Tips for Psychonauts and Their Tour Guides

On Psychedelic Assisted Psychotherapy from a Psychedelically Assisted Psychotherapist

“Once you have tasted flight, you will forever walk the earth with your eyes turned skyward, for there you have been, and there you will always long to return.”

Leonardo da Vinci

It’s been nigh on a half century since psychiatry fell headlong into the boring and fetid cesspool of SSRI’s, SNRI’s and various dopamine upper and downers. So desperate to be delivered from stagnation and the future that never arrived, it has now looked sideways and into the past to revive psychedelics from the counterculture. The fruit finally ripened with the TGA (Australia’s FDA) July 1^st 2023 approval of psilocybin in treatment resistant major depressive disorder. Also approved was NMDA for treatment resistant PTSD, though I’ll save my critique of it for another time or perhaps drop it altogether. Suffice to say we all know the story of William Withering’s encounter with serendipity in the form of Mother Hutton and her foxglove tea. But try as I might, I cannot recall anyone with PTSD coming to me saying their “illness” was cured by dropping the other vitamin E at a rave party. If NMDA was so wonderful, why did it take so long for the penny to drop? Wouldn’t you think the ecstasy of serendipity would have visited psychiatry already if there really anything to write about except for a good time had and some pruning of the serotonergic raphae? Suffice to say I also see in the PRopaganda around novel treatments one part “I love the world and want to heal it” and ninety-nine parts “we can make a buck from this”. The fork tongued hungers of all those ostensibly caring entrepreneurs are obvious. The future will be one of driving in the wedge with a magic mushroom, adding a hydroxyl group here or a carboxyl group there, visit the patent office and expand the indicated disorders list to the point of diagnosing the world. Then sit back and watch the billions (with an upper-case B) flow in. My concerns over psychedelic assisted therapies runs far deeper than the lucrative psychedelic industrial complex, though I will make the following predictions before expanding on other themes on theory and praxis

Psychotherapy won’t (really) last

Mark my words, in the minds and rhetoric of many psychiatrists, the claimed necessity of the psychotherapy component of “psychedelic assisted psychotherapy” will give way to talk therapy being a mere token or rolled back altogether. There was always some lip service paid to the value of psychotherapy in depression treated otherwise with SSRI/SNRI/ECT/rTMS without mainstream psychiatry having any real faith in the talking cure. Indeed, they lacked faith in anything beyond the introduction where pill meets synapse and tinkering with this or that drug or dose in subsequent sessions. In the end, the GP just handed out antidepressants like lollies on a cloudy day. The seeds of divorce are already apparent in the RANZCP memorandum making clear the psychotherapy component is there because current evidence has involved its inclusion, not from any principled commitment.

If it persists at all, psychotherapy will persist only insomuch as it will be of value to the business model and in virtue of psychologists have lobbying power. It will be packaged as holistic care where the needs of the psychologist who wishes to administer the improvement metrics and earn a buck are in symbiosis with that of psychiatrist who wants to write the script, talk less and earn even more. Websites look better when the content is more than a photo of a script pad. But the problem will come when the psychedelic trip is psychotherapeutically interpreted via a fundamentally materialist lens (vide infra). There is no experience to be interpreted when science ^TM dissolves real transformative meaning. More on that later. Problems will also arise when much of the psychological focus will be on monitoring for and containing the potential distressing psychological adverse effects of the substance. But helping people breathe though re-traumatization is light years away from exploring the experience itself as anything more than epiphenomena.       

Another Case of Treatment Resistance

The unconscious is a wily creature and operates on perverse incentives. If a compensation system is available, many a patient will feel pain and report disability out of the proportion with the physical severity of the injury. Likewise, many patient consumers will suffer from curiosity to try the psilocybin and take the journey of the psychonaut. Consequently, some will want their unhappiness to become “clinical” depression. They will never admit it of course, largely for lack of cultivating the capacity confess it to themselves. Many in turn will want their depression to be treatment resistant depression to pass through the final gate. Their psychiatrist will want the same. Only he/she/zee/zem has the legal keys to the psychedelic kingdom. Meanwhile their GP will want to divest themselves of the burden that the SSRI was not enough, and another solution must be found. And so the unwritten nudge nudge wink wink in between the lines of patient files will be the diagnosis being made and onto the diagnosis being refractory to standard treatments. This is not to say that SSRI’s are a slippery slope to psychedelics or that SSRI’s will vanish from the shelves. But in their heart of hearts everyone knows from the beginning where they want to travel. They know what drug they want to work for them. For many, this will be psilocybin.

