An x-ray skull surrounded by psychedelic mushrooms, praying hands, and sun beams.
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Psychedelic Therapy Needs to Confront the Mystical

Many people have a spiritual experience on psychedelics. How they make meaning of it could be influenced by the metaphysical beliefs of their therapists.

Kevin's eyes were closed, but rather than the usual darkness at the back of his eyelids, he was peering through a frame and into outer space. The cosmos stretched before him. He began to think about Einstein's theory of relativity. The equation E = mc2 appeared and he intuitively understood what it meant, more so than ever before.

The year was 2011, and Kevin was laying on a bed at an ibogaine clinic in Baja California. Kevin, who is using only his first name to protect his privacy, was participating in an observational trial on how the psychedelic drug could help people with addiction. 


Kevin had previously been to a 12-step program for addiction to opiates, but the religious angling hadn't appealed to him. “I was so turned off at the rehab by this Judeo-Christian Protestant framing of God,” Kevin said. 

He had a firm conviction that he didn’t want any spiritual elements in future treatment. The ibogaine clinic in Mexico, which VICE visited in 2014, fit the bill. The preparation included only a physical and an EKG, and his room was furnished like a typical hotel room at a beachside resort. A nurse stayed with him through the night to monitor his vitals. This experience with ibogaine set him on the path to recovery; he is now an addiction counselor. 

Yet that didn't mean he didn't have a spiritual experience in the end. “For me, the power greater than myself that I grappled with was evolutionary processes, the nature of the cosmos, and it was in a purely deterministic, laws of mathematics type of framing—nothing supernatural,” Kevin said. 

His trip revealed how psychedelic experiences, even ones that are treating a specific issue like addiction, can still have an ineffable, spiritual component to them, but one that is individual to the person having them—like Kevin's encounter with E = mc2. When Kevin looks back on his time at the clinic, “It's hard to convey the significance of that without getting into spiritual territory," he said. 


Psychedelic therapy is on its way. Legislation is loosening, clinical trials are underway, and patents are being filed. The Oregon Psilocybin Advisory Board will be announced in March, leading to potentially the first national experiment in which therapists could get licenses to practice therapy with psilocybin, the hallucinogenic ingredient from magic mushrooms. If the promising results from research are any indication, psychedelic therapy could be a desperately-needed new option for people with depression, addiction, trauma, eating disorders, and more. But as the field matures, it's continually reckoning with potential issues—one being the question of spirituality, and how it fits into a medical, therapeutic setting. 

The associate director of the Johns Hopkins Center on Psychedelic and Consciousness Research, Matthew Johnson, recently published an opinion paper which he described on Twitter as his "95 Theses." In the paper, Johnson outlined key areas that he thinks the field of psychedelic therapy should pay attention to, so as not to get in over its head. One section focused specifically on the introduction of religious or spiritual beliefs from investigators or clinicians. 


“For today’s psychedelic scientists and clinicians, frameworks of concern are likely to resemble a loosely held eclectic collection of various beliefs drawn piecemeal from mystical traditions, Eastern religions, and indigenous cultures, perhaps best described by the term ‘new age,’ although they could come from any religious or spiritual belief system,” Johnson wrote. 

This topic requires special attention when it comes to psychedelics for a few reasons. Religious or New Age-y positionings could alienate certain populations from trying psychedelic therapy. People are also highly suggestible when taking psychedelics, and so the imposition of a spiritual worldview could unduly influence them in ways that are unethical. This is part of what compromised psychedelic research in the past: People who took psychedelic drugs as well as studied them had incredibly meaningful experiences, felt clued in to the meaning of the universe in new ways, and could then impose those belief systems onto others. To avoid that, Johnson argued that this time around clinicians should operate from a “secular framework.” 

But others in the community say it's not so easy to just say, "Psychedelics are secular now," and be in the clear. Many people will have mystical experiences when taking psychedelics—and the degree to which they are causal or required for healing is still being explored. These experiences can raise questions that are difficult to answer if a therapist hasn’t spent some time dwelling on them, even though they can leave the safe confines of "secular" behind: What is the nature of any beings you meet? How reliable are any visions you see of yourself or your past? Is there life or consciousness after death? 


