Toward a Psychedelic Medicine1
Richard Yensen, Ph.D.
Yearbook for Ethnomedicine and the Study of Consciousness,
Issue 1, 1992, pp51-69. ©VWB - Verlag für Wissenschaft und Bildung, 1995.
Introduction and Goals
This paper seeks to delineate the need for a fusion of many existing areas of study into a new discipline that focuses on practice, research and study of the use of psychedelic substances as medicine. For the duration of this paper I will call the new disciplinepsychedelic medicine. This may not be the most appropriate name for the new discipline and you are invited to suggest better ones.
Four major areas will be discussed in this paper: 1) Psychedelic medicine will be defined and placed in historical context. 2) An analysis of the shortcomings of our current research methods will be made. Specifically I will discuss how experimenter errors are made because of the accepted dichotomy between subject and object, experimenter and experiment. We will see how these errors point to the need for an approach that acknowledges the basic oneness of the psychedelic states of consciousness. I will also discuss how research which views psychedelics as pharmacologic agents obscures significant factors that determine human response to these substances. 3) I will then present the process of treating a terminal cancer patient as demonstration of a new model for disclosing fully the experiences of all participants in a psychedelic session. 4) I will then propose future directions for our collaboration and suggestions for How to train the practitioners of psychedelic medicine.
Definition and Historical Context
Psychedelic medicine does not seek to replace contemporary allopathic medicine. Psychedelic medicine is deeply complimentary to most of contemporary medical practice. Since it deals with the deepest levels of human experience and motivation through human relationship, psychedelic medicine reaches the patient in important ways that allopathic medicine does not. Psychedelic medicine helps individuals to find meaning in their existence which produces an emotional healing that is complimentary to the physical healing offered by allopathic medicine. Since psychedelic medicine addresses the whole life history of the patient as a meaningful context for healing to begin, it is basically holistic in theory and practice. Psychedelic medicine seeks to produce the deepest harmony possible between mind, body and spirit. Psychedelic medicine is often most helpful at times when the remedies of allopathic medicine have been exhausted or the prognosis is terminal.
Psychedelic medicine is not actually new but is the resurrection of an ancient discipline. A contemporary Native American healer using psychedelic plants speaks of their effects on the mind and what he knows of their history:
"By means of the magical plants and the chants and the search for the roots of the problem, the subconscious of the individual is opened up like a flower, and it releases these blockages. All by itself it tells things. A very practical manner... which was known to the ancient's" (SHARON, 1978 P. 46).
Since the dawn of time psychedelic substances in the hands of priests, physicians and metaphysicians have been used in culturally significant rites of passage, death and rebirth, mystical quest for meaning, membership and healing. The study of how the appropriate use of psychedelic substances can be of continuing benefit to humanity is the focus of psychedelic medicine. Although variations of psychedelic medicine have been practiced throughout history and are still practiced in certain groups, knowledge of psychedelic medicine has been lost in other cultures and at this time is being intentionally buried in our society.
Why call this area of research and study Psychedelic medicine?First let us examine the origin and meaning of the word psychedelic.In 1957 HUMPHREY OSMOND, an early researcher in this area, introduces the name psychedelic to provide a label for experiences of great and lasting benefit. Investigators of compounds which had been given a variety of non-descriptive, pejorative or cumbersome labels, wanted a name that implied positive potential. OSMOND had observed profoundly positive personality changes in some of his subjects. These great spurts in personal growth seemed to follow transcendental, mystical or, as OSMOND proposed, psychedelic experiences with the compounds he renamed. He proposed psychedelic as a new name for these substances and their effects in the hope of liberating scientific investigation from the enduring influence of more narrow and negative labels that suggested limited fields of application and ignored the enduring positive value of these substances. OSMOND found that LSD, mescaline and psilocybin can be useful, not only in studying psychopathology, but also that they shed new light on the greatest philosophical enigma of human existence, the purpose and meaning of life:
"Our subjects, include many who have drunk deep of life, authors, artists, a junior cabinet minister, scientists, a hero, philosophers, and businessmen... Most find the experience valuable, some find it frightening, many say that it is uniquely lovely. If mimicking mental illness were the main characteristic of these agents, psychotomimetics would indeed be a suitable generic term. It is true that they may do so, but they do so much more... I have tried to find a more appropriate name" (OSMOND, 1957).
OSMOND'S neologism was brought forth from the Greek roots psycheand delos meaning mind and manifesting. In the years that have followed OSMOND'S proposal the name psychedelic has come to be associated with a counter-cultural lifestyle, wild innovations in music and art, but most if all with the dangerous, unsupervised and hedonistic use of these compounds. Certainly these connotations were not part of lamentable failure of our society to integrate, use, and understand psychedelics and their motive potential. Nonetheless the name psychedelic is appropriate for a wide variety of substances that can facilitate a broad range of human experiences many of which can be of enduring value to the individual and the culture. I call this a field of medicine to acknowledge medicine in a sense mostly lost to this culture, the aspects of medicine concerned with spiritual growth for its practitioners and healing of mind, body and spirit for its patients. This is a form of medicine more akin to that practiced by the American Indians and Ancient Greeks than our modern technological allopathic medicine. It is a medicine more concerned with healing the soul than the body.
How is it that psychedelic medicine could be an ancient discipline? There is evidence that as long ago as 100,000 years humans were using medicinal herbs. The use of plants to induce altered states of consciousness has been documented circa 8,000 B.C. (FURST, 1976). So if we take into account the plant kingdom it becomes clear that the use of psychedelic substances by humans is not a recent development. Psychedelics are not associated with counter-cultural forces in the rituals of cultures that use them. In fact, many traditional societies use these substances as powerful tools for renewing and passing on their basic belief system.