What Happened to Miracles

The psychedelic PRopaganda is abuzz with talk of miracle cures from one off or short course psilocybin treatments. Don’t misunderstand me. I’d love nothing more than for a patient to trade a lifetime on SSRI’s for a few cups of mushroom tea. They can then be done with all pharmacology, done with psychiatry and get on with their lives. But many a patient having gone on a trip outside of (or into) the matrix would like to return. Consequently, mark my words. Talk of one-off miracle cures will give way to talk of subsets of patients who relapse and require “top up” sessions. For the lucrative private psychiatric hospital industry, it will be a case of “same time next year” for the psilocybin and same time this year for the rTMS. The question will be whether their insurance coverage will allow them to afford a relapse that can purchase them another psychedelic vacation.    

Life Without Trauma is Not Life

Psychedelic advocacy groups wax lyrical of wanting to have a zero trauma world. Apart from the disturbing delusions of the Utopian wanting to dissolve itself into primary narcissism of a mushrooms bosom, the question becomes “what is trauma that it can or must be treated”? When the twin towers fell, do I satisfy criterion A of PTSD if I barely made it out the building? Or is it enough if I live across the street? In New York city? In New York state? In the small town USA, now confronted with the fact that a billion people might think of me as part of the great Satan? Or am I traumatised just because I saw it on TV? All these and none of these can be traumatic or depressing or anxiogenic. Now there are two ways of looking at this. The first is to be true to the psychiatric canon. We can’t just throw words and diagnoses about willy nilly. As one of my psychiatric mentors was oft to say, “you have to know where the corners are before you cut them”. Such a perspective allows one to reflect maturely on what upper case T trauma really is and to discern just why smaller abuses might be significant and a moral (or mortal) hazard in the life of the patient. Such a perspective is necessarily prejudiced by what one adult believes another adult ought to consider traumatic. An inappropriate response to small t trauma is not PTSD or depression but the symptom set of an immature and neurotic disorder of character (or malingering). Should this be treated also via a trip?

The other perspective is to simply be honest that major depression and PTSD are stand in terms for any and all psychological pain from which a psychedelic might be helpful and to which any diagnosis might be conveniently attached. The psychedelic industrial complex knows it must tread carefully in its uphill battle out of the stigma of 1960’s counterculture and still prevailing prohibitions. It must first drive a cautious wedge in through co-opting the legitimacy of psychiatry as the “expert” gatekeeper. That or psychiatry is the mask behind which sits a more covert project in either regression to primary narcissism or Huxleys soma by another name. A zero-trauma world is a truly disturbing ideological project of almost mystical ambition, a heaven before its deserved. Life towards and through layers of greater adulthood will forever involve necessarily working through some trauma or another. At least be honest and fight a libertarian fight to turn on, tune in and drop out for its own sake. That I can respect. But I wonder what the end goal is for many an advocate of psychedelics from its high church (i.e. Johns Hopkins) on down.   

A New Materialistic Religion? 

Psychedelic experiences can have content which seems religious, spiritual or transcendent (pick your favourite descriptor). For any but the most mercenary pragmatist, construct validity of these experiences and their metaphysical substance is THE question. Are these experiences beyond the physical or not? Is the spiritual real?

Many readers will be familiar with the so called “God spot”, a region of the brain supposedly mediating (and simulating) religious feeling which has no reality outside the brain as machine. Is God just a subjective experience bounded by the geometries of a “circuit” (note the technological metaphor) between the periaqueductal grey and centres in the temporal lobe? Or can religiosity be genuinely transcendent in any meaningful sense of the term. Pretty deflating stuff for those yearning for transcendence yet easily taken in by simple explanations.

Likewise, readers of psychedelic literature will be familiar with the text implying your psilocybin trip is explained by its activity towards serotonin receptors, particular 5HT2A. They will present as proof the fact that experiences are often thwarted by co-administering the antagonist ketanserin. Never mind that other drugs without much serotonergic blocking activity can also abort the trip. 5HT2A is an elegant though hopelessly inadequate explanation, no different than the neuro-reductionism in stories of decoupled/recoupled “default” networks explaining how it “works” as an event in and of your brain.

