Okay, hello everyone and thank you for coming. So we'll just get started. We're going to be talking about psychedelics and cultural psychiatry. Many of you, I'm sure, are aware that psychedelics are increasingly being studied and touted for a variety of psychiatric conditions. However, that's medicalized psychedelic use is one very specific type of psychedelic use among many, many others. And so one thing that's quite unique about psychedelics is how dependent the effects are, both acute and enduring, on the context in which they are used. And so we're going to be providing sort of a broad survey of that context. We have to start off a historian, who unfortunately was not able to make it today, but has recorded her talk. So we'll start with that. Who's going to sketch out some of the relevant history, both of psychedelics, but also of drug research in general. And then we'll switch to David Yadin, a colleague who is going to talk about the importance of the subjective effects. We are fortunate to have Manbir Singh, an anthropologist who studies shamanism, who will provide some context for the indigenous use of psychedelics. And then I'll kind of cap off with summary remarks. So we will switch to our historian, Erica Dick, for her remarks. And yeah, and just if the volume is not, you could raise it if it's not quite loud enough. Hi, my name is Erica Dick. I'm a candidate research chair and historian at the University of Saskatchewan. And I'm incredibly sorry that I cannot be there in San Francisco with you today to share this presentation. Unfortunately, there was a pilot strike in Canada for the specific carrier that was bringing me to San Francisco and my flights were canceled on short notice. And so unfortunately, this is my, this is what I can do to be with you. I want to talk today a little bit about the historical perspectives on the psychedelic Renaissance, something that's really been gathering a lot of momentum in the recent years. I want to acknowledge that I am a professor and research chair at the University of Saskatchewan in Canada. And some of this research has been funded by the Social Sciences and Humanities Research Council of Canada. All right, to begin. As a historian, I'm always curious about where things start and how we track change over time. And so for the purposes here today, I wanted to talk a little bit about how the concept of the psychedelic Renaissance started, and how we might think about the history of psychedelics as we imagine where they might fit today, and where that momentum is coming from. And so here, there's a couple of different starting point images that we might think about as ways of trying to reconnect with the kind of roots of a psychedelic movement, whether they come from a laboratory space, which we see up on the top left, whether they come from indigenous account encounters, which we can see in the center two images, as well as through archaeological evidence, which we see in the mushroom statues on the top right. And I'm going to walk us through a few of these different opportunities or through these different moments. As part of a research project I did with a team of people, about 22 different authors from countries in different parts of the world, we tried to map the historical origins of psychedelic research. And in doing so, we realized that there are significant gaps in our understanding of the origin points of psychedelics, and the flow of both ideas and substances around the world over the course here of, you know, several centuries. What these maps reveal is not so much the accuracy of where these substances were first identified and where they flowed into different research labs, but really some of the limitations of what's available if we start searching through psychedelic science. So looking at the kind of clinical origins and clinical publications about psychedelics, there are limitations to what we can find both in terms of what has been digitized historically, and what has been captured within that scientific frame. And so while these maps are interesting, and probably hard to read, they are nonetheless somewhat limiting in what they can tell us about where psychedelics have circumnavigated the globe, and who has been behind some of those movements. Another way that researchers have really tried to understand the movement of psychedelics is through anthropological literature. And ethnobotanists, anthropologists, and those interested in ethnobotany specifically, have created a lot of literature on the indigenous uses, but also the ways in which psychedelics have been used as part of sacred plants, as herbalism in different ways around the world. And these haven't been mapped in the same way. But we can recognize that there are a variety of different ways that people have isolated psychedelic and sacred plant knowledge in particular regions around the world. Perhaps one of the most famous ethnobotanists that brought psychedelics to attention, even before the word psychedelic was coined is Richard Schultes, who's considered not only a father of ethnobotany, but really a sort of genius figure in this in this area. He worked in the Amazon Basin for several years and ultimately produced a catalog of hallucinogenic plants. And in his characterizing of these plants, which he did in the 1960s, he brings together both chemical knowledge and plant based knowledge with indigenous and sometimes local cultural knowledge. So how people came to know and came to use these substances and for what purposes. And through this, we see a kind of blending of disciplines and a blending of disciplinary knowledge in how we come to know psychedelics. Of course, Schultes inspired many others to follow in his footsteps. But throughout the 20th century, he's working against the odds in many respects, as pharmacology and chemistry start to peel away from some of these social sciences and humanities perspectives, as we begin to see a real desire to synthesize and isolate chemicals from their plants and from their cultural settings. And these are just a few examples that are pertinent to our understanding of psychedelics, you know, the isolation of ibogaine, peyote, LSD, MDMA, or methylene dioxy methamphetamine. I put cocaine in here as well, just to demonstrate that there's a real desire at the end of the 19th, the beginning of the 20th century, to sort of pull chemicals out of those specific environments. And part of this is, of course, goes hand in hand with a larger effort to pull chemicals out of their plant structures and universalize that knowledge and obviously commercialize that