Mushrooms, Modern Therapeutics and the Psychedelic Renaissance

THURSDAY, 14 MAY 2020

Psychedelic drugs pervade popular culture, both secretly and overtly. From The Beatles classic, ‘Lucy in the Sky with Diamonds’, to the LSD tests that imbued Elle with her supernatural powers in Stranger Things, references to these mind-altering substances saturate music, literature, film and television. Despite being made illegal in 1966 as a symptom of the ongoing ‘War on Drugs’ initiated by the U.S. federal government, scientific research into the effects and uses of psychedelic substances has made a comeback to the mainstream over the last few decades. Changing public attitudes towards psychedelics and numerous decriminalisation initiatives around the world—including Denver, Oakland, Canada, and Czechia—are publicly invigorating a scientific field of enquiry long consigned to the underground. Current trials are investigating the pharmacology and therapeutic potential of psychedelics for treating a range of clinical issues, including PTSD,^[1] depression,^[2] addiction,^[3] and OCD.^[4] This so-called ‘psychedelic renaissance’ is garnering attention from researchers across the natural and social sciences, as well as the popular media.

The Psychedelic Renaissance, Western Medicine, and Clinical Trials

Derived from the Greek words psyche and delos, ‘psychedelic’ means ‘mind manifesting’: to make visible, or reveal, the mind. Humans have a long history of using psychedelics for medicinal, recreational, spiritual and other purposes with their use originating in Indigenous communities around the world. Psychedelics are compounds that induce altered states of consciousness, sometimes compared to waking dreams. They broadly fall into three main families of chemical compounds: the tryptamines (e.g. psilocybin and DMT); the phenethylamines (e.g. mescaline and 2CB); and the lysergamides (e.g. LSD). Out of these, psilocybin has gained particular attention from a range of researchers and drug advocates for its emergent potential for treating depression and other mental health issues. It can be found naturally in over 200 species of ‘magic mushrooms’ around the world. LSD, in contrast, is synthetic, and was first synthesised accidentally by Albert Hoffman in 1938. Despite this, there is no reason to suggest LSD would be any less effective in producing the desired clinical outcomes. Psilocybin’s preferability is related to its shorter acting time period—around five hours compared to eight hours with LSD—which make it more practical in a clinical setting. Moreover, LSD still remains negatively associated with the ‘hippie’ counterculture of the 1960s, making psilocybin more politically palatable, commodifiable and, ultimately (and perhaps unfortunately) profitable.

The story of how ‘magic mushrooms’ became popular in the west involves ethnomycologists, R. Gordon Wasson and Valentina Pavlovna Wasson. During a trip to Oaxaca, southern Mexico in the 1950s, they participated in a ceremony using psilocybin mushrooms led by Indigenous Mazatec practitioners. The Mazatec have been using these mushrooms in a sacred and healing context for thousands of years, referring to them as teonanacatl, meaning ‘god meat’. Their ability to heal derives from their sacred power to evade evil and disease and to keep people in relation with the divine. The mushrooms are also closely associated with the Mazatec people’s worldview in which humans and nature are inseparable. Mazatec ceremonies were originally held publicly but when prohibited by the ‘Holy Inquisition’, were forced to become more private and hidden.^[5] The Wassons were amongst the first westerners to witness and report on the effects of ‘magic mushrooms’, with their experiences being enshrined in the famous Life magazine article, “Seeking the Magic Mushroom,"^[6] in which the phrase ‘magic mushroom’ was first coined. It was only later that psilocybin became known to science for its psychedelic effects, when the Wassons and their colleague Roger Heim brought samples from Mexico to the laboratory and, with the help of Albert Hofmann (the “father" of LSD),^[7] isolated psilocybin and its psychedelically-active metabolite, psilocin.

