in pairs in Mazatec ceremonies to represent the duality of life: the masculine and feminine energies- a necessary balance, which, as I understand it, is a core concept in their spirituality. Garcia tells me that approximately 40 leaves are eaten for a Pastora ritual, sometimes more. It really depends on the curandero and the purpose of the ceremony. “Every curandero has their own style,” explains Garcia.
And to my surprise, ceremonies last about four to five hours, approximately the same amount of time as the effects of mushrooms. Then, the ritual is to be followed by another 40-day cleansing period. As far as the purpose of these ceremonies, healing and divination are two of the main reasons for seeking out La Pastora, and it’s especially common to use salvia when mushrooms aren’t in season (mushrooms only grow in the rainy season in Mexico, which is generally May through September. Garcia tells me that salvia, on the other hand, grows year-round).
Personal Salvia Divinorum Rituals
Learning about the sacred power of La Pastora got me thinking about the bad rap salvia has gotten in the west as a crazy and unpleasant, short-acting psychedelic. By smoking it, especially in extracted form, are we disrespecting the delicate plant spirit, and therefore missing its healing potential? But not everyone outside of the Mazatec community are teens like my friends and I were, tricking each other into smoking salvia. In fact, there are some folks using Salvia divinorum in a ritualized manner for healing trauma and other psycho-spiritual matters, like spiritual emergence coach and marriage and family counselor, Michelle Anne Hobart.
For Hobart, who’s also the author of Holding Sacred Space, salvia came to her in a time of need. She was recovering from trauma when she was guided to salvia, and the plant had a message for her: “Let go of all other practices for a year and work with me alone.” So that’s exactly what Hobart did. She formed a relationship with salvia in its tincture form. “She was very specific with me that I was only to take it in sublingual tincture form and not smoke it,” Hobart tells me over the phone, referring to salvia with feminine pronouns, just as Garcia had done.
In fact, Hobart’s salvia ritual had some similarities to the Mazatec tradition. She practices a pre-ceremony cleansing period where she only eats vegan and refrains from smoking or drinking (a practice that has now become a lifestyle). She also consumes La Pastora in front of her own altar with much prayer and meditation involved. For Hobart, this protocol has helped her reconnect with herself and her body, and she feels the short psychedelic experience (taken sublingually, she reports the experience lasts about 90 minutes to 2 hours) is very manageable and “integratable” for her as a highly sensitive person who is recovering from trauma.
Hobart spent much of her monogamous year with salvia working in low dose ranges that gave her a more spacious quality to her meditative practice. She explains that for those with trauma, even meditating or connecting with the body can seem like “a daunting, almost impossible task.” But by working with different levels of salvia and titrating her dose to cautiously work her way up to a higher dose range, it became more manageable. “If there was anything I learned in my experience of healing trauma with salvia, it’s that I don’t have to go to the top plateau to do the work. There’s work at every level and you can be gentle and compassionate with yourself and your nervous system. And honestly, you can integrate better when you titrate.”
That was especially interesting to me as someone who went straight to a smoked high-dose salvia experience. Are there really other levels to this medicine that are less intense? Hobart definitely thinks so, and when I ask her about the uncomfortable feeling in the body at higher doses, she reports that with her tincture protocol, she doesn’t find that to be the case. She explains that she views a salvia trip as having 3 phases: the clearing phase, the resourcing phase, and then the re-embodiment phase. At higher doses in the clearing phase, she can have visions, which she interprets as a cleansing that’s connected to the trauma she holds in her body. Then, in the resourcing phase, she can experience a type of ego-loss where she becomes one with the earth, which helps her release the trauma that can come up during the clearing phase. “It helps me realize I’m more than this body,” she explains.
Then in the re-embodiment phase, she returns to herself, “clean and free of that trauma.” Hobart specifies that she’s not completely free of trauma though. “There’s always more work to do. But in that moment, for that piece of work that needed to be done, I can re-inhabit my body in a safer way than I ever have before.” In that year of regular practice, Hobart was able to clear a lot of trauma, which, in turn, helped her anxiety decline. “I was able to return to my own sovereignty and empowerment through the understanding that this story is mine to tell,” she says.
Cloud forest of Southwestern Oaxaca
Somatic Salvia Therapy and Effects
Christopher Solomon, who is a somatic salvia guide, went down a similar path with the plant that started over 10 years ago. He had smoked salvia a handful of times as a teen in the early 2000s and found the experience pretty bizarre and unwieldy. “It just didn’t really make much sense,” he tells me over Skype. But one day, as he was loading his bong with salvia, he received a “download” from the plant. “Out of nowhere, there was a feeling inside of me that just said: ‘Wait. Meditate first.’” Even though he didn’t have much of a meditation practice at the time, he took 10 deep breaths before inhaling the salvia, “and it was just completely different… it was a lot smoother and more gentle on my system,” Solomon explains. “It was more grounded. Instead of me being taken elsewhere or torn apart, it was more like this other reality unfolded gracefully in front of me.”
Now, over ten years later, he’s also developed a very intimate relationship with the plant and its many levels of psychedelic experience, and he’s even started to guide others through salvia journeys. Like Hobart, Solomon also sees a lot of benefits in working in lower dose ranges. In fact, he’s theorized the salvia experience has about 10 levels, and a lot of the most therapeutic work is done in levels 1 through 7. Solomon explains that levels 1 through 3 are almost sub-perceptual.
“It’s very akin to being taken [to] a very, very deep, still place in meditation. One’s breath becomes deeper and there’s a feeling of grounding down and opening up. It’s not opening up to [the] world around one, it’s more as if one’s body is opening up to itself, like an internal opening. There’s a sense of slight physical tingles that come on the body and then the chattering mind gets a little bit less chattery. It can be summed up as being taken to a place of quiet, deep stillness.” He adds that finding this place in regular meditation practice can be very difficult for a lot of folks, echoing a sentiment Hobart expressed about how daunting it can be for those with trauma to try to reconnect with their bodies. But according to Solomon, in levels 1 through 3 of salvia, focusing on one’s breath feels pleasurable and comfortable, even euphoric. “It really increases your ability to remain attentive to whatever you put your concentration on. With the quieting of the mind comes a greater ability to concentrate on one’s own embodied self and be very present.”
This is a key concept in somatic therapy, in which Solomon is certified. “One of the main premises of any sort of somatic work is coming back to what is in the present,” he explains. “And instead of getting caught up in stories, expectations or memories, it’s about coming to the present moment- to the now, and seeing what’s right in front of one and seeing what we think.” When it comes to the salvia experience, the sense of presence that the plant insists on can be very healing. For Solomon, the lesson has been very clear- that learning to be present in the current moment is key to living a healthier, happier life. Salvia taught him: “Don’t worry about the future. Don’t worry about the past. Just be here now, and engaged, and aware, and playful. And then everything else kind of works itself out.”
These messages from salvia often come in the next dose range, in levels 3 through 7, where the feeling in the body becomes more intense (sometimes called “salvia gravity”), and visions, entities, and being taken to a new reality are more common. However, Solomon notes, the best preparation for these higher dose experiences is working in levels 1 through 3 first and getting comfortable there. But many of us don’t know about this preparation or don’t bother, and are shot straight to levels 9 or 10 on our first trip of smoking a bowl of 20x or 50x extract, and in turn, are completely turned off by the intensity of the salvia gravity sensation.
Photo of salvia packaged for retail sale
But when you prime your body first by titrating your dose and starting in lower, sub-perceptual dose ranges, “the pushing feelings do happen in your body, but it doesn’t feel as aggressive or foreign. It feels a lot more controllable instead,” says Solomon. And this is where things get really interesting and hard to explain. But through his deep practice with the plant, he’s learned that you can control those pushing and pulling feelings, or “energies,” and direct them towards parts of your body that need healing. Solomon’s most profound example of this is also the experience that led him to pursue sharing salvia with others as a somatic guide. Essentially, a few years ago, he had a swollen lymph node in his neck for months that he tried everything to cure, including three courses of antibiotics and diet and lifestyle changes. “But no matter what I did for months, there was this big swollen lymph node in my neck. It just didn’t go away.” At the time, he consulted with a couple of doctors who both said he needed to have his tonsils removed.
Before having the surgery, he decided to turn to salvia for the first time in nearly 2 years. “I smoked a bowl of 20x extract,” he says, “and usually when I do, I feel this pulling and pushing sensation on my body coming from outside, or it feels like I’m being moved through time and space.” But this time was different. “I felt all this energy tingling, kind of like little ants rushing up from every extremity of my body. And it all went straight to where the swollen lymph node was. This energy was congregating around the swollen lymph node and a thought came to me: ‘Oh, well, let me just heal myself.’” He says his hand “automatically picked itself up,” and he began pressing on his swollen neck like he had done many times before. But this time, as he rubbed his lymph node in a circle, “I felt it split in half,” he recalls. As he kept rubbing, it kept splitting. “It got smaller and smaller and smaller. It felt like tiny little grains of sand. And then those split even more, and it kept dividing until I couldn’t physically feel it anymore. Then all that energy that initially rushed to that part of my neck rushed over the rest of my body.” He reports that he laid there for about ten minutes until coming to, and his swollen lymph node was totally gone, and has remained absent ever since.
A Profound Salvia Divinorum Healing Ceremony
Kathleen Harrison, famous ethnobotanist, writer, psychedelic elder, and co-founder of the Botanical Dimensions library in Northern California, told a similar story in a talk at the Entheogenesis Australis conference in 2018. She sought out a Mazatec curandero who specializes in salvia healings and had a traditional ceremony in the highlands of Oaxaca. At the time, she was experiencing a lot of heart trouble and doctors told her that the only way forward was lifelong medication to manage her condition. But in a ceremony with salvia, she felt a female presence wave a hand right through her body and physically take her pain away. “A little door opened in my heart. It blew open like a sudden breeze had come, and I just saw this hurt fly out and dissolve. And my heart was better. I never had another problem with it,” Harrison describes in her talk. When she got back to her California home, medication was no longer necessary.
These healings are hard to explain in terms of what’s happening in the brain, even though there are psychedelic researchers looking into Salvia divinorum at Johns Hopkins and other universities. Formal research began in 1994, when ethnobotanist and researcher Daniel Siebert first isolated the psychedelic compound in Salvia Divinorum – Salvinorin A – and published his findings. Since then, Siebert has become salvia’s champion: he founded the salvia information vault, Sagewisdom.com, which includes a salvia safe-use guide, and he ended up piquing the interest of psychedelic researchers and run-of-the-mill psychonauts alike.
Is Salvia Legal?
Today, salvia is still legal in about 20 states, which makes it easier than psilocybin or MDMA for researchers to study. In 2010, Johns Hopkins University conducted the first controlled human study of salvinorin A, and their team is still looking into how salvia works. That’s partly because salvia is unique in the way it affects the brain, and so offers researchers a novel opportunity to study other psychedelic (and potentially therapeutic) mechanisms of action. Essentially, most classic psychedelics, like psilocybin, LSD, and DMT, mostly bind to the serotonin 2a receptors, and that action is thought to be responsible for most of their psychedelic effects. Salvia, on the other hand, has no affinity for the legendary 2a sites, and instead focuses the majority of its attention on the kappa opioid receptors.
Salvia laws in the United States (may not be fully up to date) – Source Red – Jurisdiction where salvia is illegal. Orange- Jurisdiction where salvia is decriminalized. Yellow – Jurisdiction where salvia is legal with age restrictions. Blue – Jurisdiction where salvia extracts are illegal but the plant itself is legal Green – Jurisdiction where salvia is legal.
But, How Does a Salvia Trip Work Exactly?
Yet, oddly enough, according to Manoj Doss, a postdoctoral scientist at the Hopkins Psychedelic Research Center (who is the lead on analyzing the latest salvia brain scan data), even though the receptor action site is different, the overall effects on the human brain are very similar to classic psychedelics. “We essentially found the same pattern [that Robin Carhart-Harris found with LSD],” Doss explains. “We got decreases in functional connectivity within network connectivity, so these networks are communicating less within themselves… [and] decreases in Default Mode Network connectivity, [which was the strongest effect]. And, we have increases in connectivity between areas that don’t usually communicate with each other as much.” However, although the effects were “quite similar” to other psychedelics, Doss believes more research is needed. “There are a few more caveats that are going to require a study with a larger sample size,” he says.