knowledge to a large degree as well. Where we see this really coming to a head in psychiatry is through the rampant introduction of psychopharmacology in primarily in the 1950s. Of course, there are psychopharmacological compounds prior to this point, but the sort of twinned impact of the introduction of the Diagnostics and Statistics Manual of Mental Disorders, the DSM, of course, DSM 1 in 1952, and some of the first antipsychotic medications also in 1952 in France, 1954 in the United States. And with this, the first generation of many of the antipsychotics, antidepressant, and anti-anxiety medications that rolled into the market in the 1950s, which according to some historians and psychopharmacologists, initiated a kind of revolution in thinking about how we might consider treating mental disorders and how chemicals may play a role in transforming psychiatry in particular. Of course, there are also critics of this. Chief among them may be David Healy, himself a psychopharmacologist in Wales, now in Canada, who has really quite vociferously argued that this transformation or this move towards psychopharmacology had more to do with business imperatives than good science. But the reason I bring this up is to remind us that psychedelics in the 1950s kind of came into this space at the same time that hundreds and later thousands of psychopharmacological products were rolling into this psychopharmacological space, but also transforming the ways we think about neuroscience, the ways we measure risk, and the ways that psychiatrists are interacting with patients at this time, still very much in long stay or custodial facilities. So LSD was first synthesized in 1938, one of the classic psychedelics. The first human experiment was conducted in 1943, a self-experimentation with its founder, Albert Hoffman of Sandoz Pharmaceuticals. Hoffman later went on to synthesize psilocybin for mushrooms in 1963. So he really is firmly connected with this history and an important figure for us here today. Now, Sandoz was interested in ergot, which is a fungus that grows on rye and wheat grasses, and in part because it had been used successfully by midwives and largely women for controlling fertility or for bringing along contractions, either to get rid of unwanted births or to bring out contractions at full term labor. And Sandoz recognized that there were sort of gynecological applications that might be used or obstetrical applications that might be used by synthesizing ergot. And along the way, Hoffman synthesized it as D-Lysergic Acid Diethylamide, or LSD, which of course was not used in obstetrics for much longer. People like Stan Grof, who was a psychopharmacologist, sorry, a psychiatrist, argued that Albert Hoffman's discovery of LSD was something that ushered in the golden age of psychopharmacology. Here's a quote from him where he says the discovery of LSD generated a powerful wave of interest in brain chemistry, and together with the development of tranquilizers, was directly responsible for what has been called the golden age of psychopharmacology. And he and many others have identified this period as really transforming the way that psychiatry was functioning, that relationship with patients, but also the relationship with psychopharmacology and the idea that investing in psychopharmacology could move patients out of these long stay custodial facilities. So LSD is kind of rolled up in this, and it brings psychedelics into that movement, where there's a lot of hope and optimism directed at what is potentially possible for transforming psychiatry at mid 20th century. Of course, experiments with psychedelics seem to move quickly into a different realm, where they moved away from what we might think of as some of the classy antipsychotics or antidepressant medication that was also being trialed at the same time. This is a modern depiction of a 1953 article that appeared in a Canadian magazine, which introduced the idea of an LSD psychosis to psychiatrists, and in this case, to an English reading public in Canada. In this case, a reporter traveled to Saskatchewan to have an LSD experience. The idea behind this experience was that it would introduce someone into the world of madness. In fact, the front title of this article was my 12 hours as a madman. In this case, psychiatrists felt that LSD could produce a model psychosis or one that mimicked madness or psychosis in particular, by producing hallucinations by distorting one's sense of self, one's sense of time, and introducing features of synesthesia. By doing this, they felt that their staff could better empathize with patients suffering from psychosis. In some of the major mental hospitals throughout North America at the time, psychosis was a persistent disorder that seemed to be clogging up the system in many respects. Some patients who could more easily move back into the community, particularly with the introduction of psychopharmaceuticals, but for patients suffering with acute psychosis, and again, remember, this is the beginning of the introduction of the DSM, and some of the categories were a bit fluid across different regions, that those who are suffering from delusions and hallucinations in particular, could be helped by more empathetic staff. Researchers could do better research after empathizing with the idea of hallucinations, delusions, and a distortion of reality. Now, the model psychosis as a theory kind of fell apart, particularly as many researchers identified quite quickly that schizophrenia, for example, is often more punctuated by auditory hallucinations than the visual ones more often produced by substances like LSD. Nonetheless, a number of staff members and some of the formative psychiatric nursing programs began to adapt these model psychosis ideas as a way of training and introducing people to the idea of psychosis. They also recognized quite quickly that the environment had as much to do with the outcomes as the pharmacological reaction itself. Through a variety of experiments, which I don't have time to go into here, but I will say that some of these researchers, those in Saskatchewan, but also others in other parts of the United States in particular, participated in a number of indigenous ceremonies, many of which were associated with the Native American Church. These were peyote ceremonies that they participated in, and they recognized the acoustics of the ceremony, the drumming, the singing, the preparation, fasting, and also the integration that accompanied the experience of consuming peyote. As part of this, they began to integrate some of those features