Any surface-level attempt to be "secular" could also risk ignoring that the way psychedelics are currently spiritually experienced in the West is already influenced by the psychedelic movement's forefathers, like Aldous Huxley. Psychedelic therapists will require an unprecedented level of existential self-awareness, and a willingness and ability to inquire their own thoughts about the nature of reality, the mind, the universe—or their metaphysics, to borrow a term from philosophy. 

“These kinds of theological questions apparently come up during psychedelic experiences and a therapist or clinical retreat center might bounce against these theological issues,” said Jules Evans, a philosopher and research fellow at the Centre for the History of the Emotions at Queen Mary, University of London. “It's a challenge to what extent a clinic or a retreat center should impose its own theology onto the participants.”

Unlike a visit to the dentist, primary care doctor, or even regular psychotherapist, unexplainable experiences often arise during a psychedelic trip. People have what they describe as personal encounters with God. When people take DMT, they often report meeting entities which Terence McKenna famously described as “self-transforming elf machines.” Not everyone on DMT sees elves, but many encounter "beings," or "guides." In a survey of over 2500 people asked to report their most memorable entity encounter, more than half who identified as atheists before their experience no longer identified as atheist afterwards. 


Those who are wary of the role of spirituality in psychedelic therapy don't mean that people shouldn't have these mystical or religious experiences. They're advocating instead for a heightened attention from therapists when it comes to how those experiences are interpreted. How a person is helped to integrate and make meaning could be influenced by the metaphysical beliefs of their guide. That doesn’t mean it will always be a nefarious influence—but it could be. 

“Psychedelic laboratories, clinics, and centers need to think not just about therapeutic methodology, but it's about the theology, about their metaphysics,” Evans said. 

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Therapists have to continually answer difficult questions in relation to the meaning of psychedelic experiences, and the way they answer such questions can impact the conditions people are trying to treat. 

One example from a recent paper by psychedelic researchers Christopher Timmermann, Rosalind Watts, and David Dupuis: A man in a psilocybin for depression trial confronted a “cruel creature which the participant took to represent one of his parents. As the battle with the monster subsided, the participant had an experience in which he felt himself to be an infant whose parent was attempting to smother him with a pillow.”


Though he initially reported an improvement in his depression, six months after his session his depression had returned and he was confused about his experience. He said, “It’s all very well people saying ‘it’s all totally symbolic’, I don’t think it is. When it happened it felt more real than the here and now … I do think that something must have happened. Something pretty severe in my childhood for this treatment to take me back there … But what do you do with it? Do you just deal with it?”

“How to hold this space of gentle agnostic respect for the messages that arise is one of the challenges of psychedelic therapy,” the authors wrote. 

In 2018, a study participant on DMT reported that “every human body is just on one shelf, and there is another human on another shelf. And that’s reality. The reason why we are not suffering is because machines are generating this beautiful reality for us.” When people take psychedelics, they can have “noetic” experiences like this one, feeling that they have had an intense "true" revelation related to their own life or  the nature of the universe.

“Noetic” is one of the qualities that American psychologist William James used to define mystical experiences in The Varieties of Religious Experience. Having a "noetic" experience is also a difficult hurdle for a therapist to overcome because the metaphysical truths that they may “know” from their own past experience with psychedelics are also inherently imbued with this noetic quality. 


“The danger is having people project their own ideas, bring their own stuff into the session,” said Rachel Yehuda, a professor of psychiatry and neuroscience and the director of the Icahn School of Medicine at Mount Sinai's new Center for Psychedelic Psychotherapy and Trauma Research. 

People can be highly suggestible while taking psychedelics—there's a reason the CIA selected LSD for their studies on mind control. The psychiatrist Stanislav Grof, an early pioneer of psychedelic therapy, called psychedelics "nonspecific amplifiers," meaning they are able to enhance the culture in which a person takes them. 

