It's a Saturday in Charleston, South Carolina, and Tim Arlet is thinking about doing ayahuasca for the thirteenth time. He knows a Peruvian shaman who comes to the United States to hold ceremonies, so it's easy enough for him to sign up and go.
But two years ago, after Arlet heard about the drug on the podcast The Joe Rogan Experience, the only way for him to do it was on a trip to the Amazon. He decided to go.
Arlet and 27 other people flew from Lima, the capital of Peru, to Iquitos, a large city that often serves as a gateway into the jungle. From there, they were driven in a large van to the Amazon river. They then took a boat and walked about a mile and a half to a retreat center, where they stayed for two weeks. In fourteen days, they drank ayahuasca seven times.
"I had these hopes that this mind-altering psychoactive substance could reset my brain somehow to get me beyond these anxieties and mild depression, my kind of discontent with life," Arlet says. "I had never done a psychedelic before."
When he got home to Charleston, he realized his perspectives had shifted, but everything he left behind was the same. None of his friends had done ayahuasca and they chalked up his trip to him just being "crazy" as usual. His father was supportive after he explained how desperate he was for a change, but didn't understand the experience. And he couldn't tell his mother, because, he said, "she would have been entirely too consumed with fear and worry."
That's how Arlet found himself one winter evening after his journey knocking on the door of The Oak Barrel Tavern in Charleston before it had opened. He had come to track down the one person he knew of in the city who might understand what he was going through.
Raven Ray had also been to a retreat center in the Peruvian Amazon seeking relief for her existential angst after hearing about ayahuasca on National Geographic. By coincidence, the wife of Arlet's chiropractor had recently spoken to Ray about ayahuasca and recommended Arlet seek her out.
"I was questioning if I was wrong to go [to the Amazon] in the first place without any preparation," Arlet says. "I was hoping [Ray] could give me some insight into my experience."
Arlet had done hardly any research before taking ayahuasca, because he was concerned that reading about difficult trips would taint his own. He spent his first ceremony in the Amazon in the fetal position, paralyzed by fear of the unknown and praying he wouldn't have hallucinations. By his last ceremony, he was sitting upright with a newfound courage to take on life's challenges. But upon returning, he found himself "still stuck," and struggling. Had he drunk too much ayahuasca? Not enough? And how could he hold onto the insights that he felt slipping away? He was full of questions and uncertainties.
Despite the growing body of research on the potential of psychoactive substances to help with anxiety, depression, drug addiction, post-traumatic stress disorder, and a variety of other psychiatric conditions, there continues to be a limited number of clinical trials in the US in which people can legally take these drugs. Thus, Americans like Arlet, who have had little success with available mental health treatments and think a psychedelic might be the answer, are left to their own devices.
Many people, including Arlet, who choose to do ayahuasca, peyote, and other psychedelics with an indigenous shaman find it meaningful, preferring it to a clinical setting. But they then return to their everyday lives where there are not always readily available resources to help them make sense of these intense experiences.
Therapists who have been working with psychedelic users for decades say it's natural for there to be a period of acclimation after a trip. In fact, it's widely accepted among experts in the psychedelic community that the most challenging trips can also, ultimately, be the most therapeutic. But there are also occasional instances in which these drugs uproot something traumatic—a damaging childhood experience, for instance—and the user is left feeling unsettled for months, or even years, without professional help.
There's no data on how many ayahuasca ceremonies take place each weekend in the US and abroad, but, cultural anthropologists and therapists in the psychedelic community say it's in the dozens at the very least. And it's not just ayahuasca people are using: A data analysis based on the 2010 National Survey on Drug Use and Health estimated 17 percent of Americans ages 21 to 64 have used a psychedelic at some point in their lives.
A similarity across all psychedelics, says Neal Goldsmith, a psychotherapist who studied mental health policy for Princeton University, is that they "allow you to see stuff that's already inside of you" such as painful memories, self-destructive behaviors, and unhealthy dependencies. This, he says, can be extremely difficult if a person isn't ready to confront themselves.