into their trials. Now, these are not randomized controlled trials yet, which I'll talk about in a moment. These are still basically case studies that are taking place. And there are over 1000 reports that were emanated from the 1950s alone. Psychedelic researchers began to recognize that you needed to optimize the space, you needed to think about the surroundings, and in order to optimize that therapeutic experience, you needed to think about music or playlists, the role of therapists in these spaces, but also the comfortable environment, so free moving environments. And they produce a number of protocol books, which one of which I've featured here, I'm sorry, if it's hard to read, it's called the Handbook for the Therapeutic Use of Lysergic Acid Diethylamide, and it is now freely available online. It was published in 1959 by Nick Chuelos and Duncan Blewett. They began to bring in other researchers as well and other practitioners, including music therapists. A number of music therapists sometimes were quite amateurish in their approach. In early cases, what we find is that there are, you know, wives of psychiatrists who had a large music collection and sometimes had musical aptitude themselves. But over time, this was more regularized and even professionalized, to the extent that they brought in bona fide or certified music therapists to develop playlists that would accompany and sort of choreograph the psychedelic experience, often one that unfolded over six to eight hours. At the same time that psychedelic researchers were gaining momentum, some of whom were claiming that there were 50 to 70 and even up to 90% recoveries or success rates, particularly in persistent fields of addiction, but also areas of trauma studies. And again, this is before the introduction of the concept of post-traumatic stress disorder, but trauma-based injuries or trauma-based disorders were certainly one of the focal points of many psychedelic researchers throughout North America and indeed through Western Europe. I remember there was a Cold War at the time. But by 1962 and on, there were a number of larger issues that began to shake the confidence in the public and professionals in the capacity for psychedelics to claim such results. And some of those had very little to do with psychedelics themselves. This public trust in science, I think, was shaken in part by scandals like the Little Mind Scandal, which demonstrated that perhaps researchers and regulators had not figured out how to successfully evaluate the harm profile or the risks associated with consuming certain pharmaceuticals, in this case, during pregnancy. Rachel Carson's publication of Silent Spring in 1962 also sort of sent alarm bells about the toxic effects of investing in this chemical revolution that went hand in hand with the psychopharmacological revolution. We might also look at the Green Revolution or lead paint. There are a variety of different examples that really sort of ricocheted through the public consciousness and shook confidence in the capacity for science and in the broadest sense, to safely evaluate the harms and risks associated with pharmaceuticals and chemicals more broadly. Psychiatrists responded in this case with the introduction, not just the introduction of randomized controlled trials, which had already been tested in the 1930s, but really sort of focusing their efforts on producing and getting behind the randomized controlled trial as the gold standard for psychiatric research and psychopharmacological research in particular. At the time, a number of psychedelic researchers rejected this model, arguing that their capacity to optimize success rates by changing the environment, for example, or by evaluating different doses of psychedelics rather than a fully blinded psychedelic was hampered by this ideological commitment to the RCT. And there are some historians and some researchers from the 1950s who wrote some critiques of the RCT as they fit in or didn't with psychedelics. And some researchers now beginning in the mid to late 1960s, also argued that it was more difficult to get so called naive subjects to participate in trials, even those who were trying to follow the RCT model, because the word about psychedelics or the genie was out of the proverbial bottle in a sense, newspaper reports, media reports, television headlines, suggested that psychedelics were something that was rather titillating. There was something exciting, recreational about these, even though even if there were dangers associated with it in some of the reports, it nonetheless meant that a number of the volunteers that started lining up at research units, whether that was in Los Angeles, San Francisco, or even here in Canada, came with their own preconceived ideas as to what an LSD experience might entail, including bringing their own playlists and introducing things like the Grateful Dead over Vivaldi's Four Seasons. And we know how this story ends in some respects, in concerted efforts to bring international pressure, beginning in the United States, but ricocheting throughout much of the world, on turning psychedelics into a banned substance and moving them into a category of having no medical value. And I won't belabor this point here, but there's a dramatic turn in the public health literature and the evidence that is produced, state and health-based evidence, to suggest that psychedelics are now outside of that medical realm and that they are no longer of medical value. But I want to end by asking some questions here or raising some questions about whether or not this particular kind of narrative is appropriate as we think about what is at stake in the psychedelic renaissance, whether there are elements of this history that can be resurrected or lessons that we might take from this past. One thing to note is that despite legal changes in the 1970s that criminalized psychedelics like LSD, MDMA, psilocybin, some of those same substances that we see going through trials today, we also recognize that there was a rampant underground production, distribution, and consumption, of course, of psychedelics. Some of that information has continued to develop and hone in on particular best practices, including harm reduction tendencies. And yet I think the psychedelic renaissance today is starting to cleave or perhaps is already cleaving apart the medical production of knowledge and the underground production of knowledge. And there may be opportunities to bring those together or at least learn from one another. I think the psychedelic renaissance also has an opportunity to sort of think