Genocide & Magic, a Psychedelic Constellations reflection by Danielle Hererra, AMFT
Psilocybin is not a typical mental healthcare treatment. It's not a magic bullet or a brain reset. Undergoing psychedelic treatment requires a lot of courage from patients. The experience can open their eyes and thrust them into whole new worlds. It can make people much more open, sensitive and aware. It can be destabilizing. This puts tremendous responsibility on providers to commit to an ethical approach. As psychedelic research and treatments scale, we must not allow their essence to be watered down or corrupted, or these treatments may become ineffective, or even worse, fraught with risk. My hope is that three values intrinsic to psychedelic therapy will be integral to the field at large. These are acceptance, connection, and embodiment. Being guided by these principles may help us navigate the exciting and turbulent seas that lie before us as we bring these treatments to more people.

In treatment, acceptance means not trying to run away from the difficult things that arise. You sit with them, you stay with them, you go 'in and through'. Acceptance has meaning for all who are invested in providing psychedelic care. The clinical complexity of this work can overwhelm even experienced providers. We are still at a very early stage in the research, and I am only just starting to appreciate that psychedelics really are non-specific amplifiers rather than inherently benign, and the commitments required of those who provide them. There are significant risks around boundaries, and we need to be talking much more about what happens to patients months after the treatment has ended. Sharing of expertise, seeking expert supervision, and admitting our limitations and mistakes are all essential for the psychedelic providers of the future to be able to say a strong 'yes' to sitting with complexity.

As clinicians, we will face situations we may not be ready to deal with, or we are not experienced enough to navigate effectively. It can feel vulnerable to say "I don't know what's going on here." And yet admitting that — accepting that — is part of the hard and essential work. To not do so is not only unethical, but carries significant risk. We must reflect on the kind of shared structures we need to safeguard this work, and commit to an honest evaluation of how competition and profit will complicate our efforts to embrace and respect complexity. My sense is that we need to build slowly and steadily, laying strong foundations of shared expertise and accountability. Acceptance means not just focusing on the shiny side of the coin, publishing and discussing the best results. We must acknowledge the challenges that come with providing psychedelic treatment. We must accept them, stay with them, go in and through.

In treatment, connection is the feeling of the integral oneness of self, other and world. In the psychedelic field this value is our connection to the people who have been doing this work for a very long time, either in the underground or as part of indigenous culture. Connection includes gratitude for their work, and an acknowledgement that while we're working within different models, there needs to be space for respecting each other, learning from each other, and sharing power.

Psychedelics are such enchanting and mesmerizing tools, and those entrusted to administer them to others are exposed to the lure of power and prestige. We can learn a lot from those people who, in various contexts, have been able to work with these medicines without falling prey to ego-inflation and greed. The ecosystem is full of traditions around psychedelic practice, and as we learn and grow, we need to develop best practices, to develop our skills, to research how, when, where, why, and to whom psychedelics can bring positive outcomes that benefit the collective, not just the few. It would be a tragedy for psychedelics to exclusively be a medical treatment in hospitals. That is not the only way, and it's not clearly the best way. In the field at large, connection means appreciation, learning, and power-sharing between the different contexts of use across the ecosystem.

In treatment, embodiment is the somatic aspect of therapy, and the process of living the learnings in life after the session. This is integration. Embodiment for the field at large means integrating the values we have had clarified for us by our own personal and professional interactions with psychedelics, and letting those provide the principles that guide our work. Fundamentally, these values will be different for everyone. The important thing is that we bring them to our work in the field. The values that we pledge must be embodied or they are useless, and I hope that we can develop strong methods for holding each other accountable, and increasing transparency. We must decide on what we want psychedelic care to look and feel like, and be prepared to make the personal and professional sacrifices required to safeguard this vision. Embodiment means using the insights we are given to not just improve our own lives and families, but to improve the environment we live in. It means working in service of contributing to the ecosystem, to the whole.

The substance is not the medicine. The substance should not be the business either. The substance calls us forward to a new type of care, where acceptance of pain, connection to each other, and embodiment of our values guide the way we behave. COVID-19 will add new layers of trauma to a world where there is already so much pain. In this time of global suffering, it is humbling to think that the medicines we work with could help. We have an opportunity to contribute. With it comes the extraordinary responsibility to do it right.
Accept, Connect, Embody
By Rosalind Watts
Rosalind Watts has served as the clinical lead for the psilocybin for depression study that just completed at Imperial College London.
For further reading, Ros recommends, "Ethical Challenges Within Psychedelic Medicine," a piece by Alicia Danforth, published by the Interdisciplinary Conference on Psychedelic Research.

This piece reflects the perspective of the author, independent of North Star, which serves as a platform for the message.

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