The so-called ‘psychedelic renaissance’ marks a resurgence of interest by western medicine in the potential uses of psychedelic drugs for treatment of depression, addiction, anxiety and other mental health diagnoses. Since the research of Charles Grob and colleagues in 2011,^[8] subsequent studies have explored the use of psilocybin and LSD for treating patients diagnosed with end-of-life anxiety associated with terminal cancer. Delivered in single sittings and accompanied by counselling, treatments have had antidepressant effects and led to decreases in anxiety. The psilocybin research focus then shifted towards treatment-resistant clinical depression.^[9] Patients in these trials were each given a dose of psilocybin, accompanied by counselling and cognitive behavioural therapy (CBT) before and after their experience. The majority of patients reported improved mood and a reduction in clinical symptoms after three months, and over 50% reported that the effects persisted two-and-a-half years later. Early indicators from other clinical trials suggest that these effects are reproducible, with studies demonstrating improvements in patients’ emotional responsiveness, a decrease in pessimism bias, and more realistic future forecasting.

Addiction has been at the forefront of many preclinical studies investigating the potential therapeutic effects of psilocybin. Patients undergoing psilocybin treatment for alcohol dependence have reported a significant reduction in alcohol consumption after 36 weeks.^[10] These results were echoed in studies on cessation of tobacco addiction, where 10 out of 15 smokers administered with psilocybin combined with CBT were found to be clinically abstinent after 16 months.^[11] In 2018 social scientist Tehseen Noorani and colleagues provided a long-term qualitative follow-up to the pilot study finding long-term abstinence in nine participants.^[12] The study reported increased feelings of openness and interconnectedness, as well as an increase in altruistic tendencies amongst its participants as likely mechanisms for the drive towards abstinence from tobacco. These findings echo previous hypotheses from researchers at New York University and Imperial College London that suggested the experiential effects of psilocybin were the drivers of change. They also reported increased aesthetic appreciation and pro-social behaviours as positive side effects resulting from the treatment.^[13-14]

In the clinical setting, researchers highlight the importance of staging the trials in a controlled space after a full psychological assessment has been undertaken to ensure patient safety. Not properly facilitating a psychedelic experience (often referred to as a ‘trip’) may dampen the beneficial effects, and in some cases be harmful. These protocols for recent psychedelic research projects, however, are not in any way novel. The act of outlawing psychedelics in the ‘60s drove experimentation and research underground in western contexts, where today a wealth of expertise exists regarding their safety and efficacy in a range of clinical and recreational settings. The ‘overground’ of psychedelic research, according to Tehseen Noorani, is just a small island floating atop a plethora of underground usages that have been in existence continually since the ‘60s. For example, the importance of ‘set and setting’ amongst recreational users of psychedelic drugs in non-clinical spaces is common knowledge among ‘psychonauts’. Coined by Timothy Leary, ‘set and setting’ refers to the importance of ensuring the correct mindset and intentions before tripping, as well as curating a safe and responsible setting or space in which to embark upon the trip. Some recreational psychedelic users and advocates, like the late Terence McKenna, also support the use of psychedelics outside the clinical context for personal growth and exploration.

Importantly, however, the notion of set and setting itself extends back way further than the ‘60s, with roots in the ceremonial and sacred use of psychedelic plants and fungi by Indigenous Peoples. Ayahuasca ceremonies of Indigenous Peoples of the Amazon basin, including the Witoto (Huitoto) people of Colombia and Peru, are tightly controlled by shamans who guide the healing experience by mediating the relationship between participants, the medicine, and the spirit world. Thus, according to LisaNa M Macias Red Bear, “We can’t start [the] history of psychedelics in the ‘60s in the Americas. That needs to stop. We [Indigenous People] used this medicine before Jesus Christ walked this Earth."^[15] This points to the colonial and extractivist relationship between the west and Indigenous Peoples, in which sacred practices have been culturally appropriated and decontextualized whilst Indigenous knowledges have been systematically erased and ignored. Arguably, then, the novelty of research that seeks to investigate the medicinal and therapeutic uses of psychedelics could itself be troubled, as Indigenous Peoples have long established their therapeutic potential. Future research and use of psychedelics as a medical intervention should critically engage with questions of decolonisation and justice as their therapeutic value is increasingly acknowledged. Indigenous knowledges must not be dismissed or de-valued, but rather front-staged, as psychedelics undergo mainstreaming in the west.