To folks like Solomon, while research is exciting, it’s not necessary towards understanding how salvia works for healing. “It’s very somatic medicine,” Solomon says. And it’s inspired him to complete a certification at the Hakomi Institute and provide guided somatic salvia sessions to clients. And unlike other traditions, Solomon’s clients smoke salvia, but not all in one go. In fact, Solomon has invented (thanks to a message from the salvia plant herself) an entirely new smoking apparatus for consuming salvia, aptly named “the salvia pipe.” The contraption has five separate bowls into which he sprinkles just a couple of flakes of salvia for clients. The idea is to titrate the dose to make the experience more similar to a chewed fresh leaf ceremony, which he admits is his preferred method of consumption, but isn’t very accessible unless you grow your own salvia. And so, his clients only smoke a very small amount at a time, then they meditate together for five minutes between each bowl to gradually work up to a level 3, 4, or 5 experience that they can manage and are comfortable in.
Solomon even does guided salvia sessions online, which have become increasingly popular since the pandemic, and the first thing he does is send clients a salvia pipe packed with the correct dose (if the client lives in a state where salvia is legal). He says folks come to him for a whole host of reasons: sometimes just out of curiosity, and others to work on self-esteem, physical ailments, or trauma. “I like to think of salvia as ‘the great neutralizer.’ If you’re feeling up, salvia will help bring you back down to a baseline calmness, or ‘groundedness.’ But if you’re down in the dumps, salvia can bring you up… and that is essentially how it incorporates so well into somatic therapy—because a lot of trauma therapy is getting the person to a sense of feeling grounded and stable, as if they have their own resources… it’s like a hard reset—a reboot to the present.”
Regardless of how Salvia divinorum works, it seems it has a lot of therapeutic potential that’s not getting a lot of attention, especially considering that it’s legal in 20 states. But I believe that’s because most of us go on one incredibly intense and off-putting first date with salvia at a young age and are completely unprepared for the experience. Yet it seems by building a relationship with the plant by preparing one’s set and setting, titrating dose, and being mindful of its sacred power, it can have lasting benefits for those who bother to take the time.
About the Author
Michelle Janikian is a journalist focused on drug policy, trends, and education. She’s the author of Your Psilocybin Mushroom Companion, and her work has also been featured in Playboy, DoubleBlind Mag, High Times, Rolling Stone and Teen Vogue. One of her core beliefs is that ending the prohibition of drugs can greatly benefit society, as long as we have harm reduction education to accompany it. Find out more on her website: www.michellejanikian.com or on Instagram @michelle.janikian.
Now that millions of dollars are being invested in psychedelics and platforms ranging from Fox News to Bloomberg are reporting positively on them, it’s safe to say that psychedelic therapy has entered the mainstream. But mainstream news tends to highlight catchy elements while glossing over other details, often resulting in an unbalanced portrait of the whole. For psychedelic therapy, you’re way more likely to hear about the “psychedelic” than the “therapy.”
No surprise there. Reports on people healing complex PTSD by taking the “party drug ecstasy” while wearing eyeshades and listening to music in a cozy office are more gripping than reports on the months of talk therapy that follow (ecstacy is not always MDMA, it sometimes contains other dangerous compounds). So, perhaps this article on the therapy side will not be as gripping as an Anderson Cooper60 Minutes special, but I hope it will prove informative for anyone who desires to learn more about how psychedelic therapy is currently being practiced, and the complex elements beyond the administration of a substance that go into achieving the astounding improvements in depression, addiction, and PTSD that have now been so broadly reported.
The Importance of Staying Humble
I’ll kick this off by recognizing it is not possible to “capture” psychedelic therapy in any sentence or article or doctoral thesis. There are as many approaches and strategies as there are practitioners, and eliminating the potential for exploration and breakthrough through a prescriptive definition would be an insult to psychedelics themselves, which have exploded understandings of phenomena for centuries.
“There’s a lot of impression about what psychedelics are, how they should be treated, and what the optimal therapy is,” explains Dr. Matthew Johnson, Associate Director of the Center for Psychedelic & Consciousness Research at Johns Hopkins University. “We need to keep humble in terms of how much we don’t know, rather than fooling ourselves into thinking something is cemented in.”
While the future is ripe for exploration, there are several trends in approaching psychedelic therapy. So, this article is simply a glimpse into these trends, rather than a concrete definition of the whole.
Psychedelic-Assisted Psychotherapy
“Psychedelic therapy” is more accurately termed “psychedelic-assisted psychotherapy.” This distinction is critical, because the psychedelic is an adjunct to the therapeutic process, rather than a replacement for the process itself. So, when I refer to “psychedelic therapy,” I am simply abbreviating “psychedelic-assisted psychotherapy.” And there are far fewer psychedelics being used in therapy than there are psychedelics in general.
Psilocybin and MDMA are the two predominant substances currently being researched in psychedelic therapy, and each has been granted “Breakthrough Status” by the FDA in separate clinical trials, which basically means even the government recognizes how promising they are in therapy. Other substances used in psychedelic therapy are ketamine, a legal medicine throughout the U.S., and cannabis, which is still fully illegal in only eight states.
Interestingly enough, only one of these substances—psilocybin—is a classic psychedelic. The other three are all noted as having psychedelic properties, but ketamine is a dissociative anesthetic, MDMA is an entactogen, and no one can seem to agree on what cannabis is.
Other psychedelics, such as LSD, ibogaine, ayahuasca, and 5-MeO-DMT, are being researched, yet none appear close to becoming legal. However, research into LSD-assisted psychotherapy in the ‘50s and ‘60s, especially as spearheaded by Dr. Stanislav Grof, provided foundational elements for common frameworks implemented with other substances today. But LSD’s stigmatization remains heavy, and its unpredictable effects are particularly long-lasting, so it has not re-emerged to the forefront of psychedelic therapy. So, the “psychedelics” of psychedelic-assisted psychotherapy of interest in this article will be psilocybin, MDMA, ketamine, and cannabis.
A Framework of Preparation and Integration
Psychedelic therapy is not as simple as administering a substance and Voila! Depression defeated! The psychedelic sessions—interchangeably referred to as “medicine” or “dosing” sessions—take place in a broader framework of preparation and integration therapy, neither of which involves the administration of a substance.
The ratios of preparation/integration sessions to medicine sessions vary widely and depend on many factors, such as dose size and financial limitations. The most widely-documented framework currently being practiced comes from the Multidisciplinary Association for Psychedelic Studies (MAPS), the organization behind the FDA-approved trials for MDMA-assisted psychotherapy for the treatment of PTSD. MAPS’ MDMA therapy involves three 90-minute preparatory sessions, a first MDMA session, three integration sessions, a second MDMA session, three more integration sessions, a third MDMA session, and three final integration sessions. In total, that’s three medicine sessions, and twelve preparation/integration sessions, a cycle that lasts about five months.
That’s five times as many non-medicine sessions as medicine sessions. MAPS’ significant results—i.e. one year after their Phase 2 trials, 68% of participants no longer qualified for PTSD—cannot be separated from this full process. Sara Reed, who worked on MAPS’ Phase 2 trials and is now the Director of Psychedelic Services at the Behavioral Wellness Clinic in Connecticut explains, “The integration sessions are just as important as the dosing sessions, if not even more important.”
Johns Hopkins University’s research in psilocybin therapy also involves far more preparation and integration therapy than psychedelic sessions. Among the many focuses of their Center for Psychedelic & Consciousness Research, Johns Hopkins is researching psilocybin therapy for smoking cessation.
Johnson is the study’s Principal Investigator. Results from the study’s pilot phase, published in 2014, found that after 6 months, 80% of participants had remained abstinent from smoking, compared to the 30-35% success rate of predominant treatment models. In the study’s second iteration, which is ongoing at the time of this writing, Dr. Johnson reports that at the one-year follow-up, 59% of the psilocybin group were biologically confirmed as abstinent, compared to 27% of the group who used a nicotine patch.
While the pilot study involved three medicine sessions, the current study involves only one. Everything else is preparation and integration. “Right now, they have integration sessions for ten weeks after the psilocybin session,” Johnson explains. “These are hour-long, weekly check-ins. With preparation, we have about eight hours across four different sessions.”
Given that ketamine therapy is being widely practiced, and numerous other psychedelic therapy trials are underway, it would take many articles to detail all the protocols being used. The trend to note is that sober preparation and integration sessions are essential to psychedelic therapy, and even tend to involve far more time than the medicine sessions.
A Relational Approach to Therapy
I’m tempted to write a section on what preparation and integration therapy looks like, but this would be impossible. These terms are vague; there is no set way to do them, no script to follow. Yet amidst common components such as intention setting, dose determination, and discussions of the particular psychedelic’s effects, the glue that connects these sessions across countless frameworks is the essentiality of establishing a strong and trusting therapeutic relationship.
“More important than the therapist’s psychological orientation is the rapport with the participant,” Johnson explains. “If you actually care for this human being you’re dealing with, and you’re making a sincere effort, and they get that—that overrides whatever descriptors you use.”
A client-centered, relationship-based approach to therapy arose in the mid-20th century in response to the dominant paradigms of psychoanalysis and behaviorism. Back then, therapists were viewed as the “expert” in the room, interpreting and diagnosing clients while remaining emotionally detached. Carl Rogers then theorized that interpretation and theoretical expertise were not essential, or even necessarily helpful; the central element to a client’s healing was the quality of the therapeutic relationship, cultivated in a climate of genuineness, accurate empathy, and unconditional positive regard. This client-centered approach laid the foundation for humanistic psychology.
Whether or not one aligns entirely with Rogers’ framework and disposition, it is widely accepted in psychedelic therapy that the therapeutic relationship is paramount.
“When you’re getting into psychedelic work, there can be a subconscious pull toward skipping aspects of relationship building,” explains Rafael Lancelotta, who practices cannabis and ketamine therapy at Innate Path in Denver, CO. “That can really negatively affect the process. If you’re going to vulnerable places with someone you don’t trust, your system’s defenses are going to come up and prevent you from moving through a healing process.”
Therapy is already vulnerable; that vulnerability amplifies exponentially when a substance is involved. Imbibing a psychedelic, a client sacrifices control, accepting the heightened uncertainty of where the session may lead. If they do not trust the therapist, the lack of trust will likely manifest in the medicine session and impede the work.
An important element to a relational approach is respecting and understanding the identities clients hold. Sara Reedis part of several committees devoted to increasing access to psychedelic medicines for underserved populations, and she brings specific attention to the complexities of clients’ social identities.
“I approach ketamine therapy through an intersectional lens,” Reed explains. “I take into account a person’s age, race, sexual orientation, gender, geography, socioeconomic status, education, and what they’ve been exposed to in the world. I’m sensitive to the way they language their experience and the way they experience the world. From that lens, we create treatment plans specific to their symptom presentation and symptom severity to give them a tailored psychedelic psychotherapy experience.”
Reed does not position herself as the expert; she positions herself humbly in relation to the client’s experience, listening to their unique background and needs in order to develop a course of action. This humility, and the trust-building that comes through it, is the essence of a relational approach.
Given that psychedelics often attract people with spiritual and esoteric worldviews, therapists must be prepared and willing to enter and understand a client’s way of seeing. Michelle Anne Hobart specializes in preparation and integration therapy—which, by the way, is a legal therapeutic modality, so long as illegal medicines are not administered. Hobart is a specialist in “spiritual emergence,” which she describes as “a space of people expanding beyond the separate sense of self into a larger understanding of interconnection between other beings and the planet.” This inner awakening can occur through psychedelic experiences and potentially be destabilizing, and Hobart’s specialty allows her to meet her clients in their expansive worldviews.