Psychedelics in the form of sacred plants appear to have played an influential role in the formation of religions and the early development of Western philosophy. R. GORDON WA550N is foremost among a new genre of scholars who call themselves ethnopharmacologists and who specialize in examining the role of pharmacologically active plants in history. His book Soma, the Divine Mushroom of Immortality meticulously relates the legendary Somaas described in the Hindu oral tradition of the Rig Vedato Amanita muscaria, a psychedelic mushroom. Mr. WA550N'S scholarly efforts, not to be confused with the fanciful proposals of others regarding mushrooms and religious practice (e.g. ALLEGRO, 1970), amount to a profound interdisciplinary analysis of howAmanita muscaria mushrooms fit the Rig Veda's poetic imagery from the perspective of botany, chemistry, pharmacology, anthropology and psychology. WA5SON presents convincing evidence for his hypothesis that at the dawn of human history the effect of a sacred plant were cornerstone in the foundation of one of the great religions of the world. Not content to allow this scholarly tour de force to stand alone, WASSON has since joined with others to present strong evidence that the "wine" consumed as part of the mysteries at Eleusis in ancient Greece was made from ergot infested grain and hence possessed mystical, sacred and psychedelic properties due to the effects of Iysergic acid amides. These renowned mysteries were said to profoundly affect the participants which included Plato and Socrates in Greece and Pythagoras in Egypt (WASSON et al., 1978).
Clearly sacred plants and psychedelic medicine have played a more significant role in human history than common knowledge would suggest. The use of these plants has been in the context of deeply meaningful ritual setting that invoked transpersonal experiences of a mystical and spiritual nature. Cultures of oral tradition have revealed to us their awe of the vast frontiers revealed by these substances through the names they chose for these sacred plants: semen of the sun, vines of the serpent, the tracks of the deer, plant of the tomb, vine of the soul, mainstay of the heavens, herb of divination and flesh of the gods (SCHULTES & HOFMANN, 1979).
Analysis of Current Research Methods
Psychedelics are a unique new frontier in our exploration of the universe. People from all walks of life, who have sufficient experience with the psychedelics in a supportive setting, discover that there is a profound and basic unity to the universe that is more real and true than the superficially apparent diversity and separateness of our ordinary experience. Instead of realizing the revolutionary implications of this insight our society attempted to study these substances of if they fit neatly into our pre-existing ways of understanding of the world. The scientific methods applied to studying these substances in our culture ignored this crucial insight about the nature of the universe.
In our culture the use and study of these compounds fell to the disciplines of psychiatry and psychology. Both of these disciplines had adopted methods for conducting research based on the assumption that subject and object are separate and that the experimenter is separate from the experiment. Although insights exist from 20th century physics that under certain circumstances subject-object experimenter-experiment dichotomies break down, these insights were not incorporated into the design of scientific research in either psychiatry or psychology. Psychologists and psychiatrists tried to understand the actions of these substances by integrating them into pre-existing conceptual frameworks for understanding the actions of drugs. The range and depth of understanding achieved through these methods is very limited. If our healers couldn't understand the use of psychedelics, how could they be used by the culture in a safe and meaningful way?
Psychedelic medicine accepts the basic unity implied by psychedelics and psychedelic experience. This insight forces a return to naturalistic reporting of our experiences along this new frontier. We must begin the work of gathering information from all participants in psychedelic sessions as a way of acknowledging the basic unity of the phenomenon under study. This information will assist us in making new maps of our consciousness and its inseparable union with the universe. I believe that this important unitive insight can be a fulcrum to lever our thinking about psychedelics out of the l9th century and into contemporary thought about the nature of the universe.
Our complex technological society has abandoned ways of thinking about the world that would allow us to accept these substance as sacred or divine. Yet we must take into account that all cultures throughout history that used these substances successfully, accorded them a sacred role. This perception of psychedelics is actually quite reasonable. A substance that can facilitate personal insight into the most meaningful dimension of existence where the unity of all creation is perceived surely meets the requirements for sacred status.
"[There is a] curious symmetry between people who abuse drugs and people who study them. The person who is convinced that highs come in drugs, if he is negatively oriented toward society, becomes a drug abuser; if he is positively oriented toward society, he becomes a drug researcher. But the two are essentially the same, because both arc laboring under the identical materialistic illusion. Only their mutual antagonism keeps them from realizing they are two poles of the same way of thinking" (WEIL, 1972, P. 70, 72).
The world view prevalent in our culture has made it possible to accept these substances only as drugs, pharmacologically active agents. Since drugs are considered man made tools they are anything but divine within this culture. To think of these substances as drugs is an unfortunate error. Though it may be impossible for us to think of them as divine. there are advantages to such thinking. Clearly God is everywhere at once and so the experience attained through such a sacramental substance is not contained within this substance. This way of thinking about psychedelics provides a conceptual schema superior to pharmacology for understanding that the non-drug or ceremonial factors are what determine the actions and effects of psychedelics on human beings. Thinking in this way also gives the implicit instruction that all experience engendered by these substances is to be accepted even though it may be difficult or painful.