At the end of the 1960s, the sociologist Richard Bunce found that there was an increase in “bad trips” at the same time as government figures were spreading negative messaging about LSD, like the claim that it would “fry your brain.” In research settings, this could mean that the culture at different academic institutions could bring about different kinds of experiences. In New School anthropology professor Nicolas Langlitz's book Neuropsychedelia: The Revival of Hallucinogen Research Since the Decade of the Brain, he wrote that people in European psychedelic trials self-reported fewer mystical-type experiences than in U.S. trials. Evans said he's observed this as well: at research centers like Johns Hopkins, mystical experiences are often reported and measured, whereas at Imperial College London, Evans said there are more reports of "ego-dissolution" experiences. 


This all comes back to spirituality, because it reveals how a person could be influenced by subtle spiritual ideas, frameworks, or something as seemingly insignificant as room decor or a questionnaire one fills out. (“It has unfortunately become fashionable and commonplace for statues of Buddha to be present in psychedelic session treatment rooms,” Johnson wrote in his opinion paper.) All of these factors can prime a person to think about their experience a certain way, or have a different kind of experience. 

“The effects of LSD are so radically transformed in relation with user’s mindsets and settings that you could argue that LSD, as a technological artifact, is recreated every time it is used,” wrote Ido Hartogsohn, an assistant professor at Bar Ilan University who studies the historical, sociological, and cultural dimensions of the psychedelic experience.

Again, the point is not to prevent people from having mystical experiences. And Johnson thinks it’s appropriate for researchers to measure such experiences. “There’s a difference between measuring something versus pushing it on the participants or making it the default,” he said. 

There are still a lot of unknowns about mystical or religious experiences people have on psychedelics that future research could elucidate. If scientists are interested in the nature of spontaneous religious or spiritual experiences on psychedelics, how to characterize them, and how they affect outcomes, Johnson thinks it's a more compelling area of study if efforts are made not to introduce those elements from the research side.


It could also help avoid a jingle-jangle fallacy—when the same term is given to different phenomena, or when different terms are used to describe the same thing. Take "mystical experience" and "ego dissolution." Are these the same experiences given different names? Are there other spiritual experiences referred to with one term, that are actually disparate (like machine elves)? Mystical experiences will be better understood if investigators try their best to do as little priming or expectation-setting as possible. 

“I think we have to conclude that the potential is there in terms of coloring the nature of the experience,” Johnson said. 

If only it were as simple as removing a Buddha statue from the room. Quasi- or meta-religious beliefs can seep their way into psychedelics too, Evans said. Psychedelic therapy may need to dedicate time to thinking not just about defined religions, but broader nondenominational forms of spirituality. For example, it’s nearly impossible to have a psychedelic experience today that is innocent of Aldous Huxley's interpretation of it.

In 1953, Aldous Huxley took the psychedelic mescaline, had a mystical experience, and wrote about it in The Doors of Perception. Nearly a decade earlier, he published The Perennial Philosophy. These works established a foundational framework for Western psychedelics: That psychedelics can be a bridge to mystical experiences, and that these mystical experiences reveal the unifying thread behind all belief systems. This is what perennial philosophy, or perennialism, asserts: that all religions share a core of wisdom.


“It is but a short step to the realization that all forms of life and being are simply variations on a single theme: we are all in fact one being doing the same thing in as many different ways as possible,” as psychedelic figure Alan Watts wrote in 1968

But perennialism may not ring true for everyone. In 1978, the philosopher Steven Katz argued that different religions are, in fact, quite different from one another. “They are rooted in differences of language, symbolism and culture; if you try to remove ‘mystical experiences’ from that local soil and create a global synthesis, you end up with something stripped of much of its meaning,” Evans wrote in Aeon

While a belief like perennialism doesn’t seem on its surface like a bad thing, uniting all religions together under one core "truth" is still very much a belief, and could be alienating. Perennialists have tended to be Western, and those who have rejected a Judeo-Christian background. 