“It can be helpful to check the astrology transits in preparation for journeys,” Hobart explains, referencing the Archetypal Astrology work of Stan Grof and Richard Tarnas. “It’s making correlations between the type of medicine experience that someone might be having with the overlay of archetypal dynamics at that time. It can be really empowering to know that certain tones might show up in the medicine journey.”
If an astrologically-minded seeker comes to a material scientist whose preparation cannot extend beyond images of entropic brain states and explanations of oxytocin, the amygdala, and the hippocampus, it probably will not be a good fit. A relational approach hinges on meeting clients where they are, and many psychonauts do not view the world through a strictly scientific lens.
Therapists cannot simply assume trust due to the position they hold. They have to earn it, and that process takes time and patience. If that process is not honored, numerous problems can result, including the potential for re-traumatization in the medicine session due to an unsafe container—an issue that Hobart rightly describes as a “shadow” of psychedelic therapy. Like therapy itself, preparation and integration are most effective when relational, adaptable, and responsive to clients’ individual needs. With a trusting relationship established, an “inner-directed” process can unfold.
Learn more about our course on Psychedelics and The Shadow
Inner-Directed Therapy
Psychedelic therapists often maintain that the medicine helps incite an “inner-directed” healing process, where a client’s “innate healing intelligence” or “inner healer” can emerge from its walled-off container and catalyze the necessary internal movement.
“As a therapist, your therapeutic stance is to trust the process and not get ahead of the medicine, to follow the participant in their journey,” Reed explains. “In essence, you’re just really present with the medicine, the material, the client, and yourself, navigating that liminal space where transformation can happen.”
Again, the client is the expert, and the therapist skillfully cultivates space for a process to organically unfold. Stan Grof created the term “holotropic” for this process, which translates to “moving toward wholeness.” The therapeutic approaches then used in integration can come out of the client’s authentic holotropic experience, allowing for the integration to meet emergent needs rather than place an established framework onto a process.
Psychedelic therapists create trusting, comfortable conditions that allow the client’s inner healer to guide the medicine sessions, and all ensuing sessions by extension. What that clients’ inner healer brings forth depends on other measurable factors as well, such as the size of dose administered.
Psychedelic vs. Psycholytic Therapy
When folks are talking about psychedelic therapy, they are sometimes in fact talking about psycholytic therapy. “Psychedelic” therapy involves high-dose medicine sessions, in which the client may lose contact with the therapist, if not the physical world. “Psycholytic” therapy involves low-dose medicine sessions, in which perceptual doors are opened, but not obliterated completely.
Jason Sienknecht trains ketamine therapists through the Psychedelic Research and Training Institute (PRATI), an organization he helped found. In his therapeutic practice at the Wholeness Center in Fort Collins, CO, he facilitates both psychedelic and psycholytic ketamine therapy.
“In the psychedelic session, we use high-dose ketamine to induce a fully-dissociated psychedelic state,” Sienknecht explains. “They go in very deeply, and the ketamine and music helps them move toward insights about their life and give them clarity and perspective about their struggles.”
This high-dose, non-dialogue approach is used by Johns Hopkins with psilocybin in the smoking cessation study. “We use a high dose of 30 milligrams per 70 kilograms of body weight,” Johnson says. “That generally equates to about 5 dried grams of psilocybe cubensis. So, it’s the classic Terence McKenna ‘heroic dose.’”
In psychedelic sessions, dialogue with the therapist is kept to a minimum—sometimes by necessity, when clients temporarily lose the ability to speak. In psycholytic sessions, on the other hand, clients enter a “low-dose trance state” and stay engaged with the therapist.
“With psycholytic therapy, you don’t dissociate so much that you lose your capacity to sustain dialogue with a therapist,” Sienknecht explains. “You stay in contact the entire time. Some clients I work with really like that, as opposed to me saying, ‘Goodbye, I’ll see you on the other side,’ as we do with psychedelic sessions.”
Each approach has its uses. Some clinicians believe psychedelic sessions are necessary for clients to transgress their self-imposed limitations and open to a more expansive kind of healing. Psychedelic sessions can also be helpful for crisis situations. For example, some clinicians use high doses of ketamine for suicidal clients, as an ego-dissolving experience may be necessary to help the client “break out” of their all-consuming mentality.
Psycholytic sessions allow for conscious processing of emerging material through direct, intentional work with what arises. Further, these low-dose sessions allow clients to work directly with relational wounds by remaining in contact with the therapist through the non-ordinary state. Again, the significance of this relational element cannot be understated, especially as relationship-building extends beyond the need for trust in the session.
“I find it difficult to think of any form of mental illness that isn’t highly relational,” explains Lancelotta. “I think this work is for healing those core relational wounds.”
In this understanding, the relationship with the therapist is the relationship through which deep relational wounds can be healed. These “core relational wounds” affect people far more than they often realize, playing into numerous mental conditions and existential struggles that cannot be healed in isolation.
Whether a client’s healing will come best through psychedelic or psycholytic therapy—or a hybridization of the two, as Lancelotta envisions—depends on numerous factors, to which therapists must remain sensitive and attuned. A “more-medicine-is-better” mentality can be highly problematic and potentially destabilizing for an already unstable client. Regardless, medicine sessions cannot exist in a vacuum. Without preparation and integration to support the psychedelic experience, psychedelic therapy is no different than peer support, and while this can still be hugely impactful, it will undoubtedly diminish the potential for lasting transformation.
Bringing It Home
Psychedelic-assisted psychotherapy is an umbrella term that is far more complex than someone taking a drug in a calm and comfortable room. It is an extensive framework involving a significant amount of “regular” therapy that adapts to clients’ unique struggles and needs. As much as mainstream news may want to convince you otherwise, psychedelics are not the “magic pill” panacea that will quickly and easily make all your problems go away. Yet psychedelic experiences can bring profound insight and meaning, and a growing body of psychedelic therapists use tried and tested methods to enhance these substances’ transformative potential, so that a revelatory trip can truly change a person’s life.
About the Author
Sean Lawlor is a writer, certified personal trainer, and Masters student in Transpersonal Counseling at Naropa University, in pursuit of a career in psychedelic journalism, research, and therapy. His interest in consciousness and non-ordinary states owes great debt to Aldous Huxley, Ken Kesey, and Hunter S. Thompson, and his passion for film, literature, and dreaming draws endless inspiration from Carl Jung, David Lynch, and J.K. Rowling. For more information or to get in touch, head to seanplawlor.com, or connect on Instagram @seanplawlor.
In this episode, Joe interviews Court Wing: early adopter of kettlebell training, earner of a 3rd degree black belt in Ki-Aikido, first certified CrossFit instructor for the NYC Metro area, first certified Z-Health instructor in New York, and former co-founder of CrossFit NYC; one of the world’s largest CrossFit gyms.
Wing was a recent participant of a psilocybin trial in NYC, studying the effects of psilocybin on (mostly treatment-resistant) major depressive disorder. He talks about his struggles with depression and how reading studies about changes in neuroplasticity and neurogenesis made him wonder if his depression could be alleviated, the measures taken and process surrounding the trials, the concerns over receiving a placebo or the psilocybin not working, and post-trial; the amazing transformation he’s gone through and the power of his experience, psilocybin, and intention-setting.
They talk a lot about pain and the ways pain is related to the mind: the concept that depression may be a nociceptive pain, how common back pain may often be somatosensory pain based on emotional trauma creating a neurological link (similar to Grof’s COEX system), and the Ki-Aikido phrase: “Your mind is the body made subtle. The body is unrefined mind.” How much of pain is emotional, and how much is the body trying to communicate to the mind that a change needs to be made?
Notable Quotes
“I can see, going in now, the difference that intention makes in what you’re seeking from the session. It’s just astonishing that it’s responsive to intent. …It’s so mindblowing because you’re not just taking this passively.”
“The contrast from before to after made me want to go back and upgrade my scores in those depression assessments because I had no idea how bad it was until it was gone. And it was in less than 8 hours. …We did a little intention-setting ceremony, and I did a little Shinto type of prayer thing- [an] incantation that I’ve always done since I left Aikido, and they gave it to me and put in this chalice, and I looked down at it, and honestly, I was praying to God or my higher power or the universe (however you want to phrase it). I looked at it and said, ‘I really hope that’s you.’ And it was.”
“I had been in recovery from a profound drinking problem for over 17 years, so there’d been significant hesitation on my part to do this, because there’s a lot of cautioning within that framework- you know: ‘there’s no such thing as a chemical solution to a spiritual problem.’ But, what do you do when the chemistry brings you a spiritual experience?”
“A false picture has been painted of what’s possible here. And when it’s only seen in a recreational context where they use some slightly marginalized, perverse catchphrase like ‘hippies’ or ‘dirty hippies’ or something like that, and use that as a way to blame and shame people for seeking relief, and even worse- to claim that the results they’re bringing back are invalid, I think that’s a crime. I honestly do. If I can bring any of my previous experience and reputation to weigh on the scale of the good that can be caused from this, I’m happy to do it.”
Court Wing has been a professional in the performance and rehab space for the last 30 years. Coming from a performing arts background, Court served as a live-in apprentice to the US Chief Instructor for Ki-Aikido for five years, going on to win the gold medal for the International Competitors Division in Japan in 2000 and achieving the rank of 3rd degree black belt. After a 14 year career in martial arts, he returned to Acting, getting his BFA from the Conservatory of Theatre Arts & Film at Purchase College. At the same time, he was simultaneously pursuing three leading-edge performance certifications. First as an RKC/Strong First kettlebell instructor, eventually going on to be ranked a “Top 10 Instructor” and assisting a closed-course certification of SEAL Team 6 at Virginia Beach. Next he became the first certified CrossFit trainer in NYC, becoming the former co-founder of CrossFit NYC in ’04, New York’s largest and oldest CF gym. His final certification was as a Z-Health Master Trainer, using the latest interventions in applied neuro-physiology for remarkable improvements in pain, performance, and rehabilitation.
He has also served as the principal designer for the UN’s Close Protection fitness assessment and preparation program, and has been featured in the New York Time’s Sunday Routine, Men’s Fitness, and USA Today.
In today’s episode, Kyle interviews Lauren Taus: yoga instructor with 20 years of experience, host of the Inbodied Life podcast, and psychotherapist specializing in ketamine-assisted psychotherapy.
Taus talks about growing tired of more traditional therapy and cognitive loops so many people find themselves in through cognitive behavioral therapy leading to her taking a break from therapy altogether, trying psychedelics with her brother, learning of psychedelics being used therapeutically, and coming out of the psychedelic closet to her father (who now works with her). She speaks about her practice, and the process and importance of building up therapeutic relationships first before introducing any psychedelics.
She discusses how Covid-19, cannabis legalization and the way our culture is set up are all exacerbating mental health issues and the challenges of fighting through that while trying to better partner with disadvantaged communities, the frustrations around the illegality of certain medicines, the power of ketamine, the concept of spiritual bypassing, what she’s doing differently during this disconnected time, harm reduction around psychedelics without a therapist nearby, mindfulness, and the importance of touch and dancing.
Notable Quotes
“Healing happens in relationship, and it happens in relationship with self too. I believe that so many people (and I certainly have been one of them) are walking warzones. The violence that happens inside of an individual heart and mind is far more outrageous than what you’d read in the news, and what you read in the news is a lot. …With my work, I want to know you, I want to feel you, I want you to feel safe, I want you to feel love, I want you to feel unconditional regard and care. And that doesn’t happen overnight, and that doesn’t happen when you take a pill.”
“When I think about what’s happening with cannabis now, there’s essentially white cartels, and there’s cannabis stores on every block of Venice Beach, and people making lots and lots of money on weed. And then there’s so many black and brown people in prison for smoking a joint. And so the inequity there- what kind of reparations can we do? I like to say you can’t bypass the ‘fuck you’ on your way to forgiveness. And love is big enough to hold the anger and the rage, and there’s appropriate righteous anger that’s due.”