Since just before the turn of the century Western scholars have attempted to study psychedelics without being able to grasp the full scope of the potential embodied in the knowledgeable use of psychedelics. During this period of time, the psychedelics were examined for their possible role as facilitators in psychological healing, providers of insight into the mysteries of human existence and stimulators of creativity. Of several factors limiting the development of knowledge in this area a central one has been an unwillingness of the scientists involved to look at the influence they have exerted on their own research. Scientists have labored under the commonly accepted misconception that they are unbiased or can design clever studies to eliminate the influence any bias might exert on the experiment. The dichotomized view of reality where subject and object are separate entities with exactly definable influences on each other was the state of our scientific view of the universe at the turn of the century. The application of this world view to the design and interpretation of studies with psychedelics has obscured and confounded research efforts. Dogged adherence to methods that demand a clear separation between experimenter and experimental subject to produce meaningful results are continually suggested as the most scientifically appropriate and in fact the only way to scientifically study this area. Advances in our understanding have also been limited by the materialistic illusion that pharmacologic activity must be a prime determinant of any effects that these substances might have on human beings including both the nature of the experiences reported by people taking psychedelic substances and their ultimate expression in human behaviour. Research with psychedelic drugs, even after a significant amount of time and study with thousands of published reports, is still at a frontier stage. This does not signify, as some would have it that the psychedelics are neither promising nor fruitful as area of study. Drug researchers have floundered by applying prematurely rigid and conceptually inappropriate, methodologies. They have refused to report on their own important biases and emotional responses. This has helped to maintain the fiction of the unbiased investigator. They have thus conducted research that asks hopelessly incorrect questions and may produce the results expected by mechanisms overlooked in the original research design and conduct. So rather than advancing understanding of a complex field of study, early attempts obscured the important variables in this research while laying undeserved claim to scientific status. There is no published study where the experimenter describes their biases vis-à-vis psychedelics or their own feelings during a psychedelic session with subjects. This situation is rather like a chemist reporting that he mixed two reagents together and they blew up but refusing to disclose what the reagents were! From a scientific perspective these researchers failed to report on significant independent variables.
The inadequacy of contemporary models for research in this area has combined with social concern over the threat of uncontrolled use of these substances to lead the governments of the world to impose restrictions on psychedelics which impede scientific research. The need to control use of these substances by the general public and the difficult nature of this goal has lead regulatory agencies to over-regulate legitimate researchers.
For instance in the United States the Food and Drug Administration insists that qualified investigators adhere in the design of their studies to accepted views of how to investigate other psychoactive substances where the direct chemotherapeutic activity of a drug is being evaluated. Psychedelic research involves a unique and complex interaction of psychotherapeutic, pharmacologic and environmental factors. This completely ignores the fact that psychedelics are unlike pharmacologic agents and require a serious reconsideration of our methods and techniques for conducting research. This control over the scientific community is accomplished by appointing "peer review" panels of researchers with little or no background in psychedelic research. Thus progress in this area is effectively stopped by blocking any innovative study that does not adhere to the methods and techniques deemed appropriate by committees of researchers with no specific expertise in the precise area they are offering expert opinions about.
"It is an inherent property of intelligence that it can jump out of the task which it is performing, and survey what it has done; it is always looking for, and often finding, patterns. Now I said that intelligence can jump out of its task, but does not mean that it always will" (HOFSTADTER, 1979, P 37).
For these reasons it is my opinion that a new interdisciplinary field of study called psychedelic medicine must be inaugurated. This new field should strive to adopt appropriate methodologies for studying the states of consciousness that are facilitated through the growing family of compounds that are best described as mind-manifesting.
A Case History in Psychedelic Medicine
As a model for studying psychedelic medicine, I would like to share with you the poignancy of an actual clinical experience with psychedelic substances. I do this to foster the reader's appreciation and understanding of the value of inherent in this way of producing psychological healing, T would like to do this by giving a case presentation of the psychedelic treatment of a terminal cancer patient. I will describe this experience with the most candid and complete disclosure of my experiences and those of others involved in the process as possible. This is my attempt to fully disclose of all the relevant variables in the situation in the manner I suggest is appropriate for psychedelic medicine. I introduce this material also because the moral, philosophical and religious elements that are characterized by reverence for life and appreciation of the infinite value of the individual human being are illustrated in this account and they must be the central tenets of psychedelic medical ethics. We cannot study the transcendent realities of psychedelic consciousness without accepting the unity that these experiences convey and fully reporting our own experiences as participant-observers. For these reasons I choose to look back 13 years to openly share my own first experience with administering a psychedelic to a terminal cancer patient. I hope the events that follow will highlight the complex interweaving of meaning for me as a researcher, psychotherapist and human being and do justice to the importance this treatment had for my patient. Such an account has not to my knowledge found its way into the literature before now. Most important, the study that provided the context for this experience was not reported in a manner that did justice to the remarkable nature of this and many other beautiful human experiences that are the essence of psychedelic medicine.I came to know this man in the process of therapy as a remarkable and unique person experiencing the exquisite crafting of the final facets to the jewel of his lifetime. This experience had special meaning for both of us because for each of us in our own way it was both a first as well as a last experience. For Joe it was his first and last experience with the drug DPT and our research therapy team. For me it was my first experience with a terminal cancer patient, a joyous loss of significant aspects of my virginity as a psychedelic therapist. The whole team involved, myself, the co-therapist and Joe emerged from this event with significant personal growth. Although every psychedelic session is a first and has the value of newness this experience has stayed with me over the years as a special one that demands further analysis and understanding to appreciate fully.