Evans points out that this is the case in Huxley’s writings, which suggest that though all religions share a common core, some are “truer than others," like Eastern religions, and that the “best” kind of mystical experience is one in which the self and the ego disappear. This theme has been echoed in modern research, too. 


“The foundational paper of the psychedelic renaissance was the 2006 paper by Johns Hopkins,” Evans said. “And that said that psychedelic experience leads to a mystical-like experience. It was basically recycling Huxley's acid perennialism. The whole foundation of the 'psychedelic renaissance' is to some extent informed by Huxley." 

Johnson said that in a current trial using psilocybin run by his colleague Peter Hendricks in the southern US, many of the participants are Black with Christian beliefs. Their mystical experiences don’t include Eastern religions or perennialism, but Jesus Christ. If a therapist brings Eastern or New Age-y ideas into a session, it has the risk of being jarring, alienating, or disruptive to a person’s experience. “The harm isn’t just in the egregious abuses,” Johnson said. “We don’t even see the people who don’t show up to our studies because they see statues of Buddha.”

It's another crucial reason to try and be "secular," according to Johnson: Researchers and psychologists need to be careful not to present psychedelic therapy as a treatment for a certain kind of person. “Something for hippies, something for New Age folks, something for people who are into Eastern religions, something for tree huggers, or political liberals,” he said. “If you have a Buddha or a Hindu god, a crucifix, or Tibetan prayer flags, there are going to be a good number of people out there who that sends the signal to, 'That’s not for me.'” 


It also leads to pragmatic considerations that Johnson worries about. Will Medicare someday cover psychedelic therapy? Will the United States Department of Veterans Affairs? What about private insurance companies? “Ultimately, we want them to cover this stuff,” he said. “And there is going to be an issue with covering religious therapy. The point is, someone could make an argument against it.”

James Rucker, a psychiatrist who leads the Psychedelic Trials Group at King’s College London, said that he decided not to use Hood's Mysticism Scale—which Johns Hopkins used in the 2006 study—because it creates a very specific narrative around mystical experiences, and could be creating a priming effect he is trying to avoid. 

Rucker became so concerned with how questionnaires and scales that evaluate people’s experiences could be influencing them that he removed all such activities from the dosing day. “Aside from some very basic safety stuff, I stripped out every other scale out simply because I don't want to prime people,” Rucker said. 

It can also cause trouble when patients don’t have awe-inducing mystical experiences. Liam Modlin, a psychological therapist who works with Rucker and with patients in their trial, said he’s found that as psychedelics become more mainstream, he’s noticed that people are bringing more and more expectations when entering the study. 

“What does it mean for a participant to come after reading about a mystical religious experience that has changed someone else's life completely?" Modlin said. "What does that do in terms of their own expectations and how to manage that for something so subjective and ineffable? How do we work with patients' own experiences around disappointment or around feeling that perhaps they didn't get what they should have gotten out of it? There are feelings of self-blame, shame, guilt or despair."


Still, being "secular" is not necessarily a synonym for being neutral, nor is it a synonym for an easy solution. Pieter Stokkink, a philosopher and co-founder of the Dutch psychedelic organization Open Foundation, said, “I have my doubts if you can just say, ‘Okay, I’m secular,’ or ‘This is a secular setting.'" 

“There are many different interpretations of what being secular means,” Langlitz said. "It might mean exhibiting restraint rather than offering interpretation informed by your own view. That’s different from a definition of secular that could be construed as explicitly anti-religious."

Being a “materialist,” or explaining the psychedelic experience purely through physiology, receptors in the brain, and neuroplasticity is not neutral either, but an alternative way to make meaning of a person's experiences. In experiments with psychedelics that helped terminal cancer patients with anxiety around dying, some people reported that they felt like there was consciousness beyond the body, and that there was more after death. “Just discounting or debunking their experience would be, to me, inappropriate," Evans said. 