“People are struggling to be with what is- to welcome the wildlife that courses through their veins, to sit still with their fear and their sadness, and even their joy. I have so many people who try to crush their joy and celebration because they’re afraid of losing it. And they will- it’s going to shift. But can we be in the big wideness of what it is to be human? And in our inability to do so, we create all these different unique and not-so-unique misguided defense mechanisms. All these mechanisms for evasion- flight strategies. They can look like work, they can look like sex and food and drugs and alcohol and running or even meditation. The intention is what informs it a lot- what are you doing? Are you looking to go in, or are you looking to leave?”
“Do your work and remember to play along the way. Joy is an act of resistance.”
Lauren Taus graduated summa cum laude from Barnard College at Columbia University in 2004 with a BA in Religion before continuing on to NYU for her Masters in Social Work. Lauren is licensed as a clinical therapist in both New York and California with a specialty in addiction and trauma treatment.
As a clinician, Lauren integrates alternative modalities of treatment into her work. She trained with David Emerson under the supervision of Bessel van der Kolk at The Trauma Institute in Boston in trauma sensitive yoga, and she’s trained by the Multidisciplinary Association of Psychedelic Studies (MAPS) for MDMA assisted psychotherapy for complex PTSD.
As a professional DJ and full-time psychotherapist offering ketamine-assisted psychotherapy sessions, I love selecting music for people. Almost universally, clients report a heightened sense of significance and interest in music while on psychedelics. How you select music for your client’s experience can have a profound impact on what they experience and the depth of experience they have.
There are numerous approaches to selecting and playing music for psychedelic work. While the Holotropic Breathwork people have a sophisticated method of making playlists and supporting the arc of a session, they have the added burden of having to play music that is going to work for everyone in a group experience. As a psychedelic therapist, your task is to assist a client in having a powerful non-ordinary experience, and you’ll likely be working with one client at a time. As such, there is room to get more specific and tailored in the approach that will offer a deeper and more powerful session.
Music Selection – Recreational vs. Therapeutic
One of the large differences between recreational and therapeutic psychedelic use is the focus of the experience. While psychedelics can be used in a wide variety of ways that we might consider recreational, using them in a therapeutic context has one key feature- namely that the psychedelic journeyer has the full attention and attuned nervous system of the therapist with them through the experience. This situation allows the psychonaut to go to places internally that they may not have gone without the benefit and psychological safety of being held in another’s mind. As such, people are coming to know their own depth of being in a new way. I would encourage you, dear therapist, to play things for them that will help them go deeper into their experience. You are helping someone have an experience of themselves within a psychedelic-assisted psychotherapy session.
Is the song beautiful or are you beautiful in the presence of the song?
A critical question at the heart of psychedelic music selection that was put to me by a mentor of mine: “Is the song beautiful or are you beautiful in the presence of the song?” A well-curated playlist can be used not only to have a beautiful experience, but to come to know your own depth and beauty and emotional range more fully. One thing that will help your clients go into their experience is to select pieces that are less beat-driven. Here’s a rule of thumb: if you can bob your head to it, don’t play it. This rule breaks down in working with anger/rage. In that situation, the right kind of beat can be very helpful. Generally though, find pieces that are more open and moving than a beat-driven song.
When someone is having a psychedelic experience, they are feeling their sense of self being stretched to new dimensions. Having one’s awareness bent and moved emotionally by instruments and sounds that are less known is akin to being stretched in new ways emotionally. You’ll deny your clients this gift by playing music for them that is within their musical wheelhouse. The point isn’t to have a “good” experience, but a meaningful one. You can play music that will add to that sense by picking pieces they are unfamiliar with and therefore have fewer associations to. Examples include ambient or neo-classical composers. Another critical way of accomplishing this is to play music for them from other cultures, and luckily there is no shortage of absolutely beautiful, deep, emotional world music to choose from out there that is still quite accessible to most North American ears. Middle Eastern, Asian, and African string instruments, chants, and flutes from all over the world bring out an otherworldly quality that can help your client to stretch into new ways of knowing themselves.
How to select
Aside from what to play, let’s talk about how you should select music for psychedelic sessions. I’m of the opinion that a good place to start is with something that is soothing yet stimulating and emotionally neutral. This is a great way to do no harm, musically speaking. There are many playlists out there to give you the inspiration to start. Try searching “psychedelic therapy” on Spotify or any streaming service you use. If you never do more than this, your clients will have a worthwhile experience. However, in this emerging field, I think we can do better.
Here are some guidelines that help me select during a session. When emotions or emotional needs emerge, try matching them musically in tone, or leading with music that has a slightly stronger affective tone. This can also be great for people who are by nature less in touch with their emotions or have less access to certain emotional ranges like anger or sadness. Begin building playlists and finding albums that have consistent emotional tones you can call on- sorrow, sadness, playfulness, anger, confusion, or pensive, heroic or childlike feelings, etc. This way, you’ll have them at hand when you need them. Your collection of playlists can go on and on and get more and more refined as you build your library. For me, the joy of this kind of collecting is to find new pieces that open me up to different emotional tones, and over time, they get more and more nuanced. Then try them with clients and see if they support their experience. You might have a sense a certain song will work, only to find that it falls a little flat when you try it with clients. That’s no problem at all- just as in every other aspect of therapy, you make an informed guess, you try something, and you see how it lands. Put simply, your job in session is to sonically attune to your clients. Keep an eye out for their affect and consider playing something that matches that tone. It’ll help your clients go deeper into their experience and get more out of their session with you because the music offers them permission to keep going where normally they might hold back and where a stock playlist may totally miss them.
I regularly see clients go further and deeper into the range of emotions than they ever have before. And once something that a client didn’t even know was possible becomes an option, their life starts to change. New neural networks emerge to support that experience, and that deep, new experience they had with me in the office becomes something they have access to in other areas of their lives.
Since so much of what I encounter with my clients is relational wounds and developmental trauma, it can be helpful to play music that has the voices of the same gender as the parent they have a particular wound with. If Mom was cold or unavailable, it can be incredibly powerful for a client to hear warm, soothing (non-English speaking) women singing. It offers a missing experience. The same is true with fathers and masculine wounds. I have specific playlists built out of women and/or men singing or music that for me has a particularly gendered expression. I call them “limbic feminine” and “limbic masculine.” With transference, those limbic tones can be a crucial part of healing.
Here are a few examplesof different songs:
Reflective:
Emerging:
Pensive:
Heroic:
Limbic Femininity:
Limbic Masculinity:
Stimulating Neutral:
Mendel Kaelen is also doing beautiful work creating playlists that support people going through psychedelic sessions with gorgeous general arcs.
So to you, dear therapist, I have some suggestions on how you can integrate this into your psychedelic practice.
Engage in your own work: First and most importantly, you have to keep doing your own work. As is true in ordinary psychotherapy, you won’t be able to take your clients beyond where you yourself have gone. Continue exploring your own depth of being through ongoing work with the medicines you are working with.
Widen your Music Selection: Listen to lots of things! Search out sorrowful songs, find what instruments produce those best, listen to movie soundtracks for passionate or suspenseful elements, and find music from other countries and cultures that have different instruments and scales. This can go as deep as you want.
Use Spotify to find new music: If you’re using Spotify, let their algorithms suggest things! I can’t tell you how often I find new stuff through their suggestions based on my playlists.
The collection and selection of music for psychedelic work is an ongoing venture. You’ll get better as you go, and you’ll fall in and out of love with songs or albums. And you’ll get more masterful in your own approach.
At the end of the day, what we’re offering our clients is an education into their own depth and beauty. By selecting music well, we’re saying, “You’re more than you thought you were, and what you actually are is totally welcome here. In fact, it’s fantastic”.
I hope you enjoy the endeavor.
About the Author
Pierre Bouchard is a Licensed Professional Counselor with a private practice in Boulder and Denver CO and professional vinyl DJ. He specializes in blending somatics, embodiment, attachment theory, and trauma therapy with ketamine assisted psychotherapy. He offers supervision around ketamine assisted psychotherapy and training on music selection. He’ll be opening a clinic soon to expand ketamine access and to further prepare for the psychedelic revolution. You can find out more here pierrebouchardcounseling.com and on Instagram @pierre.bouchard.lpc
Mental health has become one of the central themes of 2020 thanks to COVID-19 and the resulting societal shutdown. In fact, the psychological spillover from coronavirus is projected to evolve into an entirely separate pandemic, according to the Journal of the American Psychiatric Nurses Association(JAPNA). Like the virus itself, the “second pandemic” is nothing to ignore. The United Nations, World Health Organization and other academic sources such as the Journal of the American Medical Association have also sounded the alarm about a potential mental health crisis coming down the pipeline.
The JAPNA study, however, calls for the implementation of “new mental health interventions” and “collaboration among health leaders” in order to prepare for mobilization when the masses are seeking psychological assistance. While psychedelic medicines were not explicitly cited in the study, these drugs offer an array of treatments that just so happen to address many of the mental health issues brought on by the COVID-19 pandemic, including depression, anxiety, PTSD, and paranoia. Specifically, psychedelic-assisted psychotherapy, which is on the brink of legalization in Oregon, may serve as one such model to assuage the psychological fallout from COVID-19.
Causes of the Mental Health Pandemic
So, how can COVID trigger a mental health crisis? That answer is: Easily. At the time of writing, over 121,000 Americans have died from COVID-19 and more than 2.3 million have been infected, according to data from John Hopkins University. The authors of the JAPNA article note that survivors of ICU treatment face an elevated risk for depression, posttraumatic stress disorder (PTSD), sleep disturbance, poor quality of life, and cognitive dysfunction.
Those who contract COVID are not the only ones facing psychological trauma from the pandemic, however. Healthcare workers on the frontlines are at a heightened risk of experiencing severe trauma, PTSD, anxiety, and depression from COVID. Family members of coronavirus patients also face heightened distress, fear, and anxiety, all of which are likely aggravated by the restrictions on hospital visits and lack of testing. The rapid influx of COVID-19 cases also has the potential to decrease capacity for treating other patients, such as those experiencing psychological issues.
Moreover, even people who have not directly dealt with COVID may experience mental health troubles. A lot of anxiety exists around virus exposure, which is triggered when having to leave the house for basic reasons, such as going to the grocery store or bank. The media’s inconsistent, doomsday coverage of the pandemic adds to the confusion around what’s going on, resulting in extreme fear, information overwhelm, and hysteria.
The unintended consequences of a nationwide shut down is also proving to have a negative impact on mental health, according to a study published in European Psychiatry (EP). Lack of social interaction, specifically, is a well-known risk factor for depression, anxiety disorders and other mental health conditions. Further, the study warns that the longer such policies are in effect, the more risk they pose to those with preexisting mental health issues.
“Most probably we will face an increase of mental health problems, behavioral disturbances, and substance-use disorders, as extreme stressors may exacerbate or induce psychiatric problems,” the EP authors write.
News from the economic front is also concerning. The IMF projects global GDP will contract by 3 percent this year—the most severe decline since the Great Depression—with the US GDP predicted to drop by a whopping 5.9 percent. Data from the Bureau of Labor Statistics show more than 40 million Americans have filed for unemployment benefits since mid-March, a number that will likely increase. For many, job security means financial stability, which generally ties into one’s mental wellness.
Research published in Clinical Psychological Science found that people who lost their job, income and housing during the Great Recession were at a higher risk of depression, anxiety and substance abuse. This is particularly troubling considering the Great Recession only caused a .1 percent drop in global GDP, a decline 30 times less severe than the financial crisis caused by COVID-19. Moreover, suicide rates in the US are directly related to unemployment. In fact, for every unemployment rate percentage increase, the suicide rate rises 1.6 percent in the US, according to a study in the Social Science and Medicine journal.
Looking at all of these factors combined, a mental health crisis seems imminent. A report from the Well Being Trust predicts that COVID-19 and its associated stressors will cause anywhere from 27,644 to 154,000 deaths from alcohol, drugs and suicide. The results of a recent poll by the Kaiser Family Foundation suggest our trajectory could already be trending towards the worst-case scenario. The poll shows that 56 percent of Americans surveyed believe the outbreak has negatively impacted their mental health. But that number rose to 64 percent for those who experienced income loss.
How Can Psychedelics Help?
Psilocybin, MDMA and ketamine combined with psychotherapy show promise for treating an array of mental health conditions— many of which happen to be brought on by the pandemic.