He was 70 years old and his cancer began in the eye then it spread to his prostate and ultimately insinuated its way into the other abdominal organs. His surgeon noted that the patient had signs of depression and a markedly increased need for pain medication, this led the doctor to recommend our experimental treatment with psychedelic drugs. He had seen the treatment help other patients dramatically so Joe would improve too. For me this was a very special event, Joe was the first cancer patient I had the opportunity to treat as a research psychotherapist. The staff person at the Maryland Psychiatric Research Center who was in charge of the project laughed as he told me that I should have fun treating this man because he had lived with his mother for his whole life. This was still the case even though Joe was 70 years old!
As I walked up to the Cancer Unit I prepared myself for what I anticipated would be a significant experience in my career as a therapist. I remembered that for me it seemed a very important part of my role as a healer to assist people in experiencing the fears and joys that are hallmarks of confrontation with the boundaries of human existence. I was quite proud of my accomplishments because against all odds I had been able to join the clinical stall of the only psychedelic research project in the country working with human subjects and psychotherapy. For me this was a dream realized. I had disdain for the fact that medicine seemed to emotionally abandon people near death and was resolved to learn everything I could from this experience.
Joe was in a room with several other patients and when I asked the nurse who showed me in where we might go for some privacy she acted surprised. After walking us out to the hall she quickly darted in and out several doors and then apologetically offered us the janitor's room. There were brooms and pails strewn around the small office and she moved a couple of chairs into the closet sized room. She then said she hoped we wouldn't be disturbed by janitors looking in for their tools. My pride was a bit tarnished by the idea of meeting in a broom closet, but there seemed no other alternative.
He was quite jovial when I asked him about his stay in the hospital. He chatted off-handedly about the excellent treatment he was receiving and told me loudly of his implicit trust in the doctors. Then he informed me that the doctors might have to remove his eye because of the cancer. He told me this with such a matter-of-fact and emotionless tone that he could have been describing the cosmetic removal of a wart rather than a vital organ of sight. When I asked him how he felt about possibly losing his eye, Joe replied without a moment's hesitation that whatever the doctors decided he would accept. Then he quickly went on to say that there were many more important things for us to discuss. I prepared myself for him to say something about his impending demise, but to my astonishment he said that he needed to understand labor unions. I decided that although that wasn't my agenda for our meetings I would have to allow Joe to express whatever was on his mind. What sometimes sounded like a lecture on how to organize a labor union slowly changed into a recollection of the important events in Joe's life. I began to feel the power and beauty of the life Joe had led and to appreciate the privilege of hearing his story.
I learned that Joe was an electrician and had worked with his hands all of his life. Five years earlier he had been retired from a position in local industry. Joe spoke at length about his life as a working man and activities in organizing a labor union. When Joe was six his father had been blackballed from working as a riveter in the United States because he was involved in early attempts at organizing a union. Because of his union efforts Joe's father had to, with a group of friends, gather together enough money to get over the border to Canada. They could only gather enough funds for one of their group to cross the border at a time. In order restrict the immigration of vagrants into Canada, you needed to post a $ 50.00 bond before crossing the border. Once a man was able to secure a job in Canada the he would send his first paycheck back to fund the transfer of another friend into Canada. Joe was outraged that this had been the plight of early union organizers who were trying to improve working conditions.
Joe, his brother and one sister, were raised in a northern state where they struggled to survive on the meager income from his father's Canadian job. When Joe was 11 his father was able to secure permission for him to work as a water boy on the riveting gang. This took Joe out of school, but he was glad for the opportunity to help support the family. Joe described his father as a hard working, hard drinking man who was very kind to his children. He remembered playing ball with his father on weekends and listening to his fascinating stories about working and organizing.
Joe described for me the working conditions riveters faced in that area. The men worked in cruelly confining spaces on hot days made hotter by the blazing coal fires used to heat the rivets. When the supervisors were away, Joe's father had allowed him to work as a "holder on". This job involved using all of his youthful strength to hold a red hot rivet in place while another worker peened the end of it. Joe was especially proud of the way he had cleaned up the crew's water bucket which had been rusty and dirty when he arrived. He had first asked that the company purchase a new water bucket, but when they refused he was able to clean up the old one so the men could drink clean water.
Joe's mother was the backbone of the family. She was still living though his father passed away many years before. Joe said her faculties were undiminished even though she was 90 years old. Joe lived with her and his only sister, Jean. He said his mother was a warm, comforting and emotionally available person throughout his childhood. However the family had very little material means. Joe told me that he never married; he had a girlfriend when he was in his twenties and though he proposed marriage to her, she didn't accept because of her family's counsel against marrying a man who drank as much as Joe did. I asked if he really drank that much and Joe said, "I must admit I could really put it away." Quickly adding that his fellow workers did the same. As a way of explanation this Joe told me that throughout his childhood the men all worked in gangs and the foreman of each gang received the weekly pay in gold. So on payday the entire gang of men would adjourn to a tavern immediately after work. At the bar, in the process of dividing up the money, they inevitably drank a fair measure of their income. Joe spoke of alcohol fondly almost as though he were talking about a person, a working man's friend and entertainer, who gave a few moment's respite from the grueling daily labor that made up the lives of the men. He said he had to give up drinking in 1955 because he suffered heart damage from an accidental electrical shock at work. Though he was sad to lose the companionship he apparently had no great difficulties in giving it up.
