Psychedelic-assisted psychotherapy is widely talked about as a novel development within psychiatry, yet the ironic truth is that mind-altering substances have been used to promote mental wellbeing for thousands of years. And while the ceremonial ingestion of plants like ayahuasca in South America, peyote in North America, and iboga in Africa may seem a far cry from the psychiatrist’s couch, researchers are increasingly looking to indigenous cultures in order to learn how to utilize these potent medicines.
Inevitably, however, this attempted reconciliation of modern science with ancient medical traditions has thrown up a fair amount of cultural friction, which researchers from various disciplines are now trying to smooth over.
Set and Setting
Anthropologists studying the ceremonial use of psychedelic plants often write about the skillful manner in which shamans guide their patients into “managed altered states of consciousness”. Through the ritual manipulation of symbols, sounds, and other aesthetic elements, these traditional healers are able to steer participants’ visions and hallucinations in certain desirable directions.
Such techniques are routinely employed by indigenous healers at the Takiwasi Center in Peru, a world-leading treatment and research facility where traditional Amazonian medicine is combined with Western psychotherapy. The project’s scientific director, Dr Matteo Politi, told IFLScience that “most Western researchers who come to the Amazon and observe an ayahuasca ceremony would probably see the ritual itself as lacking in scientific value, and would not count it as a significant variable. But many of us within the field of ethnopharmacology consider ritual to be not just important, but absolutely fundamental to the outcome of treatment.”
A recent study of Westerners attending a similar mental health retreat run by indigenous ayahuasca healers found that 36 percent rated the actions of these shamans as the single most important factor in the improvement of their wellbeing. And while shamanic rituals may not be fully appreciated by conventional psychiatrists, it is widely agreed that psychedelic experiences are the product of more than just mere pharmacology.
Back in the 1960s, Harvard-professor-turned-LSD-evangelist Timothy Leary helped to popularize the notion of “set and setting”, which holds that the effects of psychedelics are largely determined by the mindset of the user as well as the environment in which they are taken, rather than the properties of the substances themselves. Adding some meat to these bones, a study published in 2018 concluded that psychedelics make people more receptive to environmental stimuli, probably as a result of their ability to increase neuroplasticity.
For this reason, set and setting has been incorporated into recent psychedelic trials. Typically, this is achieved by manipulating the therapeutic environment with low lighting and carefully selected music playlists. This last element is considered to be of particular importance, as research has revealed that music amplifies the capacity of psychedelics to enhance activity within the parts of the brain that process emotion.
“The recognition of the importance of set and setting represents a bridge between traditional healing and modern medicine,” says Politi. “However, if we want to develop this principle within modern contexts then we have to learn from the cultures that have been using these plants for centuries.”
Also located in the Peruvian Amazon is the Temple of The Way of Light, an ayahuasca retreat where researchers from Imperial College London are currently studying the efficacy of traditional healing techniques for the treatment of mental health. Researcher Adam Aronovich, who is involved with the study, told IFLScience that “when we interview people about which parts of the experience have the biggest impact on them, not everybody actually talks about ayahuasca straight away. Instead, a lot of people focus their narratives on the social aspect and shared togetherness, which all come under the umbrella of communitas.”
Another anthropological term, communitas refers to a sense of collective rather than personal identity, whereby members of a group come to see each other as one and the same. It is said to occur frequently in shared rituals during which social and relational structures are lifted so that participants are able to bond as equals. While the use of psychedelics is not necessary for communitas to arise, studies have shown that these substances tend to heighten emotional empathy and inhibit activity in the parts of the brain that process social rejection, implying that they may serve to enhance this experience of shared togetherness.
In this instance, communitas arises from undergoing intense and sometimes challenging ayahuasca ceremonies together, rather than individually. The substance itself is therefore key to the whole process, yet, Aronovich says, “for most people, the group aspect and the sense of communitas was a primary factor in their healing.” Likewise, a global study of people who have used psychedelics in group settings found that “communitas during ceremony was significantly correlated with increases in psychological wellbeing, social connectedness, and other salient mental health outcomes.”
Interestingly, another recent study concluded that people who get high and dance together at rave parties often report improved psychological wellbeing, indicating that the benefits of communitas can also be experienced outside of traditional settings.
And yet, all clinical research into the efficacy of psychedelics to treat mental health disorders has overlooked this aspect, focusing on individual treatments rather than collective healing through group bonding. Herein lies a major paradigm clash between modern psychiatry and indigenous shamanism, presenting a major obstacle to the marriage of these two contrasting systems.
A Clash of Worldviews
“Something that’s very ingrained in the Amazonian worldview is this eco-social understanding of interdependence,” explains Aronovich. “In indigenous traditions, there is no such thing as an individual in the same way that we take for granted in the west. We are all just nodes in a network of interdependent relationships. It’s a different way of looking at things.”
For those of us who have been raised as firm materialists, such an outlook can be difficult to understand, let alone accept. We are conditioned to see the world as populated by discrete, independent entities that can be neatly isolated from one another, whereas many indigenous cultures view the universe as one unified conscious system, in which everything is connected to everything else.
In line with this outlook, mental health problems are understood not as the product of faulty brain chemistry or personal psychological quirks, but as a symptom of misalignment with the encompassing whole. Healing, therefore, is typically a collective affair and is achieved by restoring the patient’s sense of connectedness to their community and wider environment.
Put another way, connection is healing, and communitas, therefore, is one of the greatest psycho-medicinal tools available to these cultures. Meanwhile, the Western scientific establishment is now paying increasing attention to the disastrous psychological and physical toll of loneliness, yet it stops short of recognizing mental illness as a symptom of the disconnectedness that is inherent to our modern worldview.
Because of this, collective rituals are not routinely prescribed by modern doctors to patients suffering from depression, anxiety, or other psychological ailments. As Aronovich explains, “in our Western medical culture, these problems have been completely individualized. So if you have depression, you take a pill and you hope for the best.”
Presenting the anthropological challenge at the center of this cultural juxtaposition, Politi explains that “we in the West must understand that our medicine is also an ethnomedicine, as it simply reflects our cultural worldview. There is no objective definition of health – we just think of ourselves as healthy or sick depending on our cultural perspective.” Thus, while we may limit our notion of health to the mere absence of physical or mental symptoms within an isolated individual, other cultures might take social and environmental connections into account before passing diagnosis.
Bridging the Divide
While most research on psychedelics continues to focus on pharmacology, a number of studies are beginning to recognize the importance of contextual factors. For instance, the Imperial College study taking place at the Temple of the Way of Light seeks to quantify the contribution of communitas to clinical outcomes, thereby bridging the gap slightly between two seemingly opposing worldviews.
At the same time, Aronovich insists that there is validity in both approaches, and that psychedelic-assisted psychotherapy can and should be adapted in order to be compatible with different cultures. “I’m a proponent of both the clinical design but also the ceremonial group component,” he says. “I think both of them are important and both of them offer unique functions.”
And while he says we must learn what we can from indigenous approaches to psychedelics, he recognizes that “it’s a bit of a stretch to impose a whole new worldview on people.” Rather than building therapeutic protocols around philosophies that “the majority of people in the West are going to find difficult to digest,” therefore, he insists that we’re better off “adapting these principles to create something that makes sense.”
Such an approach is likely to mitigate concerns about cultural appropriation of indigenous practices, yet still leaves room for the adoption of basic yet important elements like sitting around a fire and sharing one’s feelings with a group. As simple as this sounds, it may well be the key to psychedelic healing.