A simple analogy will make the problem clear. Imagine the case of opening a door to walk onto a beach from which one might swim (or drown) in an endless ocean. The fact that the materiality of the door and its locks provide the means by which one might uncouple oneself from the home does not prove that the beach and the ocean and the swim is the lock, the key or the door.  We can know nothing of swimming or drowning from looking at the lock and opening it up to the scientific (or scientistic) eye. Perhaps psilocybin’s material effect on the brain is just a way to free self from brain where self is as alien to brain as swimming is to the stuff of a door knob. And when self becomes alien to self then that’s when the swimming really begins and brain circuits all seem just a little silly really. I find my own faith as an idealist (i.e. matter is mind in Mind) no less an article of faith than the neuro-reductionist materialist (i.e. mind is matter). Now I realise this will not convince the die hard materialist. Regardless what they experience their conclusion will inevitably be “wow well the brain is complex isn’t it”. Truth is I cannot convince the higher austerities of my own sceptical self that my own trips went beyond the proverbial door in my skull. My point is not to resolve unresolvable questions of being and interaction between its aspects. My point is to acknowledge that neuro-reductionism is far and away the dominant lens by which to explain psychedelic experience. And this paradigm is on a collision course with history past and future. We run the tragic risk of creating a new religious like global phenomena which will displace the older religions. People will seek transcendence through the mushroom with promises of a more spiritual world only to have it then interpreted as brain. What starts with enchantment will end with nihilism and ironically the need for more therapy. And the oh so essential psychotherapy will be all about playing with dreams of how to interpret what was really nothing more than a brain given a good slap in the face. That’s the metaphor behind ECT also. Let’s give the brain a shock and hope its circuits fall back into place. So why persist with the psychotherapy? Like it or not, our intuitions tell us that transcendence cannot find its horizon in a 3 pound lump of mush between the ears, however complex it might be. And we have yet even to escape our own metaphors on the way to knowing brain, let alone with infinite who we may be lucky to glimpse when uncoupled from brain. We cannot enchant the world with a “science” and psychiatry of psychedelics. Its part and parcel of the therapeutic state Szasz warned us about, a spiritual future with Johns Hopkins the new Church and the psychiatrist a gloried techno shaman. Its grotesque. I actually mourn.

The Sublime Vs the Profane.

To further hammer home the point, imagine the following scenarios. I can only outline them in brief, enough for you to get the gist.             

In one corner is a patient referred with the disorder of major depression, the brain circuits locked into pathological oscillations. Perhaps these will be explained as resulting from traumas in the psychosocial axis of their lives. Perhaps their depression will be interpreted as “endogenous” or “genetic”. Never mind. The machine that is their brain has a mental function which will need process its recordings of the traumatic events when it is loosened up to do so. They attend the psychiatrists and psychologists’ rooms, give consent and the psychiatrist in turn is granted consent to administer the restricted s8 substance of abuse when the described symptoms meet the threshold required for diagnosis. The history reflects a failure to respond to other treatments also, placing the SSRI as first line and psychedelics another kind of pharmacotherapy. Initial psychometrics will be administered, and the patient will be abstracted into further numerical domains of dysfunction and their severity. After preliminaries and preparatory psychotherapy sessions the time will come for the first treatment. In all likelihood the psylocibin will be synthetic and administered in standardised dose to the patient, a dead molecule in a dead cup. They will be approaching it with the same trepidation a patient will approach the dentist or the surgeon, neither or whom are spiritual practitioners. They may or may not be sitting in some therapist’s room with kitsch inclusions simulating elements of connections with nature and custom, just enough new age setting to be attractive but not so much as to look weird and unscientific. The patient will approach with curiosity amidst fear of side effects and what trauma might trigger within them. Everything will be manualised and standardised. The therapist will have been ordained shaman of the technocratic state by way of attending workshops led by “expert” psychiatrists who speak with spiritual corpses in the words coming from of their tongues. The patient will have the experience whatever that is for them, followed by several sessions where the therapist will administer more psychometrics looking for the numerical cure (how else can a psychologist be aware of change?) and discussing the experience in light of past trauma and what it all might mean. At some point, molecule willing, they will “feel better” and the patient will be cured. It was a very vivid, even transformative dream or eruption from the unconscious. And that is that. Default circuits resynchronised and the machine can go on with its life free from trauma. Free to consume the other dead fruit of technocracy.  