Joe said he moved to an Eastern Seaboard city and where he began his efforts to create a union. He said it all started with a few men meeting in bars after work dreaming of how things could be. He told me of the fantastic battle with the management, of the dirty tactics the company used in trying to scare the men out of strike, and of his persistence and dedication to the men in the yard. As our meetings became more intimate he recalled some of his disappointments, at one point he discovered other men stealing from the union funds and he was especially hurt when one of them turned out to be a trusted friend. Joe said he always tried to handle these incidents with care and secrecy, encouraging the man to pay back his debt and resign the elected office he held.
Joe's attitude during the early interviews was heavily pedantic. Our meetings had the tone of a class on labor relations. He strongly denied any fears of losing his sight and spoke optimistically about the future. Joe's surgeon assured me that he had discussed the diagnosis and prognosis with him though Joe was discharged from the hospital at this point. He was complaining of constant abdominal pain and was receiving substantial doses of narcotic medication without great effect.
Our meetings were continues at the Maryland Psychiatric Research Center where we were able to meet in one of the comfortable drug meeting suites which was furnished like a living room. Our meetings began to have a more relaxed, less cramped, janitorial and medical atmosphere. During our second interview at the center I suggested to Joe that he try listening to some music over stereo headphones while wearing eyeshades so that he could see perhaps a small glimpse of what the psychedelic drug treatment session would be like. I talked to him about how important this experience might be if he could use the drug effects to go within himself and see where the feelings about his illness and pain were coming from. Joe, exuding confidence and bravado, allowed me to place the earphones and eyeshades on him. As soon as the music was played, his tone became complaining and angry. At first the music was too loud and then he found it reminiscent of riveting. When I asked Joe what riveting reminded him of he became panic stricken and removed the eyeshades and earphones. He paled visibly and in a frightened voice told me that he was unable to continue and would I please turn off the music. I complied and Joe then told me that he was suddenly experienced fear of losing his sight. He said that up to this point he had not realized how frightening this might be. Joe's attitude toward me changed drastically, when he became frightened the authoritarian manner dissolved revealing a man genuinely scared of what the future might bring. Over the next few interviews Joe and I discussed his claimed ignorance of the possible outcome of his illness. When I would suggest to him that he discuss the prognosis with the physicians, Joe took refuge in the belief that they would tell him as soon as the test results were in.
One day Joe complained of pain during the beginning of an interview, I asked him if he wished to know what the medical findings were in his case. He said yes, and I informed him of how the cancer had spread throughout his body and that the doctors found in cases where this happened that the most likely thing, though no one could predict the future with certainty, was death. Joe didn't act surprised or shaken instead he said he'd secretly suspected for some time that he was dying. He had taken special precautions to shield his mother from any knowledge that he was ill. He said that it was clear to him now this attitude of protection was also his attempt at shielding himself. "If I pretend my cancer doesn't exist for my mother's benefit then I don't have to look at it myself".
As part of preparation for Joe's session I interviewed his sister Jean, who lived in Joe's mother's house with him. Jean was quite upset about Joe's illness and ultimate demise which she consideredfait accompli. During a short interview I attempted to communicate to her that it was possible for Joe's last days to be a beautiful time of enhanced closeness and interpersonal warmth for the whole family. Jean seemed somewhat reassured by our talk, but she still seemed more focused on her own grief and feelings of abandonment than on relating to her brother as the alive human being that I was coming to appreciate more and more in my interviews. I offered Jean the opportunity for additional therapy sessions; however, it became clear that she did not wish to consider herself as needing help. I made it clear to her that often in times of severe stress such as this, talking with someone about the difficulties could help and that I would be available to her throughout Joe's illness. In watching Joe and Jean together, it seemed that the attitude of fear and denial on both of their parts was responsible for diminished human contact at a time when warmth and love were the best treatment available. I asked myself what I could possibly do to change this state of affairs. There was no ready answer to my question.
Joe and I discussed his upcoming drug session as a special opportunity for him to review and express the feelings he had inside himself. Joe was confused as to what I meant by his "insides". He had never imagined that there was a possibility of inner experience until our meetings and hadn't felt that he could change anything about the way he felt about himself or his life situation.
With some trepidation, I scheduled Joe's drug session. It was my feeling that we had established good rapport; however, it was still extremely difficult for Joe to introspect and share his emotions. Joe continued to use denial as a way of fending off his fear of death. Although we had been able to break through his barrier sometimes, Joe in his daily life still constantly spoke of the future as though his complete recovery were certain. I experienced great hesitation in telling him that death was almost inevitable. It was my fear that this news might be taken as a verdict or a death certificate indicating that there was no hope. I tried to convey clearly the fact that medical understanding of cancer is incomplete and that recovery could take place though it wasn't likely. We talked about death as something facing all men and I told Joe that coming to terms with our fear of death can lead to enhanced enjoyment of what life remains.
I introduced Joe to my co-therapist for the drug session, Mrs. Nancy Jewell. Nancy was in her early 60's, a psychiatric aide who had been working with the director of the Research Center for years. I liked Nancy very much and sometimes would thing of her privately as my "West Virginia Mamma" when I heard the words of a then popular song by John Denver. When I brought them together there was such an immediate rapport that I was amazed and a bit jealous that Joe and Nancy took to each other so suddenly and completely. I had been building my relationship of trust with Joe gradually and tentatively for several weeks now.