Elizabeth Nielson, a psychologist and psychedelics researcher, thinks that this is a training issue. Mainstream psychedelic therapy is so new that therapists need to be properly prepared for such metaphysical issues. Nielson is also the co-founder of Fluence, which provides training in psychedelic integration and psychedelic-assisted psychotherapy to clinicians. 


“If there is an approval of some of the psychedelic drugs that are in development right now for use outside of the research setting, and more and more therapists are able to be in that situation and provide those kinds of therapies, this is going to potentially a key point in training,” Nielson said.

Often therapists are very eager to learn the specifics of a psychedelic session, and how to assist while a person is taking the drug. But Nielson thinks that these meta-issues of integration, interpretation, and meaning making need to be emphasized equally.  

The goal is similar to traditional therapy: not to impose an explanation or a particular belief system towards explaining people's experiences to them. But being familiar with the variety of ways of understanding, and explaining, non-ordinary state of consciousness experiences is helpful. That way, if people are struggling to make meaning from their experience, the therapist doesn't just say, "I don’t know."

There’s a critical public education element, too—people should understand that some providers of psychedelic therapy could be coming from particular spiritual backgrounds and could frame the experience in terms of that background. If a patient isn't comfortable with that, they don't have to conform themselves to another's belief system. 

“The bottom line is that if somebody has a mystical experience, it comes from them,” Yehuda said. “You have to be there to hold what’s coming up for them without imposing your beliefs, but rather helping them express theirs. It’s like being a midwife. You’re not creating the baby. You’re supporting the labor.”


When Rosalind Watts was the clinical lead for psilocybin for depression study at Imperial College London, one of her patients had no pre-existing spiritual or religious beliefs. But during his experience, he embodied his grandfather when his grandfather was drowning—which had happened when he was a baby.

"He went through this experience that was so hard for him to integrate and to be really honest, I struggled to help him integrate that experience," she said. At Imperial, Watts said the perspective was very "secular." "I think there are limits to that position which we hit up against that time. There were experiences that our framework of reference could not explain.”

Watts is now the clinical director at Synthesis, a psychedelic retreat center near Amsterdam, developing a program for people with depression. Previously Synthesis was only a retreat for so-called "healthy normals." (I went to Synthesis in 2019, and wrote about my experience.) 

Watts thinks that ignoring the parts of psychedelic treatment that are ineffable, unexplainable, and “sacred” because they’re not secular would be a loss to participants. In response to the person who became his grandfather, for example, Watts doesn’t think it would have helped if the only thing she had said in response to his confusion was, "I'm a blank canvas. What does it mean for you?” 


Daan Keiman, a facilitator at Synthesis and the director of ethics and advocacy, said they're trying to move away from the binary of "secular" versus "religious" when it comes to psychedelics because he doesn’t find it a  helpful dichotomy.  “I think secular is an easy way out,” he said. “I think we need to do much deeper and much more difficult work.”

He wants to focus instead on ethical meaning making—how can he help people make sense of their experience in an ethical way? “Rather than hiding behind secular I would advocate for what in anthropology is called positionality,” Keiman said. This essentially means being transparent about your perspective. Keiman said that people working in this space must recognize that our worldview is not simple, even beyond spirituality. It’s also the accumulation of our lived experience. “For example, race comes into this, and gender and sexual orientation,” he said. 

Watts thinks parts of the field are moving in this direction. “When I trained as a clinical psychologist, if somebody said to me, ‘Where are you coming from? What are you bringing?’ I'd have said, ‘I don't know. I'm a clinical psychologist.’” Through this work, she said she's learned about new belief systems that resonate with her. 

Asking others to do the same is not a trivial task. Watts said that she recommends before anyone even thinks of becoming a psychedelic guide, or sitting in a room with somebody who's in that vulnerable state, they need to interrogate their own issues around sex, power, money, religion and death.