deeply and broadly about what is at stake in the profession of psychiatry and in its allied professions, as we think about the relationship to Indigenous knowledge. But we also can think about some of the other ways that we might think outside that RCT model. We might think about what is at stake when it comes to investing in psychedelics as a way of thinking through sort of some of the objectives for psychiatry in this 21st century. And finally, I'll suggest that we may want to reflect on whether academic institutions are the best places for investing this energy, as we think through whether how we best evaluate psychedelic evidence. It may be that academic institutions are not nimble enough or flexible enough to invest in some of these kinds of therapies that seem to step outside of the conventional box, or may also perhaps even listen to criminals or illegal categories or illegal users as a way of kind of harnessing some of that evidence to bring into this conversation. So I want to thank you very much for your attention and thank my panelists here for inviting me to participate. And once again, I am deeply sorry that I cannot be with you in person. But I hope that you all enjoy your time at this meeting. Okay, so I want to make a what I think is a pretty basic point but fairly important point. And it's a spoiler alert, I'll just give it away at the beginning, is that I think we need to do more cross-cultural psychedelic research. And this is a talk about why. So my funders. So it looks like if phase two and phase three studies continue as they have been going that it's possible that psilocybin will be approved for medical use and prescription over the next several years. And that's interesting because psychedelic experiences are interesting. Of course, it's very difficult to measure experience. We try to talk to people about their experiences. We can do in-depth interviewing and people can write about their experiences and we have standardized psychometric measures to try to ask these questions in a systematic way. But it's very difficult to measure really any kind of experience whatsoever. When we're talking about psychedelic experiences, that gets arguably even more difficult because of the intensity of these experiences and the variety of qualitative content and subjective effects that occur during these experiences. So there are other challenges as well. Most of the research on the acute subjective effects of psychedelics have been done at our institution, Johns Hopkins, in Baltimore in the U.S. There are a couple of other sites that have done quite a bit of this work, including Imperial College London and Zurich in Switzerland. So the result of this is that our current understanding of psychedelic experiences largely comes from Baltimore, London, and Zurich. Those are small places and it's a very big world. So that includes qualitative analysis, interviews, writing, but most especially standardized psychometric self-report measures. So this is a problem and this is also weird. So just show of hands, who knows the acronym WEIRD? So it's Western, Educated, Industrialized, Rich, and Democratic. So it's a weird setting here, Baltimore is WEIRD, London is WEIRD, and Zurich is WEIRD. So there's a lot of other major population centers that we have not gathered data from or only very minimal data. And very likely these additional population centers, this much broader swath of the world, will give us a fuller and more complete and richer picture of the acute subjective effects of psychedelics. So a couple of big questions with not only clinical relevance, but also scientific and scholarly relevance. So, do the acute subjective effects of psychedelics differ across cultures, and so are there similarities and are there differences? And if so, do these differences impact the risk-benefit profile of psychedelics? So these are two very pressing clinical questions. And we'll get into the scientific and scholarly questions involved as well. So some current conceptualizations, and again, remember that these current conceptualizations are coming largely from Baltimore, London, and Zurich. Here's a study that was done at Johns Hopkins showing nice dose effect curves of psilocybin. This is just what's called overall drug effect. So how much drug effect of any kind there is, and these are observer ratings, by the way. So there's no guide or clinician in the room with the participant. I showed this slide in my last talk. Some of you are here at that as well. We see here comparing psilocybin with methylphenidate, that psilocybin results in anxiety and fear higher than methylphenidate, but also feelings of joy or happiness, high arousal positive emotions as well as low arousal positive emotions like peace and harmony. And again, I said I try to show this slide every time I can because I think it's such an important one, absolutely fascinating. Most of our psilocybin samples, we see two-thirds of the participants saying it was one of the most meaningful moments of their entire life, which I think is mind-blowing and worthy of scientific research in and of itself. So this is a brief snippet of an experience from a participant in one of these studies saying they felt no boundaries, they didn't know where they ended or they began, and somehow was able to comprehend this notion of oneness. So there's a lot of what we might call connectedness being represented in this account. We do use this term mystical experience, which means a lot of things to a lot of people. For some people it means supernaturalism or non-rationalism, but since over a century ago it has more technical meanings as well, which really boil down to deep feelings of connectedness or unity. At least that's the way that the term is described by William James in this classic book that makes this point. I also try to describe some of this in my own book, which is basically a book-long length, a book-long argument to go read William James, because I think he does a good job. So this is the mystical experience measure, comprises four factors. The first one is basically feelings of unity or connectedness. The second is positive mood. The third is feelings of one's body or spatial surroundings changing, a sense of time. And then lastly, this idea that the experience is somehow special or unusual or difficult to put into everyday words. People say things like, I can't describe this, you have to experience it yourself. So ineffability. And indeed on this measure, which comes directly from scholarship by William James and others, when you compare methylphenidate to psilocybin, really