On the day of the drug session Joe arrived in considerable pain. According to my instructions, he had discontinued his pain medication on the day prior to the session. Nancy and I made him as comfortable as we could on the couch in the treatment suite. At 9 A.M. Nancy administered 90 mg of dipropyltryptamine intramuscularly, a dosage capable of producing profound experiences in a willing individual. I placed the eyeshades and earphones on Joe and suggested that he allow the music to carry him through the experience. I also advised Joe to confront whatever experience should present itself. Joe began to complain of pain and I advised him to enter the pain as fully as possible. Joe began to scream "God damn it!" "This is terrible, I can't stand this any longer!" he asked me repeatedly if he could remove the eyeshades and earphones. I asked him to trust Nancy, myself, and himself by facing the feelings no matter how terrible they might seem. I encouraged him to yell, scream, and express the powerful emotions in any way he could. Nancy reassured him when he expressed concern that his cussing might offend her.
Over the next 45 minutes Joe trashed, struggled and experienced difficulties in breathing. We monitored his respiration rate as slightly elevated. The struggle culminated when Joe said, "I guess in the end you just have to give in." This statement was followed by a deep sigh and a profound relaxation of his musculature. He listened to the music peacefully with a contented smile on his face for about thirty minutes.
Joe then called Nancy and me over to the couch. He held our hands. He spoke of being a child, of the difficulties he experienced being poor, of the joys of his profound identification with his father and the struggle that was his father's. Joe said he was experiencing that his father's struggle was also his own and at the same time it was the struggle of all men. The struggle to overcome life's difficulties; the pain, the disillusionment, and the horror of being alive. Joe said, "I feel like I am becoming the blood that flows through my veins, It's Irish blood. There is strength here, I feel the strength of the Irish people. The noble strength of working men. I can feel the meaning of the struggle, of my Irish ancestors. They are stubborn and strong." Joe said he experienced the ideals and dreams that brought people and others to this country as immigrants. "They wanted to overcome pain, injustice and suffering with their strength, not just for themselves but for all of us. I share this struggle. It has been my struggle to carry forward these ideals through my work with the union."
Joe's face softened and looked young. He spoke about his early jobs. He had dropped out of school and worked as a child so that his brothers and sister could have shoes and could attend school. He remembered working while a teenager for the railroad in their roundhouse as an apprentice mechanic. He smiled and told us of his foolish pride and overblown confidence in his abilities as a boxer. He illustrated the ephemeral quality of physical strength for us by describing an encounter he had with a fireman. He told this fireman where to go because a guy left a locomotive in a mess for Joe to clean up. As they fought Joe realized that he'd met his match in boxing, but Joe's pride would not allow him to admit defeat even though he was clearly losing the fight. The fireman finally knocked him unconscious. Joe said this was valuable lesson for him, he learned to have humility about his virtues. "No matter how big you are, you act too big or too proud."
Joe recalled the girl wanted to marry with definite sorrow. I encouraged him to use the session as his chance to express all his feelings. I asked him not to hold anything back to share all of himself with us. Joe said in his family he had learned that a man can do many things but one thing he should never do is let another man see him cry. I told Joe that crying is part of being human and a person's strength can grow through letting tears express what word cannot. Joe described his feeling of longing for his fiancee. He told us how much he loved this girl and wanted to marry her. I watched as his psychological conflict over crying expressed itself in a physical struggle. Joe was holding his breath and tensing his muscles as though trying to hold back a heavy burden of his feelings. Finally he surrendered and deep sobs racked his now frail looking body.
After crying Joe went on to describe his role in organizing the labor union in the shipboard, the long hard struggle with management, the difficult working conditions and how he was moved to action when he saw men suffer. What was most striking was the complete way in which he shared and relived all of this intense life experience emotionally. He was able to cry now with less of a struggle and he expressed in beautiful openly flowing tears his compassion for fellow worker's suffering. He fumed and spit his hatred for those managers and foremen more interested in production quotas than in human welfare. The drama and grand sweep of this man's life and his efforts seemed all the more poignant as he shared the depth of his humanity so openly.
There was a broad satisfied smile on Joe's face as he shared his exultation over the inauguration of a new four million dollar union hall. He had helped inaugurate the new building a few years before his retirement. As he beheld the costly new building he contrasted this victory with the experience he had close to 40 years before when a local merchant was not willing to accept a check written on the union's first checking account. Joe's expression changed suddenly and he was able to admit for the first time the pain that his mandatory retirement had caused him. He told us how much it meant to be called "Mr. Union" by his friends and even by his enemies at work. Joe described the sinking of feeling he felt when he was told that because he was now retired he could no longer prepare union cases for arbitration, the emptiness he felt at being excluded from participation purely on the basis of age. He said that if he knew he were going to live long enough he would take on the struggle for the rights of older people.
At this point Joe's sister and niece arrived to pick him up. Joe was able to sit up comfortably in a chair. I asked him if he was still in pain. In a cheerful manner and with a smile he admitted that he, "hurt something of fierce." Joe was relaxed and joyous reminiscing with his family about happy events in their childhood. His positive mood was infectious and soon all present were enjoying the pronounced psychedelic afterglow. I allowed Joe to leave the center at about 3.30 P.M. after making an appointment for the following day.
The next morning Joe arrived for his appointment promptly an announced that he was uncertain as to exactly what had take place the day before. He claimed that his mind was completely blank. I asked whether he felt any relief from his pain. He said that he hadn't. At this point when Joe failed to remember his session even after I mentioned some highlights to him. I became openly disappointed with him. I told him that I could not believe that he had no recall for the moving and profound experience that he had narrated so eloquently the day before. Nancy was also present during this interview and I experienced her presence as very important in that it allowed me to confront Joe more powerful than I would have dared to were I alone with him. I openly challenged his denial repeating for him his own description of the content of his experience. I bluntly told him that if this was an example of how he expected to deal with death that I was sure he would find his death hard, but that if he could recall his experience of the day before where he looked death right in the eyes and continues to do that, death should be kind and gentle.
