Abstract
The past two decades has seen a significant increase in both popular and scientific interest in psychedelic substances and plants as therapeutics for mental illness, addictions, and psychospiritual suffering. Current psychiatric practice privileges a biological paradigm in which the brain is considered the locus of mental illness and symptom-focused treatments are delivered to patients as passive recipients. In contrast, a psychedelic healing paradigm, constructed through examination of different ontologic understandings of plant medicines, is based on a complex multidimensional perspective of human beings and their suffering. This paradigm actively engages the sufferer in addressing root causes of illness through healing on multiple levels of existence, including spiritual and energetic domains. Numerous theoretical, methodological, and ethical challenges complicate the integration of the psychedelic healing paradigm into psychiatric practice. These include developing coherent therapeutic narratives that account for the complex processes by which psychedelic healing occurs and overcoming reductionist tendencies in the medical sciences. Tasked with overcoming such challenges, a model clinic is proposed that seeks to implement and study the psychedelic healing paradigm in a critical, interdisciplinary, and reflexive manner. Such “critical paradigm integration” would employ multimodal patient formulation and treatments, as well as a range of knowledge generation and sharing practices. Outcomes-oriented research would seek to establish an evidence base for the model, while critical dialogues would advance understandings of psychedelic substances and plants and related practices more generally. The clinic would serve as proof of concept for a new model of studying, conceptualizing, and treating mental illness.
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Notes
- 1.
A note about terminology: There are currently debates about how psychedelic substances or molecules are similar to or different from plants or plant-based preparations containing psychoactive (as well as other) compounds. The latter are commonly referred to as “plant medicines” by enthusiasts and some academics. The nuances of this debate are beyond the scope of this chapter, which will give preference to the more neutral and inclusive term “psychedelic substances and plants,” as most points being made about psychedelic healing apply to both.
- 2.
Effective clinicians may also imbue these treatments with additional meaning and target patient expectancy in order to boost the placebo effect of the intervention.
- 3.
By energetic, I refer to Eastern conceptions of physiology and pathophysiology involving energetic channels, meridians, and centers (or chakras), such as in traditional Chinese medicine or Ayurveda, as well as shamanic notions of energy.
- 4.
Details of this approach will be discussed further in the second half of the chapter.
- 5.
“Target engagement” refers to verification that the intervention has had the predicted effect on the target (National Institute of Mental Health, 2013). This has recently become a requirement to receive grant money from the National Institute of Mental Health (NIMH).
- 6.
This kind of work is being conducted by the Nierika Intercultural Medicine Institute (Nierika, n.d.).
- 7.
Rescheduling of a substance requires demonstrating therapeutic efficacy through large-scale, randomized, placebo-controlled clinical trials in which the substance itself is isolated as the variable that leads to changes in therapeutic outcomes while controlling for all other variables.
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Sloshower, J. (2018). Integrating Psychedelic Medicines and Psychiatry: Theory and Methods of a Model Clinic. In: Labate, B., Cavnar, C. (eds) Plant Medicines, Healing and Psychedelic Science. Springer, Cham. https://doi.org/10.1007/978-3-319-76720-8_7
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