Now imagine a different scenario. A person is drawn to reach beyond themselves and the painful attachments to grief, hurt, shame, guilt and all the jargon free descriptors when a man or woman sins and confuses against themselves and others. They might be entering into a phase of life where they are required to mature or prepare for a battle of some kind. Initiation is the task, not treatment. The fact their mind can be described in the ossified criteria of a DSM diagnosis is hopefully alien to them else it gets in the way of a mind aright in its preparation. They approach a spiritual healer for permission to receive guidance. Permission is granted. The time draws near for ceremony. They approach with reverence and fear, not of “side effects” or “re-emergence of trauma” but fear of an encounter with a spiritual force whose station in the hierarchy deserves respect. It involves a certain alignment of will and submission to one wiser than themselves. Ceremony begins. The area is darkened if not by nightfall by curtains. Music may or may not be involved. If present it is deliberate and not chosen for any vulgar relaxing qualities. The healer prepares the cups and the plants with the reverence of a priest at liturgy. Often incense is involved, once again an uncanny similarity to liturgy. This is not just “set and setting”. It is prayer and preparation. It is to be taken seriously

When the experience arrives it will come in waves. It is ineffable. It is spiritual. And the problem will not be in how it is interpreted after the ceremony without first realizing all interpretations and earthly languages fail at the task. It is a place where metaphor is the real and thoughts create space and texture. In a sense then psychotherapy is redundant or finds its value only in submitting itself to guidance. This is something the techno psychotherapist cannot know. It is the reason I have not sought a “diploma” in psychedelic assisted psychotherapy. To find value in diploma is to miss the point. It is a failure to graduate.    

Now you will read in the scientific literature of culture bound uses of psilocybin and ayahuasca as if to say psychiatry is now using the same healing in a new scientific skin. But in what sense can these two scenarios share any identity when they stand on completely different ground. This psychiatry is like a cheap tourism, entering a great cathedral, taking a few pictures, and “feeling” a few pleasantries. But the tourist doesn’t “get it”. And so “it” might not grasp them either.     

I’m actually of the mind that medicine in general and psychiatry in particular should not be permitted make psychedelics their own. Whether or not psychedelics ought to be decriminalised for the counterculture and culture bound practice, this is a different question. But regulation should regulate against psychiatric hubris rather than for it. A psychiatrist can suggest the therapeutic value of fishing or hiking in the woods. But it would be a grotesque narcissistic cruelty for the psychiatrist to claim then be an expert woodman or fisherman and hold licence to prescribe you rod or bait. More grotesque still would be for the psychiatrist to pretend to be shaman when the shaman themselves know the limitations of their own expertise which will always be light years superior to the MD with a God complex. This is a psychiatry which will traumatise the world.  

 Psychedelic Idolatry

One psychedelic funding lobby behind the Johns Hopkins group reveals itself in some interesting quotes it places on its website. Take for example them citing Camus

“Ah, mon cher, for anyone who is alone without God and without a master, the weight of days is dreadful. Hence, one must choose a master, God being out of style.”

Is this ironic? Or is it a changing of material idols already mythologised within a materialistic psychiatry? That is to say where once we had Zeus replaced by Christ, now we have Prozac replaced with a mushroom. Or worse. Christ is out of style and replaced first by Prozac and then by a mushroom, not as a pathway to the creator beyond the fungi but a pathway to itself. When the pathway or object replaces the place or person to which it is drawn, this is idolatry. I am deeply concerned that even if a psychonaut interprets the journey as genuinely transcendent, they will take the experience and meditate upon it for its own sake and not what is beyond it. This is no better than the spiritually hollow rock and roll razzle dazzle of US mega churches. Question is, what are you when you leave the razzle dazzle and what are you when you come back from psychedelia? Are you hungering after the God within and beyond the waters in which you swam? Are you bringing back love and mercy to flow from you towards others? Or are you longing for some pretty lights and fun? Every cathedral and every great work of religious art is for you to travel through the walls and the canvas into bountiful eternity, to see beyond what is seen. Same with the mushrooms or the ayahuasca. These are cathedrals. The spirit is beyond the botanical. It is in it yet not of it or at least not entirely. Same with the 3 pounds of mush between your ears.

And I can’t help wonder whether the institutions around the psychedelic revival seek to replace traditional religions. As Rick Doblin, a major advocate says

“Psychedelics are not a substance for faith. They are a door to authentic faith, born of encountering directly the sacred dimension of everyday experience. This is not the only gate to that discovery, but it is the most ancient and universal, and potentially the most accessible to the majority of the human race.”