“For the guru thing, what I’m most concerned about is spirituality, power, and sex becoming conflated,” Watts said. “We've seen with many gurus who sexually abuse, who use their spirituality as their way to give them power and that's the most dangerous way this can play out. It will only play out that way if people who haven't resolved those issues in themselves are unchecked without clinical supervision.”

Evans echoed Watts that it could be good practice in certain contexts for psychedelic therapists to be upfront about their belief systems, especially as these treatments broaden beyond the confines of academic research. It doesn’t mean that a person necessarily has to find a therapist who matches their belief system entirely—there are still other important aspects at play, like the therapeutic relationship. 

“My therapist—I don’t share all of her metaphysical beliefs,” Evans said. “I still think she’s a great therapist because, you know, I like her and she listens well and she notices stuff. She wears her metaphysics relatively lightly.”

The question about the role and presence of spirituality also brings on greater inquiries about the detail in which we should study all the components of set and setting, and how important the window dressing of the psychedelic experience is.

Thinking that set and setting don’t matter is another kind of belief system, one that the author Richard DeGrandpre called pharmacologicalism—the idea that a drug’s effects are only defined by its inherent pharmacological qualities. This isn’t how drugs work, even outside of psychedelics. While much focus is placed on the psychedelic compounds, the behavior and attitudes of the therapists themselves is likely just as influential in driving someone’s trip. 

None of this is systemized in any formal way, because there is no consistent formula for the therapeutic side of psychedelic therapy yet. Most of the minutiae of psychedelic therapy have been taken for granted, or borrowed from the psychedelic era of the past, without deep inquiry into why we’re using it. Maybe what’s more important is feeling safe, or having a good relationship with a therapist. But it's worth not making assumptions in either direction. 

Take music: Johnson and his colleagues, Justin Strickland and Albert Garcia-Romeu, recently published a paper studying two different kinds of music: Western classical or an over-tone playlist that included sounds from Tibetan singing bowls, gongs, didgeridoo, sitars, and more that didn't always have an identifiable melody. They found that there was a slight benefit to the overtone-based playlist. (And yet, “Aldous Huxley was very specific about what kinds of music people should listen to,” Evans said. “Like for God's sake, avoid Mozart's Requiem but you can't go wrong with Bach.”)

Though academic centers follow similar protocols when it comes to support, the details are still being hammered out. How therapists are trained for this work hasn’t been fully studied or researched. Only this year did researchers, in collaboration with Compass Pathways, publish a systematic therapist training program of psychological support they’re developing alongside their Phase IIb trial of psilocybin therapy for treatment-resistant depression. 

On the topic of spirituality, the authors of that paper wrote that, “Ensuring consistent ethical behavior of therapists is vitally important in psychedelic therapy and research. Participants might be more suggestible, and therefore more vulnerable, during a psychedelic therapy session. We ask all study therapists to commit to a therapists' code of ethics, placing the participant's well-being above all, and setting aside personal, ideological, religious or spiritual convictions.”

This is something that other branches of medicine haven't had to do. We don’t do clinical trials that test whether or not a medicine works better if a patient takes it with or without a Buddha statue, or while listening to Mozart versus Bach.

But maybe we should. These discussions showcase how expectations, rituals, and beliefs influence all areas of medicine—are players in the theater of medicine. We just call it the placebo or nocebo effect; we know that factors like what a doctor wears or the color of a pill can influence how well a medicine works.

“All of these things are paid very little attention to in Western medicine because it has had such a materialist model,” Evans said. 

Even if we can't control every mediating factor, we should try and recognize what's there, and its potential influence, spirituality included. Though Kevin intentionally had picked a “neutral,” non-religious location, elements of his surroundings still may have made an impact. Another profound moment while on ibogaine was when his thoughts drifted to pollination, and bees flying around to pollinate flower beds. “I couldn’t get over the fact that that’s one of the most significant, like, mutually beneficial biological processes there is,” Kevin said. 

Later, after his experience, he realized that there was a painting on the wall of bees flying back and forth between flowers. 

Follow Shayla Love on Twitter.