Studies show that psilocybin-assisted therapy decreases depression and anxiety in patients with life-threatening diseases, such as cancer. Participants reported reduced feelings of hopelessness, demoralization, and fear of death. Even 4.5 years after the treatment, 60 to 80 percent of participants still demonstrated clinically significant antidepressant and anti-anxiety responses. While we do not advocate for those sick with coronavirus to eat mushrooms, these studies suggest that psilocybin may be effective in treating the extreme fear, anxiety and depression activated by the virus and global shutdown.
MDMA-assisted psychotherapy also promises major relief from pandemic-related trauma. Multiple studies show that it is a profound tool in the treatment of PTSD for military veterans, firefighters and police officers with no adverse effects post-treatment. MDMA therapy could be particularly beneficial to healthcare workers, survivors of extreme COVID cases or those who lost a loved one to the disease— all of which can inflict significant trauma, and therefore, PTSD.
“We found that over 60 percent of the participants no longer had PTSD after just three sessions of MDMA-assisted psychotherapy,” says Brad Burge, the director of strategic communications at MAPS. “We also found that those benefits persisted and people actually tended to continue getting better over the next year without any further treatments.”
Ketamine (and the esketamine nasal spray) treatment, on the other hand, is already available in North America. It’s especially effective in assuaging the tension of treatment resistant depression, bipolar disorder, chronic pain, and PTSD —all of which could be exacerbated by pandemic-related stressors.
Keep in mind, however, that using psychedelics at home is different than receiving psychedelic-assisted psychotherapy. Catherine Auman, a licensed family and marriage therapist with experience in psychedelic integration, warns that now may not be the best time to use psychedelics, especially in a non-clinical setting. She worries that pandemic-related stressors could impact a patient’s psychological state.
“Psychedelics are powerful substances and are best to do at a time in a person’s life when they’re feeling more stable, not less,” Auman explains. “This is good advice whether someone is using them recreationally or therapeutically.”
Will COVID-19 Impede Psychedelic Research and Delay Public Access?
The pandemic has impeded both psychedelic research efforts and access to currently available therapies. We’re essentially at a standstill until COVID is controlled. MAPS is among few—if not the only—organization with FDA permission to carry on research, but at a reduced scale. When we first spoke with Burge for this story, MAPS was on its first session of Phase 3 MDMA clinical trials. More recently, however, the FDA allowed MAPS to end the first round of Phase 3 early with only 90 out of 100 of the planned participants enrolled. Burge confirmed MAPS is already preparing for their second and last Phase 3 clinical trial. He predicts the DEA could reschedule MDMA by as early as 2022.
Usona Institute temporarily paused all in-person activities related to its Phase 2 clinical trials looking at psilocybin for major depressive disorder, according to its April newsletter. Usona is still recruiting participants for clinical trials at five sites, however.
Compass Pathways is not currently accepting any new patients in its clinical trials looking into the impact of psilocybin on treatment-resistant depression, according to a statement. They continue to support already enrolled patients remotely, when possible within the protocol. Pre-screening of potential study participants continues where possible, too.
Field Trip Health is a recently formed network of clinics offering ketamine-assisted psychotherapy. The facility opened its first clinic in Toronto in March. But, after seeing one patient, it promptly shut down due to the accelerating spread of COVID-19.
The decision for Field Trip Health to close its clinic was relatively easy, according to Ronan Levy, the company’s executive chairman. They didn’t have large numbers of patients actively receiving treatment yet. But, the pandemic has forced the organization to quickly adapt. “We launched a digital online therapy program, so patients can self-refer or have referrals to our psychotherapists, who are trained in psychedelic-assisted psychotherapy, with specific protocols and behavioral therapies,” says Verbora, Field Trip Health’s medical director. “Long term, as these clinics start to open up again, we’ll have dual streams. We’ll be able to sort patients in the clinic for ketamine-assisted psychotherapy, but some of their care may be able to be done from home.”
While the COVID-19 pandemic has hampered research efforts in the short term and, the movement around the healing properties of psychedelic medicine is still going strong.
“The path to acceptance might be slowed down a little bit due to COVID,” Verbora says. “But the current path that’s being undertaken by a number of different groups and institutions is one that’s going to lead to profound changes in the way we approach mental health.”
The timing couldn’t be more perfect.
About the Author
Jeff Kronenfeld is an independent journalist and fiction writer based out of Phoenix, Arizona. His articles have been published in Vice, Overture Global Magazine and other outlets. His fiction has been published by the Kurt Vonnegut Memorial Library, Four Chambers Press and other presses.
In today’s episode, Joe interviews Jesse Gould, founder and president of the Heroic Hearts Project, a nonprofit organization that connects military veterans to ayahuasca retreats, and Keith Abraham, head of the newly created Heroic Hearts UK branch.
They discuss the similarities of their military pasts and post-combat struggles, and how they both took part in ayahuasca ceremonies at Peru’s La Medicina, where they eventually met. They note the need to create the UK branch came from the realization that UK vets simply weren’t getting as much attention as those in the US.
They talk about the unlikely allyship of Crispin Blunt, member of Parliament and co-chair of the All Party Parliamentory Group for Drug Policy Reform, the consideration of using psilocybin in future work as a less intense ayahuasca alternative, current microbiome studies and the excitement around new data vs. the “death by survey” complications when working with people in need, and how helpful a military mindset can be in these situations.
They share some success stories but talk about how far we need to go in helping veterans come back to society, and how much we’d benefit from a more ceremonial acceptance of the passage from one way of life to another. The corporate 9-5 world can be tough for anyone, but ultimately, finding a purpose and connecting to a community is what’s most important toward these veterans reintegrating back to their “pre-army” lives.
Notable Quotes
“Ayahuasca changed everything. I came out of that jungle a very different person. I wouldn’t say that I had a 400% healing experience, but I had that massive, massive, massive catalyst where I knew that my life had to change. And it has. And from there, in the year since, when I got myself together, I started realizing, ‘you know what? I’m in a good place. How can I introduce UK veterans to the experience that I’ve had, because I see that as vitally important?’ And then I was introduced to Jesse, and it turned out that the organization that I thought I wanted to create had already been created perfectly.” -Keith Abraham
“My sons actually in the same unit as I was (in the parachute regiment.) When I left the parachute regiment and went for my ayahuasca experience in Peru, I then came back, and my son was looking at me like, “wait, you’re a grizzly old war veteran, and now you’re talking about, like ‘everything is connected, and love and peace and harmony’ um… this is… strange.’’ He’s gotten really used to it now, but yea, it’s wonderful that these plant medicines can do these things for us. [We have] such strong minds and characters, and this ingrained training as well, but it can be overwhelmed in a good way.” -Keith Abraham
“One of the things we teach through Heroic Hearts, especially in the integration process, is: it’s fine to maintain your warrior- that warrior spirit, that warrior soul. But now you need to learn to use that energy and use that strength towards other means. You might be done with the fighting for now, but that doesn’t mean you’re set out to pasture and done with society. There’s a lot of different ways you can use that energy. …How can you continue to be a warrior, just on a different trajectory?” -Jesse Gould
Jesse Gould is Founder and President of the Heroic Hearts Project, a 501(c)(3) nonprofit pioneering psychedelic therapies for military veterans. After being deployed in Afghanistan three times, he founded the Heroic Hearts Project in 2017 to spearhead the acceptance and use of ayahuasca therapy as a means of addressing the current mental health crisis among veterans. The Heroic Hearts Project has raised over $150,000 in scholarships from donors including Dr. Bronner’s and partnered with the world’s leading ayahuasca treatment centers, as well as sponsoring psychiatric applications with the University of Colorado Boulder and the University of Georgia. Jesse helps shape treatment programs and spreads awareness of plant medicine as a therapeutic method. He has spoken globally about psychedelics and mental health, and received accolades including being recognized as one of the Social Entrepreneurs To Watch For In 2020 by Cause Artist. Driven by a mission to help military veterans struggling with mental trauma, he is best known for his own inspiring battle with PTSD and his recovery through ayahuasca therapy. Jesse’s work can be seen and heard at NY Times, Breaking Convention, San Francisco Psychedelic Liberty Summit, People of Purchase, The Freq, Psychedelics Today Podcast, Kyle Kingsbury Podcast, Cause Artist, WAMU 88.5 and The GrowthOp.
About Keith Abraham
Keith Abraham served 9 years as a member of The Parachute Regiment, fighting in Iraq and Afghanistan. Throughout the latter years of his military service and during this time working for an investment bank, Keith began experiencing severe symptoms of anxiety and depression. After exhausting the majority of services and options offered by the NHS and military charities without much success, Keith realized a new approach was needed. His profound experiences with ayahuasca and psilocybin convinced him of the vital role plant medicines have to offer those suffering from PTSD, brain injuries and mental ill-health.
“There is something about the core of this experience that opens people up to the great mystery of what it is that we don’t know.” -Roland R. Griffiths, Johns Hopkins School of Medicine
It is well-established that mystical experiences have historically played a pivotal role in indigenous shamanism and world religions (the miracles surrounding Moses’ burning bush and Jesus’ baptism). What is less well-known and quite unexpected is the discovery that mystical experiences are the catalyst for healing in contemporary psychedelic research.
Both the Johns Hopkins and NYU studies of the impact of psilocybin on cancer patients found that “In both trials, the intensity of the mystical experience described by patients correlated with the degree to which their depression and anxiety decreased.”
In other words, research scientists have consistently occasioned mystical experiences ̶ “flights of the soul” traditionally thought to be beyond the scope of empirical science ̶ in clinical settings by administering high-dose synthetic psilocybin. Furthermore, it turns out that these experiences hold the key to positive patient outcomes in psychedelic-assisted psychotherapy. Let this enigma sink in for a moment.
Three Seminal Studies
In the 1960s urban legends began circulating, claiming that psychedelics could allow intrepid trippers to meet spirit guides, to travel to other dimensions, and even to know God. In fact, the new science of psychedelics was in part inspired by the mystical experiences of early psychonauts: Grof’s cosmic consciousness revelations on LSD in Prague; Harner’s near-death journey on ayahuasca in the Amazon; and Leary’s mind-expanding awakening on psilocybin mushrooms in Cuernavaca, Mexico, to name but a few. Over time, the ability of psychedelics to generate authentic mystical experiences was confirmed in three seminal studies.
Stanislav Grof, MD, PhD
The first, the Miracle of Marsh Chapel (also called the “Good Friday Experiment”), was a psychedelic research experiment carried out by Walter N. Pahnke under the auspices of Leary’s Harvard Psilocybin Project. On Good Friday 1962, Pahnke randomly divided twenty volunteer Protestant divinity students into two groups assembled in a small room in the basement of Marsh Chapel. In this controlled double-blind study, half the students received capsules containing thirty milligrams of psilocybin and the other half received a large dose of niacin (vitamin B3) as a placebo. The results were compelling.Almost all members of the group receiving psilocybin reported profound mystical experiences.
As Pahnke reports, “the persons who received psilocybin experienced to a greater extent than did the controls the phenomena described by our typology of mysticism.” He built a follow-up survey into the research design, which found that six months after the experiment the psilocybin subjects reported persistent positive, and virtually no negative, changes in their attitude and behavior.
The second study showed that the Good Friday Experiment would withstand the test of time and scrutiny by independent reviewers. A 25-year follow-up investigation conducted in 1987 by then-graduate student Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies, documented that “all seven psilocybin subjects participating in the long-term follow-up, but none of the controls, still considered their original experience to have had genuinely mystical elements and to have made a valuable contribution to their personal lives.”Doblin concluded that Pahnke’s research on synthetic psilocybin “cast considerable doubt on the assertion that mystical experiences catalyzed by drugs are in any way inferior to nondrug mystical experiences.”
In assessing Pahnke’s research, Walter H. Clark, recipient of the American Psychological Association’s Award for contributions to the psychology of religion, writes “There are no experiments known to me in the history of the scientific study of religion better designed or clearer in their conclusion than this one.”