This is part of the reason preparation is built into the clinical trials at Johns Hopkins University, New York University, and other sites around the country doing government-approved psychedelic research. In the psilocybin mushroom trials helping cancer patients with anxiety and depression, for example, researchers tell participants that they may have to work through deep fears while tripping. Afterward, they meet with a therapist to process what happened, a step that researchers say is an important part of their positive outcomes. In contrast, when a person chooses to do a psychedelic on their own, they're often left to find their own support system. And it's not always readily available.
A few months after meeting Arlet, Ray founded the AfterCare Project, one of the first initiatives in the country dedicated to connecting people who have taken ayahuasca with mental health professionals. She has a list of more than 70 therapists in the country who are doing some form of what's called "psychedelic integration therapy." They're helping people use the insights they received on LSD, psilocybin mushrooms, MDMA, ayahuasca, and other psychoactive substances to maximize their personal growth. They also meet with people who are thinking about taking a psychedelic.
Ray says she's been contacted by dozens of people who feel overwhelmed, restless, or some other kind of emotional distress following an ayahuasca ceremony. Severe but rare reactions include panic attacks, insomnia, and chronic fear. Another symptom can be depersonalization, or a sense of detachment from reality. Sometimes this is brief while a person is re-acclimating to their everyday life. Other times, a person's ideas about who they are—their professional purpose, their intimate relationships, their lifestyle—can dramatically shift. In the worst-case scenario, if a person is suffering from extreme distress following an intense trip, integration therapists agree it's important for them to see a mental health professional with psychedelic expertise who can distinguish between a psychiatric condition and just challenging symptomsthat will likely pass.
A year ago, the first major psychedelic drug support center in the country, The Psychedelic Continuing Care and Education Program, was founded in New York. "We weren't like, 'Oh this is already happening and we're just going to give it a name and get people to pay us,'" says Katherine MacLean, a former Johns Hopkins University psilocybin researcher and director of the Continuing Care program. "We were like, 'I don't think this is happening for people.'"
The program, facilitated by MacLean and Ingmar Gorman, a doctoral student in clinical psychology, includes a wide range of psychedelic experts across cultures, from shamans to licensed clinical therapists. It's important, MacLean says, to include the perspectives of indigenous healers from communities who have been using psychedelics as medicine for millennia.
They offer individual therapy and monthly integration circles where there's an emphasis—as there is in much of the psychedelic community— on individuals tapping into their inner healer. Integration can include yoga, journaling, meditation, listening to peers discuss their psychedelic experiences, or listening to music from their trip.
MacClean says even just doing a short meditation in the integration circle can cause intense flashbacks. The group normally has 20 to 30 attendees. She estimates about ten percent of them talk about unresolved feelings from their trips, sometimes that have been lingering for years.
The participants begin by closing their eyes as MacLean, in a slow, monotonous tone, asks them to notice where they feel their breath most strongly in their bodies. "Recall a single psychedelic experience," she says. See the visions again. Hear the sounds again: the sounds of nature or music or conversation. Invite your organs to re-experience the sensations. "Did your body feel expanded? Uncomfortable? Maybe you were too warm or too cold."
Entheogen Research, Integration and Education (ERIE) holds similar monthly circles in the Bay Area. There's also a number of integration circles that are being facilitated by alternative healers who have had psychedelic experiences. It's impossible to know how many of these events are happening nationwide, but the majority take place in California and New York.
This leaves people like Arlet with few options for integration. He says he's grateful to ayahuasca for making him feel less broken, but it also awakened a nagging desire for personal and spiritual growth. And he says he can feel isolated or even judged by society for prioritizing this desire over professional ambitions.
Arlet used to be a social worker helping people with special needs, but now he works by himself in a large Good Will so that he has ample time to work on his own integration practice in-between donation drop offs. He spends most of his downtime listening to mindfulness podcasts such as The Drunken Taoist and reading the Psychonaut Reddit board. He's been told by a number of psychedelic users to meditate, but after two years he still finds it extremely difficult.
The closest he's come to finding a community who understands is a Meetup group in his hometown of Pittsburgh, Pennsylvania. He doesn't have much time to go there, though, between work and taking care of his mom in Charleston. "I'm trying to do the work," he says.
The concept of 'the work' (or integration) was introduced to Arlet just before he left the Amazon. The people running the retreat center kept talking about it, but, he says, he never quite understood what they meant and he's still not sure he does.