History of psychedelics and Indigenous Peoples

‘Psychedelic’ is itself a western term, coined by Humphry Osmond at a meeting of the New York Academy of Sciences in 1957, and is largely associated with predominantly white recreational use. For this reason, many people increasingly refer to plant medicines as ‘entheogens’—meaning bringing forth the divine within^[16]—to refer to their sacrality and traditional use. This is just a small gesture towards a larger task of ensuring the recognition, inclusion, and support of and for Indigenous communities in psychedelic science. According to Tehseen Noorani,^[17] a starting point in the decolonisation of psychedelic science involves troubling the ‘medicalisation’ of these medicines. Medicalising psychedelics involves turning plants and fungi into capsules or other preparations to measure and control dosage whilst stripping them of their cultural context. These medicalising narratives simultaneously appropriate their traditional use without respecting their sacred significance, whilst missing important lessons that could bring benefits to all involved. For instance, there are many studies on ayahuasca and other plant medicines, but little research into the local knowledge systems and practices that are central to their use and meaning within Indigenous cultures.

Whilst westerns often view ayahuasca (and other psychedelics) as psychological tools or medicines of the mind, much evidence suggests that for Indigenous Peoples, the sacred brew plays a larger role in treating ailments of the mind and body, which are fundamentally connected: the mind/body.^[18] Moreover, they are more-than-medicinal for many people and communities. Amongst Indigenous Peoples of the Amazon, for example, ayahuasca is consumed during warfare, used for storytelling, for solving interpersonal conflicts, and for artistic inspiration.^[19] Ayahuasca’s ability to induce ecstasy, disembodiment and soul-flight to other usually unseen dimensions is harnessed to acquire knowledge of social and ecological importance from plant teachers, or other spiritual figures encountered during the experience. In Peruvian ayahuasca ceremonies, songs (icaros) are sung, leaves (chacapas) are waved, and smoke from Peruvian tobacco (mapacho) is used to create a safe space in which healing can occur.^[19] The tendency of science to decontextualise plant medicines comes from colonial stereotypes of Indigenous Peoples that depict their knowledges as non-expert, subjective and constructed in comparison to an objective and factual biomedical science. What is required, then, is a move towards acknowledging and supporting Indigenous worldviews and practices on their own terms as equal partners to scientific enquiry.^[18]

In some instances, western biomedical psychedelic science and traditional uses of psychedelics may not be reconcilable. The notion that a specific treatment is required for a specific disease is unique to biomedicine.^[20] As outlined above, traditional uses of plant medicines are often more holistic processes, focused on healing a person, relationship or community, rather than curing an individual(’s) ailment. This speaks to how western psychedelic use has been largely individualising, focusing on self-improvement and personal transformation, fundamental to the neoliberal model of subjectivity. These narratives, then, must be resisted if the social context and meaning of psychedelics are to be respected and taken seriously. Psychedelic science in the west is, after all, a part of western science more broadly. It therefore contains and reflects the same limitations, power structures, and systemic inequalities as western science in general, but due to its relatively recent revival could hopefully imbue itself with a decolonising ethic.^[21]

Narcotourism, psychedelic markets, and Indigenous Peoples

An increasing western appetite for psychedelic experiences accompanies the psychedelic renaissance in western medicine. This is having direct negative impacts on the lives and cultures of Indigenous Peoples for whom certain plants and fungi are a sacred and central part of community life, providing connection to the land and spirit world. The political narcoeconomies surrounding these plants have violent consequences in the Amazon, for example, where narcotourism is leading to fears about a shortage of the plants involved in the ayahuasca brew,^[23] which could make them unavailable to local communities. Proposed privately-owned ayahuasca plantations could also lead to further increases in deforestation and potential displacement of Indigenous Peoples. Not only does this prevent local communities from engaging in traditional practices, but it also risks them losing the ability to use these sacred medicines in the process of healing from ongoing colonial traumas. The inflow of capital generated by narcotourism and the emergence of new markets is substantially affecting local economies and power relations between people in the Amazon, too. Diné (Navajo) scholar, Belinda Eriacho, notes that when “engaging in a healing relationship with Native Peoples [therapists and other practitioners] should be aware of these fundamental aspects of the Native American culture. This includes trust/respect, confidentiality outside of the context of therapeutic setting, culturally based therapy that is inclusive of Native American traditions, and culture, and making efforts to gain an understanding of the culture with which one will be interacting."^[22] This message must be central to psychedelic science going forward. We must see the connections between the psychedelic renaissance in western science and the upsurge in popularity of these compounds in the west, which drives demand for native plants and fungi in Indigenous territories.