Now I’m not dismissing psychedelics as a door to authentic faith. Quite the contrary. My own experiences were deeply religiously Christian and deeply authentic, and a kingdom divided against itself cannot stand let alone be authentic. I feel a touch of envy towards those who transcend through fasting and prayer alone. But we must pay homage to other doors and existing faiths Doblin curiously fails to mention. What would the bishops of these secular churches of psychedelia (Johns Hopkins, MAPS, RiverStyx, Mind Medicine, APA and RANZCP etc) say of another who taught

“I am the way and the truth and the life. No one comes to the Father except through me”

This was the utterance by the one beyond the mushroom. Advocates of psychedelics need make clear their positions on religion and what dreams they have of a world they wish to create. Patients also are obliged to explore what their God or Gods prescribe and proscribe. They must be true to themselves.  

This question was concretised circa 1620 in the new world when the Roman church outlawed use of psychedelics (peyote, ayahuasca etc). The prohibition was on pain of physical death for sure, yet also with the diktat that such substances were always and only from the evil one. For the native convert to the church, the curious clergy that missioned to them or the pagan wanting inter faith harmony the question could not be avoided. Was the Roman church of the 17^th century AD fundamentally correct in its proscription? Was the plant the road to Lucifer? Or was the Roman church and its God cruel and evil? Or is it the case that these plants were provided by God and the church was the victim of its own human political xenophobia and want to abolish any and all competition in its hunger to conquer, just as the new secular church of the psychedelic might be want to do today?

I’m inclined towards the final interpretation of the three. I’m of the mind the entities encountered in my own journey are not all demons and that angels familiar to the Peruvian jungle are not likely to take on the form of some winged beautiful European the likes of which we would see on the canvasses of the Uffizi or the Vatican. Just as art is different in different places, so are representations or emanations or agents of Gods love. Whether angel or demon, you will know them when you encounter them.  Or perhaps I can skirt the boundaries of humility and say that I could discern the difference in virtue of my Christianity. Maybe yes or maybe it is given to all to know the difference, this given to Paul when he stated

“For when Gentiles, who do not have the law, by nature do what the law requires, they are a law to themselves, even though they do not have the law. They show that the work of the law is written on their hearts, while their conscience also bears witness, and their conflicting thoughts accuse or even excuse them.” 

Here Be Dragons.

“ The goal is not to rid life of its darkness, but rather to reconcile it into our lives, to make relationship, and to honor both light and dark as necessarily two sides of the same coin.”

The above quote from the prior mentioned prominent psychedelic funding group is very interesting. It points to a philosophy not of reconciling with the reality of evil and confusion (or whatever negative darkness is meant to represent). No, we are also asked to “honour” darkness. Moreover, we are not asked to see to it that darkness and the false lights in ourselves and the spiritual realm submit to true light. Rather we are asked to submit ourselves to the idea that God is both good and evil in an integrated whole. The problem is that reconciliation is cousin to integration, though both might be enemies to each other. Both are certainly enemies of purification. And purification is what we ought to long for. Is God and his heaven both good and evil? Be careful now. We would do well to ponder the dangers here leaking out from the minds of some of the psychedelic lobby.

If I am correct that psilocybin and ayahuasca are doors to the spiritual ocean then we are obliged to take swimming very seriously. What’s the young know nothing psychologist to do when a patient says they encountered a demon or angel of false light? The answer is not to say dogmatically that this can only represent past trauma. Or worse, they could throw it back to the patient as in “what’s it mean to you” as if there be no objective meaning beyond what works. You see the demon may already be at hand in the form of philosophical pragmatism where truth is instrumental and not real. The ceremony will involve encounters with phosphenes of pretty lights and patterns and other trivialities. Some things can be explained away. But it may also involve encounters with entities of true good and true evil. Clonus and yawning, tears and purges are sometimes beyond the physical. You might be taken into an agony of contorted writhing, an exorcism of real evil spirits from a real spiritual body. Please heed the voice of experience. Ego’s and demons do not go down without a fight. You will find both in yourselves if you submit to the true light of God. And though the great surgeons scalpel never slips, the great surgeon does not use anaesthetic as he breaks you into a thousand pieces. Thankfully benevolence takes care of you with wisdom beyond the understanding of any psychologist. You breath through the agony of death into life as he creates his work within you. Nonetheless with good there is evil, a darkness not to be honoured so much as understood. There be dragons within and dragons without. And dragons in the space in between where God penetrates all lacunue to break their backs and chase them out. Healing requires a shaman priest and guide of spiritual maturity and experience. It requires a mind wise that once a demon has been evicted there is space for more to take its place. The psychiatry I know is dangerously ill equipped for the task. To be a tour guide one must have first made the journey the hard way, and I don’t mean through the guild of psychiatrists. Having made the journey the first, second and third task is not to be a guide to anything or anyone. Its to slow down, breath, pray, listen and keep listening.