A third round of studies initiated more than 40 years after the Good Friday Experiment was conducted at Johns Hopkins School of Medicine under the direction of psychopharmacologist Roland R. Griffiths. In two papers, published in 2006 and 2008, Griffiths empirically demonstrated that psilocybin could regularly result in mystical experiences with lasting benefits for participants. These double-blind studies found that: psilocybin was safe in structured, clinical settings; generated one of the five most meaningful experiences for most participants; and produced improvements in mood and quality of life that lasted more than one year (up to 14 months) after the sessions.
Roland R. Griffiths, PhD
Mystical Experience Questionnaire
Our understanding of the common elements in mystical experience is largely based on the insights of William James (The Varieties of Religious Experience, 1902) and Walter T. Stace (Mysticism and Philosophy, 1960). These elements were refined, validated, and incorporated into a 30-question operational definition of mysticism, the Mystical Experience Questionnaire (MEQ30) utilized in the Johns Hopkins psilocybin studies.
The five common elements of mystical experience are:
Unity/Sacredness – deep sense of unity with all of existence; knowledge that “all is one”; profound sense of reverence.
Positive Mood/Ecstasy – deeply felt sense of well-being; experience of ultimate peace and tranquility; irrepressible feelings of joy and amazement.
Transcendence of Time and Space/Eternity – loss of usual sense of time and space; existing beyond past, present and future; entering in a liminal, mythical dimension.
Authoritative/True Self – ability to know reality beyond the illusion of the senses; encounter with all-knowing divine presence; understanding one’s authentic or true self.
Ineffable/Indescribable – difficulty describing the experience in words; impossibility of adequately communicating it to others.
Psychedelic-Assisted Psychotherapy
Since 2006, Johns Hopkins School of Medicine has been conducting the first research since the 1970s administering psilocybin to human subjects, including studies of personality changes and of psychedelic therapy for treating tobacco/nicotine addiction and cancer-related distress.
In 2016, Johns Hopkins undertook the largest ever study of psilocybin in treating chronic depression and anxiety among patients with life-threatening cancer. In this randomized, double-blind, cross-over trial, 51 patients were given a low placebo-like dose (1-3 mg/70 kg weight) vs. a high dose (22 or 30 mg/kg) in two sessions with a six-month follow-up.
In a Journal of Psychopharmacology article, Roland R. Griffiths, Matthew W. Johnson, and colleagues report that “High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety.” A six-month follow-up study showed that these results were sustained in most of the participants.
Some 70% of the cancer patients rated the high-dose psilocybin sessions as among the top five “most meaningful” and “spiritually significant” life experiences. In addition, their post-session mystical experience scores served as statistically significant predictors of therapeutic efficiency in reducing anxiety and depression.
Source: Matthew W. Johnson, “Psilocybin in the treatment of cancer-associated depression and anxiety,” Powerpoint presentation, Ottawa, 2018
The daughter of one study participant noted that “This opportunity allowed my dad to have vigor in his last couple of weeks of life ̶ vigor that one would think a dying man could not possibly demonstrate. His experience gave my father peace. His peace gives me strength.” These outcomes prompted Griffiths to observe that “It’s very common for people who have profound mystical-type experiences to report very positive changes in attitudes about themselves, their lives, and their relationships with others.” And to exclaim that “As a scientific phenomena, if you can create a condition in which 70 percent of the subjects achieve positive, lasting results…in one or two sessions!”
Guided Imagery-Assisted Psychotherapy
Julie M. Brown, coauthor of this article, is a psychotherapist who for thirty years worked with women’s issues and cancer patients. In her private practice, she utilized a variety of therapeutic modalities, including guided imagery which she studied under her mentor in psychosynthesis.
Guided imagery, also known as visualization, is a technique in which psychotherapists help clients focus on mental images in order to facilitate relaxation, healing, and resolution of life issues. In guided imagery-assisted psychotherapy, a person can call on mental images to improve both emotional and physical health.
Typically, Brown’s cancer patients turned to psychotherapy after conventional treatments (chemotherapy, radiation, pharmaceuticals) failed to reduce or eliminate tumors. By combining guided imagery with a complementary cancer approach, Brown found clients could enter states of mystical experience that empowered both emotional (anxiety, depression) and physical (cancer) self-healing. The profiles and outcomes for three clients are summarized in this table.
Client Profiles and Guided Imagery Therapy Outcomes
Unlike the controlled Johns Hopkins study involving 51 participants, these three case studies were not validated by independent observers nor subjected to methodological controls. Nevertheless, the seminal role of mystical experience in both psychedelic-assisted psychotherapy and guided imagery psychotherapy raises important questions.
Comparative Questions for Future Research
In the case of Brown’s guided imagery outcomes with cancer patients, significant questions are:
Can success in healing cancer via guided imagery be validated? Beyond Brown’s anecdotal cancer outcomes have other therapists been able to reduce or eliminate tumors utilizing guided imagery? Could healing have taken place in this context without a strict sugar-free diet, or was it the combination of diet and guided imagery that facilitated remission?
Can psychedelic therapy protocols be integrated into guided imagery therapy? As an experienced psychonaut, Brown recognizes that the ability to administer psilocybin to clients could have significantly shortened the therapeutic healing process, possibly from years to months. Given that clinical trials on psilocybin for treating depression have been given “breakthrough therapy” status by the U.S. Food and Drug Administration, what changes in state and federal policies and professional regulations would have to take place so that psychiatrists and psychotherapists could legally integrate psychedelics into more conventional treatment modalities?
In the case of Johns Hopkins psychedelic therapy outcomes with cancer patients, significant questions are:
Can psychedelic-assisted psychotherapy be used not only to alleviate psychological anxiety and depression in terminal cancer patients but also to facilitate physiological healing in cancer patients?
Given the pivotal role of mystical experience in both short-term psychedelic-assisted psychotherapy and long-term guided imagery psychotherapy, could psychedelic therapy combined with guided imagery possibly reduce or eliminate tumors in cancer patients, if integrated into a mid-term treatment protocol?
Will long-term, costly psychotherapy eventually be replaced by short-term, more affordable psychedelic psychotherapy? Since short-term psychedelic therapy has achieved positive and sustained outcomes in 70% of the participants, based on one or two high-dose psilocybin sessions administered over several weeks, will it eventually replace long-term psychiatric and psychotherapeutic modalities which require years of treatment and cost thousands of dollars?
How Does Mystical Experience Facilitate Healing?
These rigorous psychedelic therapy studies of psychological stress reduction and anecdotal guided imagery therapy cases of physiological cancer remission suggest that mystical experience can facilitate both mental and physical healing. “How” this healing takes place is the theoretical Holy Grail of the new science of psychedelics.
Our quest to unravel this mystery begins with the insights of four mind explorers: Roland R. Griffiths, grandfather of the psychedelic renaissance; Robin Carhart-Harris, pioneer of psychedelic brain imaging; Stanislav Grof, founder of LSD psychotherapy; and Carl G. Jung, who with Sigmund Freud laid the foundations of modern psychotherapy.
In essence, Griffiths concludes that “the psilocybin experience enables a sense of deeper meaning and an understanding that in the largest frame everything is fine and that there is nothing to be fearful of.” How the brain expands from normal consciousness to encompass this “largest frame” is visually revealed in Carhart-Harris’s magnetic resonance imaging (MRI) of the brain’s neural pathways before and after ingesting psilocybin mushrooms. Psychedelics allow us to leave the “brain’s default-mode network,” the brain’s everyday information highways, and travel into areas of the mind only available in expanded states of consciousness, clearing the way for mystical experience.
Carhart-Harris: Brain’s Neural Pathways: Before and After Magic Mushrooms
Source: G. Petri, P. Expert, et. al., “Homological scaffolds of brain functional networks,” Journal of the Royal Society, December 2014
What is the source of this expanded consciousness? Based on guiding thousands of psychedelic sessions, in The Holotropic Mind, Grof reaches this paradigm-shifting conclusion: “I see consciousness and the human psyche as expressions and reflections of a cosmic intelligence that permeates the entire universe and all of existence. We are not just highly evolved animals with biological computers embedded inside our skulls; we are also fields of consciousness without limits transcending time, space, matter, and linear causality.”
Jung’s concept of the “spiritual self” (also called “spiritual consciousness”) embodies knowledge that emerges from these transcendent “fields of consciousness.” Beyond Freud’s three-fold model of the self, comprised of the body, emotions, and intellect, Jung proposes the existence of a “spiritual self.” Through dreams, messages from the spiritual self are brought into awareness. This paper shows that, in addition to appearing in dreams, the authentic spiritual self may emerge through mystical experiences occasioned by psychedelic-assisted psychotherapy and guided imagery.
Mystical experiences arise when the doors of perception are flung wide open so that the spiritual self can emerge from the depths of the psyche, empowering us to heal and understand that in the cosmic scheme of things “all is well.”
Grof suggests that “the potential significance of LSD and other psychedelics for psychiatry and psychology was comparable to the value the microscope has for biology or the telescope has for astronomy.” We propose that, just as in astrophysics “dark matter” cannot be directly “detected” but only “implied” by gravitational effects, so in psychology, mystical experience cannot be easily “accessed” but can be regularly “occasioned” through psychedelics. Hidden from ordinary consciousness, mystical experience manifests from the dark matter of the mind.
Hopefully, these reflections on the role of mystical experience in psychotherapy will inspire further exploration of this unique phenomena that holds a key to health and well-being.
Jerry B. Brown, Ph.D., is an anthropologist and Julie M. Brown, M.A., LMHC, is a psychotherapist. They are coauthors of The Psychedelic Gospels: The Secret History of Hallucinogens in Christianity, 2016.
Undoubtedly, psychedelics are valuable tools for self-understanding, transformation, and healing, enabling us to peer into our inner workings and understand the world around us in new ways. By nature, psychedelics are destabilizing as they facilitate non-ordinary states of consciousness, catapulting us outside the bounds of our everyday perceptions. They heal us by disrupting our normative flow of consciousness leading to a multitude of insights ranging from the somatically strange to the mystically ineffable.
But, psychedelics and the realizations they enable will not necessarily change your life if you are not committed to working with the experienceafterwards. This step is known as “psychedelic integration” and it involves chewing on our experiences, digesting any insights, and taking practical steps to implement those insights as positive change.
Psychedelic researchers and psychedelic-assisted psychotherapists have long considered integration a key component in psychedelic healing. In fact, they place major emphasis on post-experience “integrative follow-up sessions” as a scientific approach to aftercare. Many believe that integration protocols and strategies play a crucial role in positive long-term therapeutic outcomes, and some even argue that the value of integration is greater than the psychedelic sessions themselves.
What Does Psychedelic Integration Mean in Practical Terms?
Going on a psychedelic trip is a lot like physical travel. If you’ve ever gone backpacking or traveled for an extended period of time, you will know that returning home can often come as a major shock to the system, sometimes taking weeks—months, even—to re-adjust to our former lives.
Similar to travel, psychedelic experiences can also shift our perceptions about the world, pushing us outside our comfort zones and into self-realization. Returning to our regular work-life patterns can be psychologically jarring, as we find ourselves irrevocably changed whilst everything we left behind remains the same. Thus, reshaping our lives to mirror the inward changes we’ve undergone can be profoundly challenging.
The psychedelic experience produces a spectrum of insights, ranging from personal to transpersonal to ecological. Sometimes a person will gain a new perspective on who they are, shifting the landscape around their professional purpose, intimate relationships, and lifestyles.
Psychedelic integration, then, is the process of weaving the practical with the mystical, taking profound, ineffable experiences beyond the temporality of the psychedelic state and grounding them in our day-to-day lives in the form of enduring, positive changes.
In this sense, integration is an active, intentional process where an individual consciously reflects on their psychedelic experience and what it means for them personally. It involves exploring how insights can be translated into bite-sized actionable steps. The personal nature of integration means that an individual needs to find an authentic way of implementing their experience in a way that suits their unique needs and personality.
After an initial revelation, the experience, materials accessed, and insights gained can quickly fade into a dreamlike memory or become psychically compartmentalized, getting lost in the busy pulse of modern life. Thus, it is important to carve out time to consciously work with these experiences.
