The Case for Psychedelics
Introduction to Hero’s Dose: The Case for Psychedelics in Ritual and Therapy
IN THE FOURTH century before the modern era, a student from the Hippocratic school made an observation that would reverberate through the millennia. Some people continue to deny his thesis today. This enterprising thinker pushed back on the popular notion that epilepsy is divinely created. Though the cause of this disease remained mysterious to his peers, he cautioned against attributing this or any ailment to the heavens. “Men think it divine merely because they do not understand it. But if they called everything divine which they do not understand, why, there would be no end of divine things!”
A fascinating proclamation in an era when diseases were believed to be stewed in a deity’s cauldron. Plagues were the handiwork of Asclepius and Artemis, not invisible viruses proliferating in unsanitary environments. Medicine always evolves. Today is only a stop to somewhere else. Hippocrates left behind an important legacy with his famous Oath, but the mainstay of his system, humoral theory, was abandoned long ago. That’s important because medicine is also complex. We need to carry forward what works and abandon what does not. Every generation has proffered cures only to discover their methods harm more than heal. Miasma theory. Bloodletting. Mesmerism. Trepanning. Antidepressants.
Let’s not get ahead of ourselves. We’re in no position to declare current mental health protocols are more damaging than beneficial. But we can certainly question how we’ve arrived here.
The massive increase in antidepressant usage is troubling. Between 1999 and 2014 there was a 64 percent uptick in prescriptions for Americans over the age of 12. By 2017, 12.7 percent of the US population received a script for an antidepressant; 19.1 percent of adults over age 60. Meanwhile, proof of the long-term efficacy of antidepressants, such as Zoloft, Prozac, Lexapro, and Cymbalta, has always been on shaky ground. One 2020 study found antidepressant users still experienced withdrawal symptoms, including continued panic disorders, depression, and sexual dysfunctions, over two years after quitting.
There are many questions to be asked, such as: Why do rates of anxiety and depression continue to increase even as more antidepressants are prescribed? Why does the health care industry make access to pills easy and the cost of psychotherapy prohibitive, even though the latter is shown to be as effective as prescription medication without damaging side effects? Is the notion of a “chemical imbalance” even valid? Why do psychiatrists often spend little to no time assessing a patient’s environmental conditions, focusing instead on neurochemistry? Given prior clinical research supporting the efficacy of psychedelics in treating mental health issues, why did our health care system abandon this promising field of research and demonize this class of drugs?
Medicine evolves, yet not always for the best. Antidepressants represent an important turning point in our understanding of mental health. But, as with everything today, politics and money were injected into the conversation. Psychedelics were falsely claimed to cause psychosis even though they’ve played a pivotal role in group cohesion for thousands of years. The traditional approach to medicine was simply different. There were no copays or detail of coverage in ancient Mesopotamia. Shamans were not in or out of network, nor were they incentivized to use this root instead of that vine. Medicine carriers were tasked with keeping their community together. That meant ensuring everyone’s heads were on straight, even when their minds needed occasional bending.
Psychedelic traditions spring up whenever and wherever the conditions are right, which includes always and the entire planet. Peyote-containing cacti and psilocybin-containing mushrooms sprouting across North America. Nightshades and vines in South America. A rainforest shrub in West Africa that will “break open the head.” Datura in Papua New Guinea, nutmeg in Indonesia, cannabis destined to be packed into chillums in Jamaica. Ergot and tobacco. Humans trip whenever possible with whatever resources are at hand. We love altering our consciousness. Wherever you find a DMT-containing flower or an evergreen bush packed with ibogaine, you discover rituals associated with their ingestion.
Psychedelic rituals play a critical role in the communities that create them. While these plants and fungi expand an individual’s consciousness, the social impact of ceremonial usage is equally important. Rituals bind members of a tribe together. They bind you to your environment as well. You no longer feel separate from all of the life surrounding you.
Psychedelics have been shown to quiet the brain’s network concerned with ego. Fear and anxiety involving the self dissolve. These plants and fungi dampen existential concerns. The oceanic feeling of unity so often reported while under their influence is healing. Rituals created around their usage teach interconnectedness. Mental health problems are rare when an individual feels connected to their community and environment. Such a holistic approach to medicine, one that defined the parameters of medicine for quite some time, is sorely lacking in our current health care system.