Joe looked somewhat sheepish and asked that I got a little easy on him. He acknowledged that he could remember what had transpired the day before and said that it was so new and different an experience to him that he found it difficult to understand and accept. Nancy and I reassured him that the experience was genuine and worked with him by discussing the different aspects of the session. When Joe returned for his next interview he described to me that he dad been having a great time going through his tools. He said that for him one of the deepest pleasures of being alive was the ability to give pleasures to the others. He had gathered together all of his tools and made up three tool boxes. One of these went to his brother, one to his nephew and the third to the workshop of the blind. Joe said that it was plain to him through his physical deterioration that death was near he told me that this was no longer frightening and said he planned to spend as much time as he could with his family.
This was the last meeting I had with Joe. I tried unsuccessfully to reach him by telephone several times, but was informed that the telephone would not reach his bed. Joe's niece relayed messages from him sending his regards and she told me that Joe spoke so warmly of me she wished she could arrange another meeting for us. I told her that I would be glad to come out to the house and visit Joe. She said that Joe's sister was still trying to keep Joe's mother from knowing how sick he was. the mother had recently broke a hip and was bedridden in another part of the house. They therefore preferred that I not visit the household.
Joe died peacefully about two months after his drug session. One of the secretary's at the Research Center saved the obituary for me and I felt my body tingle and could feel tears welling up in my eyes as I read the headline: "MR. UNION DIES". I knew that Joe would have really been pleased by his obituary!
The experience with Joe was an especially meaningful one in my training. I gained insight into my own feelings and how they affected my conduct as a therapist. I marvel still at the amazing confluence of coincidences that allowed this event to happen. In looking at the session and the events that surround it I am struck by the blending of the meaning in each of our lives into a harmonious whole. I had my own, at times proud and arrogant, at times humble, goals for helping Joe to confront his fears and emotions through facing death, an experience that is one of the mysteries of human existence. How could a 22 year old young man such as I was feel that he could have anything to offer his elder facing such an enigma? My own training experiences with psychedelics had provided me the utterly convincing feeling of confronting death on many occasions. This gave me the conviction that although I hadn't physically died I knew something of the human emotions that surround such an event, how they might manifest themselves in a person, respond to the effects of a psychedelic and how I might manage them helpfully.
I needed for my own growth and development as a healer to confront death in many aspects, both in my own psychedelic experiences and in work with patients like Joe. A different experience at this juncture could easily have changed my area of interest. In order for this experience to be valuable it needed to be preceded by the series of sessions in which I confronted many aspects of my own fears and feelings about death. These sessions also involved confronting the fact that I grew up with the notable absence of a fathering figure. These factors added to the emotional import of this first experience with a dying person. I felt that in accompanying Joe through his treatment process I experienced him as offering me something a great value, a deep sharing of his wisdom as an older man reflecting on the meaning of his life. Certainly this is one of the more meaningful levels of the nurturing between father and son. It fascinated me that the process was mutually rewarding and beneficial, that somehow my need to listen, understand, and help joined with his need to tell the story of his life to produce an experience of deep meaning and healing for us both.
Most striking of all is the basic unity of the shared experiences around the psychedelic session. The way in which the inter-related factors of my own personal history and training combined with my prior relationship with Nancy Jewll, my developing relationship to each of us added together to create a complex set and setting for Joe's experience. It is not really Joe's experience or my experience or Nancy's experience but rather the amazing confluence of meaning in this session that proved moving and significant for each of us.
I think that such accounts such as this one must be a definite part of the reporting process in psychedelic medicine. The history and personality of all parties involved in a psychedelic session are relevant background to the experience that ostensibly unfolds only in the person taking the drug. In fact Joe's experience was not only psychedelic for Joe, but also for me and for Nancy even though we were not under the pharmacological influence of any drug at the time. We cannot reduce an experience such as Joe's to a set of before and after measurements and hope to justly report useful information. We do not yet know or fully understand all the elements that influence the process and outcome of experiences with psychedelics so we must try to bare our psyches and those of our subjects for there is no clear subject in these experiments and we must not prematurely dissect into components such exquisite experiences. We must first gather together enough of this naturalistic data that we allow a new and more comprehensive view of this process to emerge.
The need for sweeping revision of the paradigms that organize our approach to the clinical investigation of psychedelic drugs as significant elements in a complex process of human healing and transformation can be clarified by turning to mathematics. KURT GODEL brought a famous paradox from philosophy into mathematics and it seems to have relevance for research with psychedelics as well. GODEL'S theorem holds that the logical consistency and completeness of a system may not be assessed from within that system, in fact in order to assess such properties one must build another system from which to observe and assess the first. With this situation we may then make an assessment of the logical consistency and completeness of the first system but may not be sure of the consistency or completeness of the system that we are observing from. If one applies this to psychedelic research it becomes apparent that when researchers sought to apply previously existing conceptual frameworks to the startling new phenomenon of psychedelic drugs they influenced the results through mechanisms outside of their awareness at the time. The logical systems they sought to apply to psychedelics were incomplete, but they nonetheless served the limiting and organizing function described for scientific paradigms (KUHN, 1970).