Integration and the Importance of Pre-Session Intention Setting
Preparation and pre-session intention setting are critical components to integration. Returning to the metaphor of travel, preparing for a psychedelic experience is likened to all the work that goes into preparing for a long-distance trip. We would never go to the airport to catch a flight without the basic essentials: passport, money, a bag with at least the bare necessities, and a destination.
Similarly, setting an intention is akin to having a destination. It can provide a grounding anchor in a psychedelic session, helping guide an individual and give them a lens through which to process insights that arrive post-trip. Integration is unique to each individual — it’s inextricably intertwined with their reason for using psychedelics in the first place.
In the cult classic, The Psychedelic Experience, former Harvard researchers Timothy Leary, Ralph Metzner, and Richard Alpert write: “In planning a session, the first question to be decided is ‘what is the goal?’” Whether your intention is to heal from a traumatic experience, overcome addiction, deepen your connection to nature, or examine a specific aspect of yourself, it is important to know what you’re aiming for.
According to clinical psychologist, psychedelic integration therapist and author of The Psychedelics Integration Handbook, Dr. Ryan Westrum, psychedelic integration is a continuous process similar to an infinity wheel in that “future stories will be cultivated, supported and benefitted if you are thinking about them prior.”
Another crucial element of preparation involves tending to your set and setting. “Set” generally refers to a person’s pre-session mindset. However, it can also include both immediate and long-range states of mind, covering everything from fears, hopes, and expectations about the session to personal history and enduring personality traits. The better the preparation, the more equipped an individual is to integrate their experiences.
The “setting” is the container of the experience. It factors into account when and where the experience will take place. In The Psychedelic Experience, the description of “setting” includes a temporal dimension, encouraging individuals planning for a psychedelic session to set aside up to three days to process their insights, so there’s “sufficient time for reflection and meditation.” The text cautions that returning to work too hastily will likely “blur the clarity of the vision and reduce the potential for learning.”
Similarly, Dr. Westrum advises:
“One could argue that the first hours and the days that immediately follow the psychedelic experience are the most crucial when it comes to integration. In general, our modern-day, contemporary lifestyles are so hectic, and we find ourselves constantly working, traveling and moving. It is important if you are considering taking a psychedelic, to take the proper time to do so, more appropriately thinking of it as a two-day experience. We need to carve essential time out to reflect and digest what happened, using the second day for purposes of integration.”
When considering healthy integration practices, it is essential for an individual to carve out the time and space needed for processing. Individuals are generally advised to avoid making any major life changes in the weeks that follow a psychedelic experience, and instead take time to rest, digest and distill insights before initiating dramatic changes.
Integration, Intuition and “Inner Healing Intelligence”
The concept of psychedelic integration is closely linked to “inner healing intelligence,” a notion originally developed by Stanislav Grof, and later refined by Michael Mithoefer, Clinical Investigator and Medical Director at the Multidisciplinary Association for Psychedelic Studies (MAPS).
The notion of “inner healing intelligence” is built on the premise that nature is intelligent by design. For example, when we injure ourselves physically, bruising a knee or cutting a finger, our body automatically initiates its own sophisticated healing process. Just like a seed contains within it all the knowledge to become a tree, humans have an innate capacity to heal when they are in the right environment. Similarly, the psyche has its own innate healing capacity to extend towards wholeness. In the integration process, individuals are encouraged to connect with their inner healing intelligence and take responsibility for mending.
The Emerging Field of Psychedelic Integration Therapy
With the psychedelic renaissance in full swing and the resurgence of research illuminating the therapeutic potential of hallucinogens, it’s no surprise that the public opinion of psychedelics is beginning to shift.
But, the stigma around psychedelics still exists. For this reason, individuals who undergo psychedelic experiences outside of a psychotherapeutic or clinical paradigm meet challenges upon reentering their day-to-day lives. The reason is that they usually have no one to openly share the experience with and no available resources to help sift through the intricacies of the trip.
Sometimes individuals need to reach out for professional support in order to digest the experience properly. Unfortunately, most mainstream therapists aren’t equipped to have a constructive conversation about psychedelics, however. As a result, many patients feel reluctant to talk about their experience for fear of being judged.
This gap in the mental health system paired with the growing public interest in psychedelics creates a higher demand for psychedelic therapists. As a result, the number of professional integration therapists, coaches, and specialists is increasing. The newly growing subdiscipline of psychedelic integration has risen to prominence, creating a bridge between traditional psychotherapeutic practice and the “psychedelic underground” in which the two cross-pollinate.
Many individuals who have not followed the institutional track to become an accredited mental health professional are emerging as practitioners within this space. But, what makes an individual qualified to be an integration expert? To an extent, it seems that a bona fide psychedelic experience takes greater precedence than formal certifications.
In choosing an integration therapist or coach to work with, integration expert Dr. Ryan Westrum expressed his concern over individuals falling into the wrong hands:
“Neo-integration therapists and coaches that don’t have a psychological background or a deep understanding of the world of consciousness scare me. There is beauty if calling something a ‘spiritual emergence,’ but if you start to recognize a person has suicidal ideation or chronic depression that didn’t break, you need healthy psychiatric and psychological support.”
He is careful to emphasize that beyond having the training to deal with such difficult scenarios, he believes “relationship is number one” and that ultimately “there needs to be a relationship established that feels safe, is psychedelic friendly, without judgment and is willing to hear where you need to go.”
Beyond psychotherapeutic and research paradigms, psychedelic integration is beginning to take root in the mainstream. Spanning across the US, there is now a variety of public integration circles emerging in the form of in-person and online groups. Psychedelic integration circles provide individuals who cannot afford therapy or private coaching a low-cost alternative. It gives them a judgment-free space to talk about their experience and provides access to a community that otherwise might not be there.
Recognizing the growing need for psychedelic literacy in mental health, Psychedelics Today founders, Kyle Buller and Joe Moore, created an online course “Navigating Psychedelics For Clinicians and Therapists” especially directed at healthcare professionals looking to deepen their knowledge of psychedelic research and to support their clients with psychedelic integration. The next eight-week online course is currently open for enrollment, scheduled to begin on May 7, 2020.
Is Integration Always Necessary?
I asked Dr. Westrum for his thoughts on the importance of integration after a psychedelic experience. Is it always necessary? He cautioned:
“It is never that you’re not taking enough medicine or not having enough experience. Rather, it is that you aren’t processing it appropriately. In 90% of cases, you look at people’s behaviors and lifestyles only to find they’re still stuck, they’re not taking what they are learning through psychedelic experiences and integrating it.”
It can be helpful to envision integration as existing on a spectrum or continuum. Four days of consecutive ayahuasca ceremonies will likely require more time for integration than a microdosing experience. Even if we feel that we don’t have anything that needs integrating, Dr. Westrum urges us to “at least process the experience at the level of ruling it out,” emphasizing that “everything deserves to be integrated into our lives.”
About the Author
Jasmine Virdi is a freelance writer, editor, and proofreader. She currently works for the fiercely independent publishing company Synergetic Press, where her passions for ecology, ethnobotany and psychoactive substances converge. Jasmine’s goal as an advocate for psychoactive substances is to raise awareness of the socio-historical context in which these substances emerged in order to help integrate them into our modern-day lives in a safe, grounded, and meaningful way.
Throughout my twenties, I spent a lot of time wondering what the meaning of my life was. I was reading Hermann Hesse, Viktor Frankl, and other similar authors, but I couldn’t quite connect those books to my own life. I wanted to know what it was like to experientially engage in a vocation. Reminiscing on this struggle, I was motivated to write an article on my experiences thus far with psychedelic integration, share what has been helpful to me, and provide insight to those either wondering about this practice, studying it, or actually beginning it.
My path towards becoming a licensed psychotherapist was not direct, as I did not receive my clinical license until my late 50s! I can now see, with that lovely 20/20 hindsight, that everything I did led me here, with valuable insight that I would not have had if my path had been more direct. I studied food, nutrition, and painting, had children, taught yoga, and became a certified Ayurvedic counselor before landing on my current path.
My Ayurvedic practice began to really crystalize my direction. Ayurveda is a science of life and embodies the mind, body, and spirit to integrate a lifestyle most suited for each individual. Much of my Ayurvedic practice had to do with clients’ emotional states. As such, I became more focused on the mind. This led me to a conversation with the dean of a nearby university, and shortly after, I enrolled in a Master’s program that had not even been an idea in my conscious awareness the year before.
Plant medicine was not on my radar at the time of my schooling. This path evolved through witnessing the healing that close friends and family experienced. Having had my fair share of psychedelic experiences as a young adult living through the ‘70s, I was always comfortable with the experience but did not yet see it as a healing therapy. After going directly to the source again and having my own experience with this new idea in mind, I now KNEW this was an unprecedented healing modality. I have since expanded my mindset to welcome plant medicines/psychedelic experiences as one of the most effective healing therapies that exists.
For thousands of years, people have been using psychedelic substances to further their understanding of themselves and the universe. Sadly, most of these medicines have been labeled as Schedule 1 drugs in the USA, though this is changing with several FDA clinical trials currently taking place. These research trials are studying the efficacy of using psilocybin as a treatment for depression, and MDMA as a treatment for PTSD. The trials for MDMA are in Phase 3, and the hope is to have this as a valid form of therapy by 2021. In the meantime, outside the US, there are countries where plant medicine is legal now.
Psychedelic Integration is designed to assist those seeking support in connection with psychedelic experiences. Individuals who have had difficult experiences can benefit from a better understanding of the often-challenging feelings stirred up by psychedelics; while those who have found the use of psychedelics to be a positive method of gaining insight can use supportive therapy to bolster and integrate that knowledge into their daily lives (http://www.ingmargorman.com/psychedelic-therapy). This part of the process, before and after the experience itself, is such an integral component of the whole journey. Working together, the therapist helps the client to understand what may happen, guiding them toward the safest set and setting (this phrase describes the physical, mental, social and environmental context that an individual brings into a psychedelic experience), and then fully integrates the experience afterward, perhaps even for months or years to come. We all have the capacity to understand our own selves, but having a guide makes sense of a plant medicine journey or psychedelic experience leads to deeper healing and a deeper understanding of self. I like to think of it like this: if plant medicine is a teacher, then an integrative therapist is a tutor, helping the traveler understand the teachings.
There are 3 categories in which I have been offering integration to clients, not one necessarily more prevalent than any of the others.
Category One: “My husband is freaking out! He did Bufo 3 days ago and he is sitting on the floor of the shower, shaking and crying… he can’t seem to come out of it.”
Category Two: “I found your name on an integration list and I need to talk to someone about an experience I had…”
Category Three: “I’ve been thinking a lot about going to do ayahuasca (or psilocybin, etc). I’ve read so much about it but I feel scared. I’ve never done anything like this before.”
All names and details are changed to protect privacy as I proceed to describe a sample of each category:
Category one:
I received a call from Ron, who was clearly in distress, evidenced by the urgency and desperation in his voice. He was begging me to see him (he lived 2 hours away). He had experienced a powerful bufo journey (the strongest known natural psychedelic on planet earth, tryptamine 5-MeO-DMT, produced by Bufo Alvarius, a toad of the Sonoran Desert). I found out that he was not an inexperienced partaker in psychedelics, as he had gone on an ayahuasca retreat for a week the year before. Regardless, the bufo experience floored him. Until I was able to get him in to see me, I instructed him to go to the beach, assisted by his friend, and sit on the sand, feeling the sand under his hands and legs, and breathe in the healing salty air, using a mantra of “I am safe, I am right here” repetitively. This mantra was to ground him to the here and now. I also had him eat grounding (comforting) foods, which his friend was able to provide (warm stew, butternut squash, soup, etc.).