when you compare psilocybin to most things, you'll get much higher scores on this mystical experience measure. So at Hopkins, we use this mystical experience measure primarily. We use the others as well. This measure, the dimensions of consciousness measure comes from Zurich. But basically, it includes some other factors, but this blissful state experience of unity, that's basically what a mystical experience is. And when you correlate these two measures, they are basically identical. So there are measures that are picking up essentially the same thing. While the labels may change, the underlying acute subjective effects seem quite similar. So it's not only that there's these acute subjective effects and there's some commonalities that have been captured across measures, but these acute subjective effects do matter. So what you see here are acute subjective effects ratings on this mystical experience questionnaire. Again, we could have used the other measure as well. They're basically identical. And what you see is that the acute subjective effects on the session day, when the participant is actually taking the substance, predicts the therapeutic effect weeks, months, or even many months later across smoking craving, depression, and anxiety. Here you see the same point with this other measure, the altered states of consciousness scale. And again, this blissful state, insightfulness, experience of unity is basically what the mystical experience measure is. Okay. I just want to keep reminding you, all of this is from like Baltimore, London, and Zurich only. So why would it matter clinically to include more data from cross-cultural contexts and other major population centers? Well, cultural sensitivity. Many patients will come from these cultures and these cultural expectations may come with them and that may influence their acute subjective effects. And so we should be able to capture those acute subjective effects and understand what the impact is on the therapeutic benefits and even potentially the risks. So I think the clinical case for doing this is very straightforward, but I'm not a clinician. So I actually care less about that. I'm interested in this longstanding scholarly question that's been around for over 100 years. So let me talk about that. So this is a quote from Darwin that it's good to have splitters and lumpers. And when it comes to thinking about cross-cultural effects of psychedelics or even experiences like mystical experiences in general, not triggered by psychedelics, the kind that William James wrote about, some people have a tendency to be lumpers. And so they say these experiences are basically all the same everywhere with some differences in interpretation and language, whereas others are splitters and they say, well, actually one's cultural expectations change the very nature of the experience. And so these experiences are totally different across cultures. And we have names for these two positions. One is perennialism and the other one is constructivism. And it's not just things like psychedelic experience that these two categories matter for. It's lots of things like even pain, for example. So the perennialist, which is again the lumper of this debate or just the ones that see similarity, draw on quotations like this. So here's William James saying, in these experiences, they're hardly altered by clime or creed, meaning geography or belief system. So William James is often taken by scholars to be a proponent of this naive perennialism. And so in the same way that a lot of times in psychology we say like, oh, Freud said this ridiculous thing, but here's what the data say. A lot of scholars do that with James with this quote, actually. But James actually said the exact opposite as well. He contradicted himself a lot. So here you see in this quote him saying that these experiences can be infinitely varied. So that's a very, very different view, right? So this perennialist tradition has been re-described, you might say perennially, but many times and is being re-described today. So a lot of popular press, popular psychology writings on psychedelics will say things like, these experiences have been reported by mystics the world over and it's basically the same experience everywhere. And there are some real problems with that. So Stephen Katz in the 70s, I think, actually decisively dismantled this view. So he said when you actually read these accounts and carefully look at what people are actually saying, there are many differences across different cultural contexts. So here he offers the most naive kind of perennialism, which is that all, and we could swap out mystical experiences to say psychedelic experiences. So this idea that all psychedelic experiences are the same everywhere, it's just that people will describe them using slightly different terms because of differences in language. That's probably not right. The second is more sophisticated, this idea that mystical experiences are the same, but reports are culturally bound, and so they're using slightly different symbols. But basically the experience itself, if you were somehow able to view the experience cutting through language, you would see just the identical experience across all cultures. And then here's the more sophisticated kind of perennialism, that you can divide these experiences into a small class of types, which cut across cultural boundaries. So the language is culturally bound, but the experience is not. But that there are different types of experiences, and you could even formulate that in a bit more of a sophisticated way. And so here's Ralph Hood, who created one of the early mystical experience measures, and he's saying there's this modified common core theory, which admits even more social construction into this process. He's saying that at the level of the factors, there are different interpretations that can occur, and yet there are still substantial similarities. Personally, I advance a view that I think that the cultural variation is quite substantial, and that when we start collecting data outside of Baltimore, London, and Zurich, we're going to see a very wide variety of experiences, some of which will be well-captured by existing psychometric measures like the two that I showed to you. I think we will see descriptions of feelings of connectedness, for example, with nature and one another and the world, as well as positive emotions. But I think there will be a number of themes that are not captured by current acute subjective effects measures, and we're actually beginning to see that. So all three of us are writing