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.
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.
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.
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.
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.”
Understanding Negative Body Image
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.”
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.
The Research So Far
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.
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.
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.
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.
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?
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.”
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.
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.”
How to Deal with a Spiritual Crisis
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 Dark Side of the Moon
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.
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.
It turns out, dissociation isn’t all bad.
A Term With Many Meanings: What Is Dissociation?
So, what exactly is dissociation?
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.
Dissociative Disorders
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.”
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?
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.
CW: Yes!
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.
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.
Accountability First Steps
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.
The Transformative Justice Approach
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.
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.
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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Watts, R., Day, C., Krzanowski, J., Nutt, D., & Carhart-Harris, R. (2017). Patients’ accounts of increased “connectedness” and “acceptance” after psilocybin for treatment-resistant depression. Journal of Humanistic Psychology, 57(5), 520–564.
Zefferman, M. R., & Matthew, S. (2021). Combat stress in a small-scale society suggests divergent evolutionary roots for posttraumatic stress disorder symptoms. PNAS, 118(15), e2020430118.
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.
What About Other Drugs That Aren’t Listed?
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
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.
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.
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.
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.
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,