Shamans based in the United States will often give their cell phone numbers or email addresses to ceremony participants in case they need help after taking ayahuasca, but psychedelic integration therapists unanimously agree that the ceremony facilitators don't have the bandwidth to provide the support Americans often need long-term—nor should they be expected to.
"The history of sharing and analyzing is meaningful in a Western context, but in other cultures it is not necessarily a rule," says Bia Labate, a cultural anthropologist who has worked on 17 books related to shamanism and drug policy. "I think integration means a lot to a lot of people and is very important in certain contexts, but from an indigenous perspective, mystery, silence, invisibility, is also important." The amount of integration resources at retreats in South America varies widely from places with virtually no follow up to centers facilitated by psychologists who vet applications.
Edward Hillard Deull has been providing emotional support during ayahuasca ceremonies in South America, and legal Kambo ceremonies in the US for about four years. He says he knows the shamans he works with "mean it" when they offer their personal information, but that he's sad to see there's been a decrease in the proactive integration offered after ceremonies. He's spent countless hours listening to people who are disoriented or upset after taking a psychedelic. "I find that people can feel very alone and very lost and excluded" says Deull. "You're not meant to walk alone after that, you're meant to be with a tribe."
Deull now places more emphasis on integration than the ceremonies themselves. He holds sweat lodges, integration circles, and storytelling nights in San Diego, California, where he says he's seen significantly more transformation in people who commit to finding an understanding community after their psychedelic experiences.
Ray says one of her primary motivations for founding the AfterCare Project was to inform people that ayahuasca is not a "quick fix." This misconception, she said, can lead to "spiritual addiction," in which people are taking psychedelics regularly with unrealistic expectations that they're a panacea.
"I feel like on some level, there's this resistance to wanting to do the hard work afterward," MacLean says. "Or maybe it takes away from the mystique of psychedelics. You want to believe that once you're done with the trip, you've got everything that you need and to have to actually do something in your everyday life to work with that material. It takes that magic away."
Some psychedelic researchers and therapists say, ideally, integration wouldn't even exist as its own discipline. Integration would be a part of a larger process that includes preparation for the drug, taking the drug, and then working through the experience with support. "If it were not illegal, I would do the entire process from beginning to end," says Goldsmith, who has been helping clients integrate psychedelic trips for more than twenty years.
Since most psychedelic drugs continue to be federally classified as Schedule I substances with "no currently acceptable medical use," though, Goldsmith is left with few options. He tells his clients: "If you're going to use a psychedelic drug, make an appointment with me for the day after."
There's no data on how many people in the US are currently choosing to take psychedelic drugs on their own, but MacLean says she and her fellow researchers at Johns Hopkins used to get emails constantly from people saying: "I'm desperate, I'm suffering. I want to try psilocybin or I want to try MDMA and who do I talk to?'" Eventually, many of her colleagues, unable to help, just stopped replying.
It's unfortunate that not everyone can get into trials, MacLean says, because a part of the protocol is screening applicants to determine whether they should take a psychedelic at all. Experts agree that it's not the right decision for everyone. It's well-known in the ayahuasca community, for example, that the brew can interfere with SSRIs, a class of antidepressants.
The Psychedelic Continuing Care and Education Program hopes to soon roll out a two- or three-day workshop for medical professionals outside the psychedelic community. They envision a society where general practitioners, emergency room teams, and all therapists can do "acute integration," meaning they understand the basics of how to address someone during or after a difficult trip.
Arlet recently tried mushrooms and LSD for the first time. He says they helped him reset his perspective, but he still finds that "it's entirely too easy to fall back into your routine." He keeps intending to get into yoga, but when he tries he feels uncomfortable. He ordered a bunch of religion, philosophy, and psychotherapy books for his Kindle, but he's been unable to make any headway on them. He's also heard writing can be helpful, but he's discouraged because it doesn't come naturally.
"I would like to support others as much as I want to be supported," he says. "Unfortunately, there's not much here in Charleston."
Update 1/9/17: An earlier version of this story misspelled Catherine MacLean's name. It's MacLean, not MacClean.