a paper currently that looks at various accounts of psychedelic experiences from a variety of cultures and shows which of them can be captured by current measures and which ones are outside of current measures. For example, there are cultures in which people very often have the experience of turning into different kinds of animals in their experiences, journeying to other realms that have been described in their stories or folklore or traditions, as well as speaking to ancestors. We see that infrequently in our current data, which again comes from weird settings. So the idea is to have a more full and richer description of psychedelic experiences, and in order to do that, we need to collect data from all over the world, and this is important for clinical reasons, for cultural sensitivity, but could also weigh in on and potentially even answer very longstanding scientific and scholarly questions, which is very exciting to me. So thank you. Thanks, David. Great talk. Yeah, so my name is Manveer Singh, and today I will be talking about indigenous uses of psychedelics. I have no conflicts of interest or disclosures to report. So I'll start very quickly with a little background about myself. I am an anthropologist, and as an anthropologist, one of my major domains of study has been healing and shamanism. These are some examples of papers. Feel free to download them and cite them extensively. I also conduct ethnographic fieldwork, so since 2014, I've worked with the Mentawai in Indonesia, and I've also more recently started a project with Sandeep Nayak, right here, investigating indigenous psychedelic use in the northwest Amazon, which is all to say that I think for an audience like this, for a context like this, I am a bit of an outlier, and my approach is that of an anthropologist. So I want to start with how I perceive the popular discourse on psychedelics to often go, and there's this idea of indigenous use tending to comply with a certain model, and I think it's well-captured in these quotes. So this is from a Vox article in 2019, cultures around the world have been taking psychedelics for thousands of years, and each one developed rituals for them. This is from a Neolife article, again, psychedelics have been used for millennia by indigenous peoples around the world, from the Amazon to Gabon to the American Great Plains. This is from Michael Pollan's book, How to Change Your Mind, elements of shamanism might have a role to play in psychedelic therapy, as indeed it has probably done for several thousand years before there was such thing as science. So now all of these quotes, I think, reflect what I will call the ancient worldwide psychedelic shamanism hypothesis. I designed it to be very catchy, snappy. So the idea here is simple, psychedelics were widespread, they appeared around the world, they are ancient, so they appeared not only around the world but for millennia, and they have been used in these shamanic contexts of therapeutic healing. Now this presentation is mostly about the third point, shamanic contexts and the context of indigenous psychedelic use, but I'm going to start by quickly just addressing what we currently know about these first two points. So to understand where and when psychedelics have historically been used, we first need to establish what a psychedelic is. Now for some people, this term is very broad, it can cover many psychotropic substances, including things as diverse as even tobacco or marijuana or opiates. Others, perhaps most people, have a much more constrained usage in mind, and that is restricting the term to these 5-HT agonists, that is substances like DMT, LSD, psilocybin, 5-MeO, etc. So today I'm going to focus on this more narrow category, these so-called classic or serotonergic psychedelics. So like I mentioned, these include psilocybin, DMT, LSD, mescaline, etc. So there are many claims, as we saw, of peoples around the world using classic psychedelics in hallucinogenic doses, but in fact there has been very little systematic work testing that, telling us that, showing that. So little to no systematic work. A really important exception to this, however, is work by this person, Martin Fortier. So Martin studied psychedelics, cognitive science, and anthropology. He actually worked with the Shipibo people in Peru, famous for their ayahuasca use, and pictured in the background over there. So Martin started what he called the HUTHAC database. Hallucinogenic use, I think it's throughout... Time and space doesn't correspond with HAC, so it's, I think, human history and culture. This was an incredibly ambitious project. It was meant to include more than 1,000 cultures, and so he scoured academic books, historical chronicles, the diaries of explorers, and for every mention of hallucinogenic use, or for every mention of psychedelics, he looked at which substances, who used them, was it in hallucinogenic doses, how were they used, and how reliable is the evidence? So he was really trying to build a reliable record of hallucinogenic psychedelic use. Now, incredibly tragically, Martin died in 2020 while he was still finishing his PhD. Before he died, however, he posted some of his preliminary findings online, and so what he found was that reliable evidence of hallucinogenic usage of classic psychedelics was limited to Mesoamerica and South America, so to the Rio Grande area and southwards. So some usage clearly goes back thousands of years. Still, however, even in the Americas, it was a very small number of societies for which we have records of people using classic psychedelics in hallucinogenic doses. So he estimated that on the basis of this reliable evidence, if we are most liberal, about 5% of cultures in the Americas were using psychedelics in the pre-colonial era. So on a global scale, that means less than about 1% of ethnolinguistic groups, of human cultures or societies engaged in hallucinogenic use of classic psychedelics. Now, really importantly, absence of evidence is not evidence of absence. I think it's reasonable to suspect that psychedelic use went undocumented. Still in Martin's review, he made this argument that when psychedelics were used, it was very clear to anthropologists and explorers. It was salient. There was lots of evidence. It does not seem likely that, at least as anthropologists and explorers arrived in societies, they were missing lots of indigenous psychedelic use. Regardless of this point, however, I think Martin's project is a really important reminder and precedent and invitation to approach the topic of indigenous psychedelic use with more systematic