Shamans popular amongst westerners are sometimes looked upon unfavourably by other members of their communities, which in some cases has led to violent confrontation between rival ‘shamanic experience companies’ and community disputes. Sadly, this is not an unfamiliar tale. Maria Sabina, the Mazatec shaman who first shared magic mushrooms with the Wassons received backlash from her own community for bringing outside attention to their sacred practices. The international fame she received after the Wasson interview forced her to flee to the outskirts of her city, Huatla de Jiminez in the Sierra Mazateca, after her home was burned down, highlighting the violence and coloniality associated with the popularisation of psychedelics in the west. Sabina herself, as well as the Wassons and other western psychedelic writers, expressed regret that their work encouraged the influx of predominantly white, wealthy westerners into Indigenous communities in the ‘60s (especially in Mexico), which brought unwanted attention and has led to changing relationships with psilocybin-containing mushrooms amongst younger generations, some of whom are not finding a purpose in the ritual anymore.^[5] Many healers are now seen as celebrities to the dismay of local communities, a culture imposed on them by western tourists. This pattern is repeating itself in the Amazon with ayahuasca tourism. Efforts to prevent harmful forms of narcotourism should be at the forefront of decolonisation efforts related to psychedelics.

Recent reports find that psychedelic users are most likely to be young, white, single men with an above average income and level of education.^[24] This creates problems relating to the beneficiaries of therapeutic research into psychedelics, as most of those screened and assessed for clinical trials fit into the aforementioned demographic, with minorities and other disenfranchised groups playing only a minor role in the studies. Specific traumas experienced by marginalised groups are therefore absent in the current research, which could prevent the development of potentially helpful treatments for all, rather than a specific and limited subpopulation.^[19] Alongside Indigenous Peoples, the work of ethnic and racial minorities, women, and other disenfranchised groups is also regularly overlooked and often unsupported in the mainstream psychedelic literature, despite these groups playing a major role throughout the history of psychedelic science and experimentation.^[19] This is especially troubling as their work was, and is, often undertaken in the ‘underground’ and at their own personal risk. A growing risk of sexual assault has also been recorded by “some participants in ayahuasca ceremonies [who] have been sexually assaulted by individuals conducting or facilitating" the ceremony.^[25] The associated risks with psychedelic ceremonies must be prevented from the outset, and the role and inclusion of marginalised groups must be brought to the forefront when designing, recruiting for, and facilitating psychedelic studies that can benefit everyone. Encouragingly, MAPS—the Multidisciplinary Association for Psychedelic Studies—has recently begun to prioritise the enrolment of a ‘non-normative population’ (presumably, meaning more diverse), including those affected by race-based trauma.^[17] As well as this, the Detroit Psychedelic/Ethneogenic Conference recently gathered in inner city Detroit, inviting mostly speakers of colour from around the United States. “The list of presenters comprised almost entirely African American scholars, clinical herbalists, metaphysicians, authors, musicians, behavioural specialists, alternative medicine healers, entrepreneurs, midwives, and urban gardeners."^[19] Community action is being taken but there is still more to be done.

The future

The socio-political landscape surrounding these fascinating compounds is changing in the west. In May of 2019, Denver became the first US city to decriminalise psilocybin-containing mushrooms for more-than-therapeutic purposes,^[26] with other US states looking likely to follow. As the restrictions are relaxed and the positive results continue to be published in scientific journals, we can expect the use of these compounds to continue to spread into the clinic and further into popular culture, if Ari Aster’s latest film, Midsommar, is anything to go by. We suggest here, however, that the psychedelic renaissance must sensitively engage with the historical and cultural legacy of psychedelics, adequately recognising their medicinal, recreational, cultural, and sacred uses, if it is to reap benefits for all. Decolonisation of psychedelic science (and science in general) must be a priority to avoid the erasure of Indigenous knowledges and further marginalisation of Indigenous Peoples. The most important question remains, “If we’re really in the midst of a psychedelic renaissance, who are we leaving behind?"^[21]

Jonathon Turnbull is a second year PhD student at the Department of Geography and studies at King’s College. Andrew Malcolm is a second year PhD student at the Babraham Institute and studies at King’s College. Art by Sam Mills.

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