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.
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.”