The Ten Lessons of Psychedelic Therapy, Rediscovered
Psychedelic plants and derivative compounds and admixtures have been used safely for millennia by indigenous peoples. This tradition of shamanic practices provides the context for the use of psychedelics in psychotherapy and the foundation for our discussion of the methods of psychedelic psychotherapy.
As tribal societies evolved over thousands of years, a set of ritual and community support structures--guidelines of procedure and context--grew up around the use of psychoactive plants, resulting in the first “safety and efficacy” standards. The driving considerations were and are now: 1) how to take these substances in such a way that people have the experience they are looking for and 2) how to do so with the least deleterious effect on the body, mind, and society. The regulatory and policy debates we’re having as a society today may be seen, in part, as an attempt to re-create the controls, guidance, and support that evolved naturally in prehistory.
Over the past fifty-plus years, Western researchers have systematically reinvented the wheel of ancient practice in roughing out the contours of safe and effective psychedelic psychotherapy. The primary clinical “innovations” discovered in the West for the use of psychedelics, such as “set and setting,” turn out to be rediscoveries of methodologies honed through centuries of hard-won tribal trial-and-error experimentation. As such, we must now rethink, embrace, and expand upon the true foundations, not just of Western practice, but of Western research as well.
What follow then, are ten “lessons learned” for psychedelic psychotherapy, along with--in italics--the tribal foundation for each.
1. Setting Can Strongly Influence State of Mind and Thus Outcome
Early researchers sometimes strapped subjects to beds in hospital rooms, under the mistaken view that psychedelics mimic psychosis. Most subjects under these conditions had hellish experiences, thus seeming to confirm the “psychotomimetic” hypothesis. Another, similar term used at that time was “hallucinogen,” which is still used in medical and some scholarly contexts. However, drugs such as LSD rarely produce true hallucinations (e.g., seeing and conversing with a person who is not actually present). Even in institutional settings, enough subjects had beatific experiences that another explanatory term emerged: “psychedelic” or mind manifesting. Over the years, researchers and clinicians have generally come to provide a nonthreatening, physically comfortable, pleasing to the senses, safe, and secure environment, often with specific familial items (such as pictures, dolls, and so forth) or religious content. (The setting must be “safe and secure” not just so there are no outside interruptions but also to assure that a frightened or confused subject or patient cannot bolt the session room.)
Psychedelic subjects can be highly suggestible. Although beatific psychedelic experiences were possible in mental hospitals during the psychotomimetic period, therapeutic peak experiences are more readily attained amid a setting with personally meaningful spiritual music and iconography. Far from problematic, this suggestibility is one of the foundations upon which successful psychedelic psychotherapy must be built.
At the opposite extreme, some healing and psychotherapeutic use of psychedelics has employed carefully designed and controlled intensity as a lever to help patients experience, confront, and resolve their deepest fears and pains.
The tribal context for psychedelic use is inherently safe. Unlike in industrial society, tribal use of psychedelics takes place in a natural context, both environmentally and culturally. When a young person takes a psychedelic in a tribal setting, it is generally in the context of ritual, frequently a rite of passage from one stage of life into the next, and support by family members and other authority figures is the norm. Later, the entire tribal milieu naturally assists in integrating the experience. No sneaking behind the barn to hide drug use here; rather, this is publicly supported use of a sacrament, in a positive and relaxed environment.
At the opposite extreme, many tribal practices have a fearful and intense component to stimulate change during the rite of passage. Yet within the supportive tribal environment, these fearful or painful practices are accepted as healing.
2. Mind-set Can Scuttle a Beautiful Context or Transcend a Hellish One
Open-mindedness and willingness to surrender to the process, confidence in people and surroundings, and motivation to learn and heal rather than to escape or be entertained are all associated with successful outcome.
Mind-set is perhaps the single most important factor in determining the outcome of a psychedelic experience. More influential than setting or dose, “set” trumps all, because set determines the phenomenology or direct internal experience of those other factors.
Even so, it is difficult to discuss mind-set without simultaneously discussing setting. Setting strongly influences the mind-set of the suggestible psychedelic user, and yet mind-set can overcome the influence of even the most powerful religious or family triggers. Another term, used similarly to “set,” is intentionality.” If the deepest, truest intent with which one approaches the experience is sincere and open to whatever learning is encountered, then a positive experience is more likely. On the other hand, if one’s true intent is to avoid certain issues, the stress of that avoidance could cause emotional symptoms that influence the nature and outcome of the psychedelic experience. Of course, such a “negative” experience is also a developmental challenge, the addressing of which brings maturation and a more open intentionality.
The forces that explain the Universe in the animistic worldview are well known by all and driven by spirits that include the plant aides. The plants are seen as active, conscious agents--plant spirits--rather than as things, it is an engagement with the world and with experience that is explicitly reverential.
Tribal participants are completely “ bought into” the concept and practice of using plants for healing and divination and are positive about the benefits to be accrued. Tradition communicates the appropriateness and value of the experience. The tribal worldview fully accommodates the healing action of the ceremonial use of psychoactive plants. Psychedelics increase suggestibility and the sacramental, receptive tribal mind-set is ideal for the effective use of these plants to catalyze spiritual transformation.