rigor, with, yeah, with a systematicity and with a skepticism of stories that might be endorsed because they feel good or because they make psychedelics more palatable. Okay, so that was a quick consideration of where and when, now let's shift to the context. What did psychedelic use look like? What does it look like now? Okay, so I think a popular view is that these modern therapeutic applications are echoes of indigenous use, that there is some really important analogy here. And this idea pops up often. This is just an example of something I found online. I don't mean to pick on this person, it's just one of many examples. This is a UCLA psychiatrist, Charles Grubb, and he wrote, for goop, the shaman wouldn't, yeah, the shaman wouldn't minister these compounds only for very clear circumscribed reasons, circumscribed reasons such as an initiation rite or a healing ceremony to address individuals with severe medical or psychological problems. So the idea here is simple. You have a patient who is psychologically distressed and the shaman administers the drug to them. It's a familiar model for, I think, a lot of the people here. Now, in contrast, what I am going to argue and show over the next couple slides is that indigenous psychedelic use is much more diverse. And I'm also gonna show that, although this psychiatric therapeutic analogy is misleading, there are nevertheless important patterns and important lessons that I think come from engaging and examining, engaging with and examining indigenous use. Okay, now, there are many contexts in which psychedelics are used, the most important of which I think is used by specialists, often called shamans. So in many, perhaps most contexts where people have consumed psychedelics in hallucinogenic doses, patients do not seem to consume them. Rather, specialists consume them. They use them to assist in services like divination, so identifying the source of an illness, engaging with spirits, often as a part of healing, to fight illness-causing witches or sorcerers, and even in some contexts, to kill enemies. Now, importantly, in most contexts, specialists need to undergo training. They have to observe diets, often sexual abstinence. Most importantly, there's often very frequent psychoactive drug use that is a part of their training regime. An important point, I think, is that there is often an appreciation that individuals need to learn to master and control these psychedelic states. So this is an example, this is a quote from an ethnography about the Barasana, a Tucanoan-speaking people in Colombia, and it's about, essentially, ayahuasca. So the ethnographer writes, in their trance, these novices would tear off their loincloths and walk around naked without shame. They even urinate or defecate in public. But others, the truly experienced paellas, control these impulses. They are transported to the Milky Way or to the houses of the hills or the waters, and there they talk and negotiate with the beings occupying these places. And so I wanted to include this just as one of many examples in ethnographic literature where people describe this contrast between people who have very little experience with psychedelics and those who have mastered it, who have controlled it over time. Now, specialist use has been studied quite a bit, but an example that I find especially evocative and which has been studied in great depth is among the Yanomama who live in the Orinoco Basin in Venezuela and Brazil. So Yanomama shamans, in some places, they also consume bufotinine snuffs, but they very often consume varroa snuff for which the main psychoactive compound is 5-MeO-DMT. Shamans consume it for healing, for divining, for warfare. They sometimes do it alone, so a single shaman might do it. Sometimes they'll do it in a group. Now, okay, in fact, there is an ethnographic film about Yanomama shamanism called Magical Death. Now, Magical Death actually features a shaman taking varroa snuff and fighting off illness-causing spirits, but then the second half of the video shows Yanomama shamans inhaling a varroa snuff and then using this new power to try to kill children in an enemy group, and to be sure, this kind of aggressive sorcery is not uncommon. In fact, before I gave this talk, Sandeep was like, are you going to put up the Magical Death video? And I was like, no, and he's like, okay, good. And then I forgot that I actually do have mention of it, but I do not have the video, but the video you can find online. So building on this idea, the musicologist and ayahuasca researcher Brabec de Mori emphasized in a recent paper what he calls the whitewashing of indigenous ayahuasca use that occurs in popular and even academic literature. This is similar to, in an earlier talk today, someone had mentioned the Disneyfication of psychedelics. And so what Brabec de Mori writes here is that there is this presentation of shamans are good, ayahuasca use is by definition beneficial, sorcery is not inherent, it's not connected to emotion control or psychological stability. So Brabec de Mori has lived with Shipibo people, he actually married a Shipibo woman and lived for many years among them. And what he emphasizes is that a huge component of ayahuasca use in these groups is the identification of sorcerers and the use of ayahuasca to attack enemies. And he also notes in one of his publications what he calls a double discourse, where the Shipibo people have one discourse for tourists and researchers. Researchers are a category of tourists, he says, and then a different discourse amongst themselves. So moving on then to consumption by patients, like I said, this seems to be rarer in these non-weird contexts, but it has been observed. So Dabken de Rios has found that shamans in mestizo communities in the Peruvian Amazon occasionally administered ayahuasca to their patients. Again, however, ayahuasca here is viewed as a means of accessing special powers and engaging with the supernatural. And for patients, she writes in her book, a big part of this was identifying witches who might be causing illness. Again, you find this theme of it being caught up in a worldview where witches are causes of illness or sorcerers are a cause of illness and this is a means of engaging with that. Okay. Another context to move on is communal consumptions. So in some contexts, groups of non-specialists, typically men, consume psychedelics and hallucinogenic doses together. So Rusty Greaves, for instance, who has worked with the Pume of Venezuela found that in roughly one-third of nights people held 11-hour dances in which all the men consume yopo