Since these investigators had no vantage point outside the logical systems they sought to apply they were blind to the manner in which their own theoretical and scientific orientations were influencing the psychedelic experiences of their patients and subjects. When one looks from the vantage point offered by history it becomes apparent that this is how at least three differing and at times mutually exclusive views of nature, effects and possible usefulness of psychedelics came into being. Each system had ways for dealing with its competitors and each system had its own blind spots and inadequacies. What has been missing from our Western scientific approach to psychedelics has been the original awe and humbleness necessary when approaching an entirely new dimension, a new frontier in the study of the human mind and consciousness. Awe, wonder and open minded, open hearted description of the human experiences of all parties involved in psychedelic journeys with the quality of a beginners mind is what must be used to begin a new science of consciousness. Surely as we grasp the new view of consciousness and the universe that will emerge from these early naturalistic studies and their careful analysis our mind will distinguish new pictures, new paradigms, new views of human nature. These insights will lead us in turn to the development of appropriate analytic instrumentation and new research methods to reflect and enhance the detail of the emerging picture of humanity and its relation to the cosmos. In order to make the necessary conceptual leaps we will have to abandon our precious status as unbiased and knowledgeable scientists. We will lose little in doing this for psychology and psychiatry, the disciplines most involved in psychedelic research to date, currently tend to make poor use of research methods and techniques derived from l9th century physics. This subject object dichotomized view is simply not applicable to substance since it denies the basic unity at the core of any psychedelic experience and relies for validity on the presence of boundaries that are clearly transcended by the states of awareness possible when humans take psychedelic substances.
"Many great physicists over the years have become deeply absorbed in the role of the mind in constructing reality. Schrodinger, for instance, remarked that exploring the relationship between brain and mind is the only important task of science. He once quoted the Persian mystic Aziz Nasafi: 'The Spiritual world is one single spirit who stands unto a light behind the bodily world and who, when any single creature comes into being, shines through it as through a window. According to the size and kind of the window, less or more light enters the world.' Western thinking is trying to objectify everything, Schrodinger said, 'It is in need of blood transfusion from Eastern thought.' A Hindu sutra proclaims, 'There is nothing in the moving world but mind itself,' a view echoed by physicist John Wheeler: 'May the universe in some strange sense be brought into being by the vital act of participation?"' (FERGUSON, 1980, PP. 172-173).
The scope of substance is clearly interdisciplinary because of the many different disciplines can bring useful techniques and partial understandings to this new area of study. Disciplines that can both enrich the study of psychedelics and be themselves enhanced by psychedelic medicine include: anthropology, philosophy, religion, physics, psychiatry, ethnobotany, history, pharmacognosy, pharmacology, psychoanalysis, psychiatry, psychology, sociology. Psychedelic medicine may also be called transdisciplinary in that it can offer scholars and scientists more as a unique whole than does a simple collection of the separate insights from the individual disciplines that combine to form this new field.
The possession of a degree in allopathic medicine or any other existing discipline should not be taken as a qualification to practice psychedelic medicine, neither should such degrees disqualify an individual. Training in psychedelic medicine involves a series of explorations employing the technique of full disclosure reporting by all participants in the training sessions. Through the series of training sessions the trainee is exposed to progressively deeper layers of consciousness ultimately including profound experiences of a mystical-unitive nature. During this process the trainee will inevitably suggest modifications to the naturalistic method on the basis of their training and background in other scientific disciplines. Creativity enhancement has been documented to occur in properly planned and conducted psychedelic sessions. It is therefore reasonable to expect that trainees will gain creative insight into their own disciplines and psychedelic medicine in addition to experiencing personal and transpersonal insights into human condition. This training is conducted by a core training group of psychedelic therapists and the trainee is qualified for practise by a consensus of the training group.
The field of psychedelic medicine will eventually develop its own methodology out of the initial purely descriptive naturalistic phase that we must begin now. The basic paradigm of psychedelic medicine is that the psychedelic phenomenon can only be studied by methods which accept the basic unity of the process under study. Furthermore the study of human experience with psychedelic substances must always take into account the infinite value of the individual and must always seek to do justice to the human qualities of the psychedelic experience. This means that our techniques of study must not lump together different varieties of human beings and their experiences in such a manner as to efface the meaning and significance of individual experience. Much use of statistics in research studies with human subjects involves such lumping together of these scores across individuals without regard to differences. Though this may be necessary at a certain point it is not apparently useful at the beginning stages of investigation and in fact often obscures the meaningfulness of individual experiences and their relationship to psychological change and growth.
The profound challenge of conducting significant research with psychedelic and empathogenic compounds can only be met by creating a new discipline: psychedelic medicine. This new outlook allows us to overcome the existing paradigms which limit and confound scientific research with these substances. We are called to incorporate a quantum leap in honesty and completeness of scientific reopening in this research. Work in this area also requires that respect and empathy play a central role in the design and conduct of studies with human beings. And foremost, ways must be found to overcome the fear and misunderstanding so prevalent in our society's reaction to this new frontier.
1) This paper was originally presented to the second annual conference of the Association for the Responsible Use of Psychoactive Agents, Esalen Institute, Big Sur California, June 16th—22nd, 1985. (back)
2) The development of three competing paradigms for understanding psychedelics is discussed in detail and at some length in a prior paper: From Mysteries to paradigms: Humanity's journey from sacred plants to psychedelic drug (Yensen 1989).(back)
3) This shortcoming in the scientific literature is not merely some lack on the part of the psychedelic researchers involved, but the fact that in order to have reports of psychedelic research published researchers are forced to fit the presentation of results into the dominant paradigms held by editors and reviewers of scientific journals. (back)
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