He arrived the next morning to my office wrapped in a blanket with sand on his feet, as he was coming straight from his second day of sitting on the beach. He was trembling and he didn’t understand what had happened to him. Having been further informed by his friend, and thankfully, with the knowledge of Dr. Stanislav Grof’s work with “spiritual emergency,” I was able to normalize this intensity for him. He was experiencing past trauma (that he re-lived during his ayahuasca ceremonies the year before), but now he was somatically experiencing it, coming up and out of his body, resulting in uncontrollable shaking. Through his tears, he described his trauma as his body continued to tremble. As a child, Ron had been repeatedly molested by his older brother, and when he went to his mother, she told him he was lying. Confused and traumatized, he left home at 11 years old to stay with a friend, and his mother never came to collect him. I encouraged him to just keep on letting his body tremble- that this was a necessary part of releasing the traumatic experience. I found myself moving closer to him and making sure he felt safe. After giving him the encouragement that this was exactly what needed to happen, and with the support of his loving friends and family, he was eventually able to go home, instead of what normally would have resulted in an ER visit (I have to admit, when he first arrived, I thought I would have to refer him to the ER, but am very thankful that this didn’t happen). His trusted friend kept very close by, physically assuring him that he wasn’t alone and he was safe.
Two of his friends brought him back the next morning. Ron already looked better and was able to articulate more about his experience. He went on to meet with me several more times and has been able to process these very difficult events to the point where they are no longer stuck in his body. He has since described a sense of calm that he couldn’t ever remember feeling.
Because of the knowledge of what each of the particular plant medicines can do and how the body processes trauma, we were able to prevent what could’ve been a very detrimental stay in a psychiatric hospital. This is a very clear example of why integration is so important, and particularly with a trained therapist, with prior experience working in an acute care unit of a psychiatric hospital.
People who reach out for integration are looking to understand their experience and process it through their own history and trauma. They’ve turned to plant medicines or psychedelics because what they have been doing hasn’t been working and they’re not happy with how they’ve been living. They have not been able to get through the walls they built to keep them safe growing up (but no longer serve them as an adult).
In a therapeutic environment, there are no “bad trips.” The experience referenced above may appear to be frightening, but as we can see, it was very intense, and yet, very healing.
Category Two:
As for Category Two, I’ll share an example I had with Paul. He called to tell me that he wanted an appointment because he had a psilocybin experience that left him feeling happy for the first time since he could remember. He had been on the verge of suicide many times for the 3 years prior, seeking different forms of therapy and medication to no avail. He could not get out of a deep sadness and numbness that he felt, no matter what he tried. Plant medicine was a last resort, and in his words, if it didn’t work, he was done.
He tentatively arrived in my office and described this feeling of peace and love that he was somewhat desperate to hold on to. This integrative therapy evolved in a way that I didn’t expect, because over the course of a year of our work together, Paul went through some physical symptoms that derailed him for quite some time, but was so closely connected to the fear that kept him from experiencing any joy in his life. As he came to realize that these symptoms were connected to past trauma, and as he realized that he was, indeed, a very sensitive person (this was met with almost disdain when it was suggested in the early stages of therapy), he truly began to heal and come alive. This is an example of what the “spectrum of trauma” means. Paul’s repressed grief had a lot to do with his intense emotions around the death of a beloved pet when he was 11 years old. He was shamed for his grief by family members and peers. By pushing down these feelings of grief, coupled with this new shame, his capacity to feel was also pushed down, and depression became his norm. While this trauma may not appear to be nearly as intense as Ron’s trauma, it affected Paul to the point where he had disconnected from himself, and ultimately, didn’t think life was worth living, although he had no understood connection to the repressed grief at the time.
The psilocybin journey showed him what was possible, but it did not enable him to live a happy life until he got underneath his “firewall” (described below) and worked at it. There was a lot of grief for him to process, and tears came along with shame until it moved its way out. Today, I can happily say that smiling is the norm for him, and spontaneity is part of his daily life. He embraces his sensitivity and sees how it has become a gift to him. He worked hard to get there.
We all have unresolved trauma. Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, diminishes their sense of self and their ability to feel the full range of emotions and experiences. Some of us have experienced more intense trauma than others, but some of us are more sensitive than others as well. If a disturbing experience led you to disconnect from your true self because what you were feeling was too much, that is the internal impact of trauma. We create a “part” that protects us from this overwhelming emotional pain, assuring us that we will not feel it again. Most of the time, we are completely unaware that we have done this.
These traumas become more clear during integration therapy, as the plant medicine helps to reveal that which we have buried deep in our subconscious. I truly believe that psychedelics/ plant medicine, when used properly, are here to bring us back to our whole self- to show us our own “operating system” that we have created as a result of our experiences, and how there may be some “firewalls” up that are protecting us from pain and keeping us from our true nature. Why would we want to pull down this firewall that has protected us for so long? Because that pain we are protecting is where we are going to find ourselves the most alive. We need to sit with it, feel it, allow it, and finally, let it move its way through us and out. What is depression, but a condition where we feel disconnected from self and others, where nothing will make us feel better because we have lost our way? What is anxiety, but an unprocessed fear that we are not going to be ok? We may have felt like we couldn’t survive this emotional pain as a child (emotional pain can be very intense and confusing for a child, and none of us are exempt from this), but we need to know that we will survive it now. This is also what integration therapy is about- having a safe place to be reminded that you will be okay now. You are safe. You can learn to witness and feel at the same time, thus allowing the firewalls to gently move out of the way.
Category Three:
Finally, I’ll touch on Category Three. Terry called to tell me that she wanted to take psilocybin but was very scared to. Her husband and brother had both taken it and assured her that they would be there for her. Her motivation for wanting to do this was to help understand and heal her Misophonia, a condition meaning “hatred of sound,” which manifested in her becoming highly irritated at many sounds, with the sound of someone chewing or sniffing causing her the most distress. She loved her husband and children, but these sounds, even coming from them, created anger inside of her, which in turn, stressed her out even more.
We talked about some of her history and when the Misophonia began. She described overhearing a conversation between her parents that involved her father being unfaithful with a man. Terry loved her dad, and I believe she did not know what to do with any feelings of anger towards him, and she remembers being really angry at him chewing his food. This wasn’t the first time she thought there was a connection, but she didn’t know how to remove the root of it. We talked about what the set and setting would be like for her journey: music, a mantra she could use as she began preparing for the day, and what her husband could do as her “sitter.”
When we met after her journey, she described feeling so much love and no fear at all. She shared that she had a sure feeling that whatever was going on, there was something inside of her that was going to know how to handle it and know what to do. This was the plant medicine reminding her who she really was. Our subsequent sessions were about connecting with the anger that she was sidestepping and sitting with feeling uncomfortable around that, as she was able to understand that while it wasn’t safe for her at the time to feel anger towards her father, she transferred it to something that did feel safe. Obviously, this was no longer serving her and it was hurting her and her family members. Because of the inner knowing that she received from her experience with psilocybin, she was more easily able to access the anger in our integration sessions afterward, without feeling like she couldn’t handle it. She worked hard through these sessions and in-between, and while the Misophonia isn’t completely gone, she feels it very rarely now, and she is able to easily ride through the irritation.
As a therapist, it is a very rewarding experience to see the recognition in someone’s eyes that “yes, I can handle this and I will be ok.” This concept, called “therapeutic alliance,” allows a client to let go- to begin to trust. Many clients aren’t aware that they don’t trust because they’ve never experienced trust in the first place. They don’t know what it feels like to let go and still feel safe. Somewhere along their road of life, usually in early childhood, the world became an unsafe place to be. This is often due to parents or caregivers unable to see their child’s pain, or not knowing what to do with it, likely due to their own unrealized traumas. The child then learns to do whatever is necessary to survive because their world depends on them burying their intense emotions and “pushing through.” Intense emotions can make someone feel as if they are going to die. The emotion is too big for the child to bear, and often, there are no words to communicate this. If they are not seen by someone who cares, then the child has to figure it out for themself. This is where plant medicine can reveal deep traumas, underneath all of their survival mechanisms, beyond the “firewall.” Of course, there are other methods, but here, we focus on plant medicine.
It takes a great deal of courage (doing something in spite of fear) to put yourself in the hands of a shaman or sitter and enter the unknown. Most clients will say that they were scared but did it anyway.
Another final case I’d like to share: Brian had been addicted to heroin on and off for about 7 years. Many rehabs and detoxes did not accomplish what a 10-day stay at an ibogaine clinic did.
Brian had been on and off with me for about 3 years. We were working on a harm reduction approach away from opiates. This approach involved cannabis and kratom (an extract from a tropical evergreen tree from Southeast Asia, often used to help wean someone off opiates). Brian had already been through Buprenorphine and Methadone enough times to realize they weren’t going to keep him from relapsing back to opiates. The cannabis and kratom approach was up and down, and he still felt desperate. After much talk about ibogaine (ibogaine is a plant-based substance extracted from the iboga shrub, which originates in Africa), he went to a clinic out of the country and was administered ibogaine from a medical doctor. I believe that it is an immense disservice to addicts that ibogaine has not yet been legalized in this country for opiate addiction, although that is a subject for another article (stay tuned!). Two weeks later, he was back in session with me describing his experience, and it was clear that something had truly changed. He was able to see different paths that he took in his life, and how he always had other options. These paths were shown to him in a way that he reports “almost felt like it had rewired my brain. My interest in opiates is just not there”. A year and a half later, still clean from opiates, Brian has been working on creating that trusting relationship with his own self, developing confidence that he can withstand uncomfortable and painful emotions. Without integration, the uncovering of painful emotions could have led back to a relapse.
Thus, integration involves creating that relationship with yourself, dialoguing with that younger version of yourself, and helping your inner child to heal- integrating your OWN self. The word integration is so perfect, because as we are integrating the plant medicine experience, what we are really doing is integrating our true self, beyond all of our ego’s constructions of what was necessary at the time, but no longer serves us in being whole.
What has been most helpful to me as an integrative therapist was my own experiences with plant medicine, particularly ayahuasca. It’s not always easy to “hold space” for some of the pain that is releasing from clients, as the energy can be intense. One of the most important visions I had during an ayahuasca journey in Peru was the night I had a matrix in front of me of all happenings between humans for a long timespan. Certain squares of the matrix would become the focus as I observed specific human mental suffering, abuse, some more benign scenes… some family members and friends I knew… I could move the scene out of the way if it wasn’t something I felt I needed, and focus closer on scenes that were meaningful to me in some ways. I witnessed a scene between a relative and her father that was devastating, as well as several others like this. The reason this was the most important vision for me was I was a silent observer. I was aware of the pain and tragedy, but I wasn’t in pain myself. This is not usually true for me in my daily life, as I feel pain in my own body when someone else is experiencing pain. It has, at times, made it difficult for me as a therapist to hold back tears when a client is in tears, and I have had to momentarily think of something funny to pull me out of this empathic experience. Being able to be aware of the pain in this matrix experience, but not be in pain myself, has helped me tremendously in my practice, as well as with friends and family. I feel less responsible to “fix” it, in a way, because I clearly realize the pain is not mine. This has not made me less empathetic in any way, but it has enabled me to have more clarity. Therapy isn’t about fixing, but helping people to uncover their own guide within; their own inner wisdom. This has become my purpose, to just be a guide in the storm of someone’s life and allow them to see that they’ve known all along who they are, they just need to move their “firewalls” out of the way.
If you are reading this and have been wondering what it might be like to work with people in this capacity, I hope this has been helpful. As Terence McKenna once said, “It’s all about love… making someone else’s existence just a little easier… nothing else matters. I know this now.”
About the Author
Debbie Kadagian became certified as a Holistic Health Practitioner in 2007, specializing in Ayurvedic Health Counseling. She traveled to India to study at the Jiva Institute with Dr. Partap Chauhan. She received her Masters in Social Work from Fordham University and became a licensed clinical social worker. She has worked at inpatient psychiatric hospitals and outpatient treatment centers prior to setting up her private practice. Debbie is also a certified yoga teacher since 2001. Debbie has a true desire to assist people in finding meaning in their lives in order to transcend suffering, addiction, and trauma.
Debbie is the producer of the film, “Healing the Mind: The Synthesis of Ayurveda and Western Psychiatry.”
Jon Dennis, Esq. is a lawyer and activist in the psychedelics ecosystem and a consultant at the firm, 