There is no singular cause for the outlawing of psychedelics. As with all complex topics, the journey from A to B has many turns, roundabouts, and roadblocks. There are a few clear reasons, however.
- Hallucinogenic plants and fungi can be overwhelming when ingested without trained supervision. You need guidance. The environment matters. Set and setting determine the experience. A bad trip is imminent if you’re unprepared. Sanctioned drugs are much different: take a pill and only call your doctor if there’s an adverse reaction. Little context is offered. Sadly, that sums up much of the system we’ve been born into and perpetuate. Don’t misunderstand: many aspects of modern medicine are wonderful. When discussing mental health specifically, however, our health care model is failing us.
- A toxic combination of xenophobia and racism has long fueled America’s drug wars. As the 20th century’s economic and militaristic superpower, the American government influences drug policies around the world. Previous administrations explicitly demanded that psychedelics be made illegal in foreign nations. Such legislation began with the intention of demonizing minorities and freethinkers in our country and has purposefully been spread around the planet.
- Capitalism plays a critical role. A marriage between the pharmaceutical and psychiatric industries with government agencies resulted in broad acceptance of the chemical imbalance theory. A concerted effort to promote lucrative drugs began shortly after World War II. Casualties included psychedelics and talk therapy, both of which show positive results in mental health treatment. These drugs, beginning with tranquilizers through to antidepressants, also initially showed promise. Yet they were never studied for long-term effects. Even worse, a worrisome number of studies promoting the efficacy of antidepressants are funded by pharmaceutical companies, which have a habit of throwing out data that doesn’t agree with their bottom line. This behavior is incentivized in our for-profit health care model.
- We’ve been taught every disease has a physical cause. This is true when discussing cancer or diabetes. Mental health is different. The impulse is to treat neurochemistry instead of rooting out the actual causes because chemistry has been mistaken as the cause. Antidepressants take weeks to begin working and can have detrimental long-term effects. They produce better outcomes in conjunction with psychotherapy, but the latter treatment is cost-prohibitive. Time is money. Psychedelic therapy depends on two atypical factors in the social media age: time and attention. These are low-dose medicines. Some advocates, such as ayahuasca devotees, ingest this medicine every two weeks with positive outcomes. A single dose completely changes others. The process of preparation, guidance, and integration demanded by the psychedelic ritual are considered laborious in American, where citizens are accustomed to taking a pill and moving on with their day.
This short list touches upon topics fleshed out throughout this book. The goal isn’t to sell you on psychedelics or dissuade you from a current pharmaceutical protocol. But you might question what you’ve been sold on.
HERO’S DOSE BEGAN as a memoir of my experiences experimenting with psychedelics, which started in 1994 while I was studying for a degree in religion. The connection between ritual substance use and religion makes perfect sense. Plants and fungi have long been used in ceremonial contexts. Hallucinogenic mushrooms and peyote predate Cortés’s invasion of Mexico. One became a guiding light for Native American tribes while the other served as an essential ingredient in Aztec rituals. Nightshade and Mandrake were mandatory in witches’ brews. Long pipes were invented to facilitate snuff sessions — shamans blowing hallucinogenic resin into the nostrils of their tribesmen. And where would we be without cannabis? Divine nectar in India, the milky bhang helped sadhus travel through the cosmos. Chinese shamans mixed marijuana with ginseng for potent prophesying. Herodotus wrote about a cannabis steam bath enjoyed by the warlike Scythians. Marijuana was discovered on Jewish altars dating back to the 8th century BCE. Even Buddha is said to have dabbled.
We only know what’s been recorded, which in the long arc of history isn’t much. Psychedelic usage certainly predates our earliest literature. Our ancestors would’ve never missed snacking on or smoking the hundreds of known hallucinogens. In a time when every plant or fungus could be food, adventurous culinary explorers put practically anything into their mouths. When a leaf opened their mind to the music of the spheres, they were certainly going to keep it in circulation.
The ingestion of psychedelics might even have preceded language. Psilocybin mushrooms are thought to have helped inform our special brand of consciousness. Terence McKenna believed psychedelics first caused metacognition, self-reflective thought, in humans. According to the ethnobotanist, our ancestors invented language to communicate thoughts about their psychedelic experiences, although to be fair his claim is disputed by anthropologists and linguists. If you’ve ever taken a hero’s dose, however, you can certainly imagine pre-lingual states.
