Bureaucracy and Psychedelia

I wonder what will become of psychedelia. After a lifetime’s banishment from the clinic the substances we care for, and often venerate, have returned to the framework of grant funding and legal sanction. I don’t think this is a thing to fight but I do think it’s a thing to think about.

I’m grateful. Seeing how these substances operate in the brain, however limited the experimental apparatus is, verifies the radical alterations that can come about by way of numbers and pictures. We can stare at the relics of gnostic experience and codify the realization that when everything else is gone, love remains.

Thus, the introduction of psilocybin to the regulated space of the clinic makes it at once more accessible and less mystical. In some senses the barriers to entry will be lifted.

It is possible, even likely, that patients in formal medical settings will have an experience dissimilar from those of the freaks and weirdos of drug nerd culture. They will receive a capsule or some other vehicle for a chemical many steps removed from the organism that provides the blueprint. Dosing will be reliable, no longer prey to the unpredictability of indole content summoned by a living thing. They will lie down. A social worker will sit there for hours. A med tech will likely check their blood pressure, not because of any dangerousness posed by the substance, but out of the danger posed by litigation.

One of the curious things about the new paradigm will be the erasure of the chemical baeocystin. Though it appears in far smaller concentrations than psilocybin in the mushroom, it moderates the experience, playing far up the fretboard over psilocybin’s heavy percussion.

I am reminded of a passage encountered in a biography of Maria Sabina, patron saint of psilocybin, martyred by Americans in their thirst for recognition: After her encounters with Anglos she no longer understood the language of the mushroom. It ceased speaking in her indigenous language and began speaking English. (One of the more interesting things about this is that in addition to Alvaro Estrada, R. Gordon Wasson, the man most responsible for the theft of her skill, participated in the writing of the book in which this statement is recorded).

There’s an ethical concern I have, or perhaps just an aesthetic consideration, and it relates to the comment above. We can’t pretend to know the nature and span of human interaction with the organisms that give rise to these medicines, but we can assume it is a long one. It is a very important and precious beckoning between two species. I don’t want humanity to have learned fungi’s most precious technology (this being their chemical language) and then cast them aside. But I might not need to worry about this.

For all the promise of psilocybin we can safely guarantee that it will be subject to rigorous gatekeeping. Medicine is suspicious of anything it prescribes that a person might enjoy. We still operate in a paradigm where cures can’t be pleasant and for many reasons the use of antidepressants will persist, promising flaccid penises and weight gain rather than a four hour experience of boundlessness.

And the ubiquitousness of SSRIs and SNRIs will pose a serious problem for the use of psilocybin in the clinic- they severely curtail the ability to experience the therapeutic benefits of and they’re profoundly difficult to withdraw from. Even for those who experience no relief from psychiatric medication the withdrawal can be miserable. It will be a double-bind: Withdraw and get more depressed to use a treatment that will hopefully make a person less depressed.

Anyone who follows what I have to say, and there aren’t many, will have been reminded ad nauseum, of the fact that I have been taking intranasal esketamine for over a year. It’s fine. It’s been helpful. But it has none of the pleasure or mystery of mushrooms, none of the interactivity. It is like watching a movie that can be terrible or beautiful depending on a number of factors.

I talk with the psychiatrists in the clinic about the changing paradigm. A doctor I don’t interact with frequently was administering last week. I asked her what she thought the future held for psychedelic therapy and she answered that she couldn’t imagine the hospital administrators that she was familiar with being alright with any treatment that required four hours of supervision. It’s cheaper to give people pills and it’s even cheaper not to see them at all. Insurance loves psychiatric medication. It qualifies as care (even if it doesn’t work) and costs very little to administer.

I wonder how this will play out. I can see a number of broad scenarios. The first of these is that psilocybin will be relegated to the same paradigm as ketamine: It will be ostensibly legal, but owing to a reluctance on the part of insurance providers to approve claims for its use it will become a boutique therapy for practices that charge desperate people exorbitant fees. Those who need it most won’t have access, and those who can afford it won’t be able to afford it after a single session. Thus, the grey and black market sale, trading and gifting of mushrooms will expand.

Another scenario, and I see this playing out in the few cities and states that have decriminalized the substance, is a proliferation of integration therapists who assist experiencers with aligning the lessons and feelings encountered in a psilocybin experience with their passage through ‘consensus reality’. (As stated in so many other pieces of writing, I hate this term. None of us have been given any say in the construction of reality.)

I understand and have sympathy for the people already delivering this service. Work is terrible, and some work is more terrible. Making your living untangling the mystery of a life-changing experience is far preferable to working at Starbucks. However, if this becomes the therapeutic paradigm for psychedelics, another gross dynamic emerges in which ranks of professionals (who can afford a formal education) will march into psychedelia with their guns aimed at individual practices and community settings.

In our society therapy is administered by credentialed practitioners, who are either psychologists or social workers (who take their modalities from psychology as a discipline). While there are exceptions, on the whole I find psychology to be a quackish scam oriented around confirming the pre-existing ideological positions of the researcher. Should we arrive at a time where our already existing cadre of professional helpers brand themselves as ‘psychedelic therapists’ we will arrive at another professionalization that pulls psilocybin the ‘quasi-commodity’ firmly into the accounting of formal, legible economics.

My own biases are written all over these concerns. While plenty of people derive benefits from therapy, I feel strongly that a right to housing, food and education would do a great deal more to mitigate suffering than a lifetime on a couch. To internalize the misery of the world through a repetitive framework of acceptance does nothing. It does less than nothing. It is harmful.

Despite my concerns regarding the emerging paradigm, I have to acknowledge that the regulation of psychedelics has always been inevitable and omnipresent. But we have to demarcate what regulation means. After so many hundreds of years of all-encompassing bureaucracy the citizens of planet earth expect that it entails licensure, litigation, criminal justice and the application of metrics at every point along the way.

In response to this, I reply (to myself) that a social regulation of psychoactive substances has always existed in the form of taboo, shunning, oral tradition and gossip. We are used to not thinking about this as a form of regulation. We are so used to being told what to do that we assume that humanity will devolve into a depraved and violent free-for-all in the absence of someone who will tell us ‘no’ and kill us if we don’t listen. Psychoactive substances have always had ‘rules’ to mark the boundaries of acceptable use.

While we may not get a choice, I would vastly prefer a well conceived and widely understood ‘social’ regulation of psychedelics on the part of users, producers and practitioners to the framed diplomas and requisite credit hours that will come into play with the introduction of these substances into formal medical practice.

For those who consider the mushroom to be sacred, it is worth considering that the religion of our era is Cartesian science, but as with so many faiths, we are lapsed Cartesians. We cheat all the time, calling on it when it’s useful and pushing it aside when it’s not. Many of us who are involved in psychedelia perform a sort of weird Catholicism in which we allow our hopes, dreams and fully formed ideas into this model. We love the neurological investigation of the mushroom experience just as much as we like to think about its spiritual significance. These modes of thought aren’t incompatible or mutually exclusive, though they are contradictory.

So we approach a hybrid moment in which medical practice, good time party drug and religious sacrament co-exist, and for now I think that’s about as good as it’s going to get.