Others speculate that religion itself only began after the discovery of psychedelics. Quests are common in religious practices. Flow states experienced during spiritual rituals stir up feelings of overwhelming beauty and interconnectedness. These sensations are inherent in the psychedelic experience. Your imagination is cracked open — a rite of passage for a creative animal. Eating a toad because you need food is one thing. Licking it to get high, quite another.
This is where memoir merged with research. I couldn’t ignore my longstanding anxiety disorder while writing about my psychedelic experiences. I suffered hundreds of panic attacks over the course of 25 years. Thankfully, I was able to overcome this disorder. Psychedelics played a pivotal role in the process of my healing. A brief period on antidepressants caused me to investigate my brain in more detail — the organ my doctor told me was suffering from a chemical imbalance. This spurred another question: How does an animal successfully evolve for millions of years only to discover its brain chemistry has been “imbalanced” the whole time? Something didn’t add up.
Anxiety is fundamental to the religious impulse. Religion is effectively a response to existential distress. Disentangling anxiety from the spiritual quest is impossible. That doesn’t mean anxiety has to become a disorder, however. There’s something troubling about a society that produces such stark numbers of emotionally aggrieved citizens. Considering the lackluster health care response to the growing mental health crisis of which I’m a statistic, therapy needs to be considered in any discussion of psychedelics. The ritual model might seem unfamiliar given the structure of our current system, yet it has much to offer.
The lessons learned during a psychedelic ritual become disciplines to implement during normal life. Discipline is the correct word. Psychedelics point the way. You have to walk there yourself. This makes psychedelics wildly different than antidepressants. Prescription drugs alter your brain chemistry to make you feel a certain way. They’re capable of blocking physiological reactions that corrupt your grip on reality. The problem of long-term side effects is one part of the story. More importantly, we have to address what they’re blocking — selective serotonin reuptake inhibitor. A drug that stamps out sensation also diminishes the incentive for self-reflection. It dulls motivation, a repeated complaint by long-term antidepressant users. Anxiety is like any drug: too much kills, too little is ineffective, but the proper dose taken in the right mindset can be a powerful motivator. Perhaps we need to ask why anxiety is useful instead of trying to block it out at every turn.
While you won’t yet find them on tap at your doctor’s office (yet), psychedelics are also prescriptive: they prescribe a course of action. Though they temporarily alter your neurochemistry, their long-term effects are negligible. Their healing powers are inextricably entwined with ritual. You can’t separate therapy from ceremony.
The time has come to move beyond trippy colors and machine elves. The true power of psychedelics resides in their ability to make you deal with emotional trauma. Anxiety isn’t blocked; it’s confronted. You ask questions you’d rather avoid, questions you’ve likely spent years or decades skirting. A mirror is turned back onto you. Every wrinkle and flaw is exposed. This isn’t as easy as swallowing a pill. It is, however, therapeutic.
We can’t escape anxiety. We can, as Søren Kierkegaard suggests, forge ahead in spite of it. That sentiment is the basis of courage, and we can all use a little courage right now. There’s nothing worse than feeling stuck. Psychedelics help you transform an obstacle into an opportunity. Your anxiety becomes fuel for action. As Marcus Aurelius phrased it, “The impediment to action advances action. What stands in the way becomes the way.”
Fear cripples only when you refuse to face it. Anxiety kept me suspended in a constant state of dread for an intense and prolonged period of my life. Psychedelics provided a framework for new possibilities. Nothing I’ve experienced makes me feel as connected to everything around me as this ancient ritual. In a fragmented and disconnected society, that’s powerful medicine.
INTRODUCTIONS ARE OFTEN written at the end. What you set out to accomplish at the beginning changes as you go through the process of writing a book. I realized shortly after setting out that I couldn’t honestly discuss psychedelics as potential therapeutic agents for mental health disorders without also investigating the drugs and protocols they’d replace. That rabbit hole made it clear that the monetization of mental health has damaged a lot of people, myself included.
I also realized that, as a journalist who has covered health and science for a decade, scientific illiteracy is a serious problem in our society. For that reason, this book briefly covers the history of medicine.
In some ways, this is two books that find a convergence point that strives for a better approach to psychiatry. Regardless of how quickly the psychedelics industry is advancing, no future is guaranteed. Given current trends, many are poised to continue spending years and decades of their lives dependent on pharmacological interventions for anxiety and depression without investigating their social and environmental conditions. Sadly, this is happening at younger ages. We don’t know the consequences of pharmacology on developing brains, yet we’re signing our children up for experiments they don’t deserve and probably don’t need.
While I’m excited about the recent interest in psychedelic therapy, as I believe it has the potential to positively transform lives, the overwhelming amount of money pouring into research means investors are going to expect a return — and to profit. Don’t get me wrong: investors deserve to earn money on their risks. I’ve worked for a number of tech start-ups and understand the tenuous world of investment. But the rushed trials on ketamine, which downplayed damaging side effects, force us to confront the same problem we’ve encountered with antidepressants for decades. If we want to successfully implement psychedelic therapy into a culture that’s been trained to fear these substances, we have to treat them (and the people who take them) with respect.
Let me be clear on this point now, as I know how dangerous writing about mental health is: some people benefit from antidepressant medication. I agree with Paul Offit that there’s no such thing as “alternative medicine.” As he phrases, it, “There’s only medicine that works and medicine that doesn’t.” Sometimes that medicine is an SSRI (most likely in conjunction with psychotherapy). Sometimes, an ayahuasca ceremony. And sometimes the placebo effect is the ideal prescription. I discuss this phenomenon near the end of the book, as it’s an intervention that needs to be studied in more detail. It’s also important to note that nothing in this book constitutes medical advice.
One of the most powerful placebos we have is language. Language is how we experience reality. The words we use have a profound impact on our lives. The language of psychedelics is empowering. The rituals devised around this medicine are holistic: the individual is always placed within the context of their environment. While the psychedelic experience can be intensely personal, the ritual is designed to support the individual as part of a community. Healing is never dependent on the substance alone. In fact, many “bad trips” occur due to poor leadership during rituals. Feelings of abandonment overwhelm them, which is why set and setting are relevant in psychedelic therapy.
In contrast, antidepressant medication begins with a sense of abandonment. You are the way you are because of brain chemistry gone awry. In conjunction with psychotherapy, these medications can be empowering, but doctors are incentivized to write scripts, not talk to patients for an hour. Stripped of the ceremony of dialogue, patients feel apart from their surroundings. They’re given a pill, often with little guidance, and are expected to integrate back into society.
It’s important to restate that SSRIs, SNRIs, benzodiazepines, and antipsychotics haven’t been tested for long-term effects. Extremely popular medications, such as Xanax — the benzo I was prescribed — are put into circulation after trials as short as four weeks. No wonder so many people suffer negative consequences. Even worse, there’s no universal tapering protocol agreed upon by doctors for patients that went to wean off these drugs. Physicians readily write scripts, but good look coming off.
We rightfully treat psychedelics as powerful — there’s no other way to describe an ayahuasca ceremony — and pills as if they’re benign, a little pick-me-up or calm-me-down. The latter is untrue. There is nothing benign about pharmacology. These drugs are, as journalist Robert Whitaker told me, creating actual chemical imbalances in our brains. When you start tinkering with your physiology, especially for conditions that often resolve after a few weeks or months on their own, you’re setting yourself up for a lifetime of dependence without the healing you were promised.
I’m not going to make a grandiose claim about psychedelics being for everyone. They’re certainly not. But I suspect a growing number of people dependent on antidepressants, or just anxious or depressed in general, or just curious about these longstanding rituals they’ve heard about, might learn a few things.
The language you use defines your outlook, which is tethered to your mental health. So much of how you perceive your everyday reality — your role in society and the environment you live within — is defined by the stories you tell yourself about yourself, and the words your culture uses to describe you. Something as simple as a sentence can make the difference between an anxious and depressed existence and an empowered and confident life. Are you a part of your community or apart from it? Do you feel supported by those around you, or are you the sole structure trying to hold up weight you were never built to support?
The drugs you take and society’s feelings about those drugs also matter, whether caffeine or steroids or antidepressants or psychedelics. Every substance speaks a language that contextualizes your perception, that helps define you.
No hero is an island. We all need one another. Let’s find a language to support that reality.