snuff. Yopo is a, it contains bufotamine and a little bit of 5-MeO and DMT, sometimes with the MAOI containing copy or yaje. He calls them dances and they clearly involved lots of dance although curing and communication with the dead also occurred during these all-night events. Another example of communal consumption was among the Barasana, so we actually saw them earlier, this Tucanoan group in Colombia. So they had nighttime ceremonies in which men consumed ayahuasca. So this is a brew of DMT and an MAOI, taking between 8 to 10 cups in a night. These were typically, in the ethnography it says overseen by shamans and elders. The ritual was suffused with mythological themes. People were said to experience death. As a group they reenacted the moment of creation. People met deities. They felt that they flew towards the Milky Way. So the final one that I'm going to really dig into in greater detail here is the cultivation of knowledge or wisdom or sabiduría in Spanish. So this is discussed less actually in the ethnographic literature, but it's something that Sandeep and I have run into in our own trips to the Northwest Amazon. So for example, we found that among the Piroa who live in the Orinoco region of Colombia and Venezuela, some knowledge-seeking apprentices, always men took psychedelics with a shaman. These apprenticeships could last for many years, and sometimes groups of apprentices would come together and take them. What was really striking and perhaps, you know, it's striking but also in some ways expected, was about how much of the knowledge that was seen to be attained in these apprenticeships was mystical. So a man told us, for example, that through his use he came to encounter and know very intimately an anaconda deity in the river. He said he developed the ability to listen to the rainforest before that training. He had never heard the rainforest, he said. Okay, so some other uses, just for the sake of time, I'm not going to go into these in so much depth. Okay, well, I don't have slides. But so one is recreational. So for both the Piroa and the Hue of the Colombian Amazon, people seemed to inhale small doses of bufotinine snuffs for vigor. And some of these other contexts I've mentioned, so the knowledge, the communal consumption, there are also clear recreational elements involved. So blurring the kinds of distinctions that maybe I've been drawing here. People also consume hallucinogenic doses of psychedelics in initiations. So Nukak initiates take Virola. These Barasana initiates are described in the ethnographic literature to sip Yahé, although it's unclear in that example if it contains DMT. So as we start to wrap up over here, I just want to underscore how these diverse groups tend to really appreciate both context and prior experience in affecting psychedelic experiences. So like we saw in some of these examples, many peoples really emphasize training or that novices tend to have uncontrolled trips. The Barasana, meanwhile, recognize four conditions that they say are really valuable or important for creating more vivid experiences. So they say you want to be, you want to have some sexual abstinence with a light diet. You want to before the experience engage in physical exercise. You want to perspire. You want to have some degree of dehydration. They say you should do it in total darkness or with a little bit of light, possibly a fire. They say it makes the experience more vivid if there are kind of dissonant acoustical simulations, shrill notes of a flute, the sudden sound of a seed rattle. And again, I only want to mention this because there is an interesting kind of psychopharmacology, an interesting appreciation of how these experiences can be mediated by one's preparation and the environment that those are being taken in. Finally, just another example, the Pume, who held these 11-hour dances, Rusty Greaves has told us and written in prep publications that they titrate doses based on prior experience. So long-time Yopo users are given larger doses than these relative newbies. So I have two conclusion slides. In conclusion number one, reliable evidence of hallucinogenic use of classic psychedelics seems restricted to a few, 5% or less, cultures, societies, ethnolinguistic groups in the Americas. The modern therapeutic encounter is a misleading analogy and it abstracts from the diversity of use. Some important, the most important context in indigenous use may have been for specialists to access powers and to engage with unseen realities so as to provide instrumental services like healing, divination, battling enemies and these various other sorcerers and witches who might be believed to cause your illness. Still, there are many other uses. There's communal consumption, some patient consumption, knowledge apprenticeships, recreational use and initiations. Conclusion number two, key points. So that indigenous use is diverse but it's also morally ambiguous that we shouldn't be so quick or eager to put a particular moral lens on there. It's often linked to these mystical and mythological themes. There is a recognition of power. So this is something I talked about less throughout the talk but in many societies, many people will say that they fear these substances. In some contexts or many of these contexts, there's an emphasis on specialist oversight. There's an importance of training. And there's a really sophisticated understanding of the cognitive effects of these substances and how to manage them through training and through managing context. Okay, so these are just a couple of key references. You can find some relevant links on the bottom. Here's just a link that will take you to Martin Fortier's writings. Here's how you can find me. A lot of this, some of this material will be coming out in my book in the future, Shamanism. So buy it. Thank you. Thank you. Okay, thank you, Manvir. So I am a psychiatrist and primarily work on clinical trials of psychedelics through various psychiatric conditions. And I'm going to be talking about what happens in these clinical trials within the context. I think, sorry, co-investigator of a trial of psilocybin funded by USONA. These are our philanthropic funders. But I'm going to talk about the medicalized use of psychedelics and describe what happens, what the rationale is, contrast this with many of the types of indigenous use that you've heard from Manvir. Describe some of the interplay that's occurring now between some of these, and I'll talk through two cases. So one of the things that I just want to drive home, though, is that what we do with, you know, medicalized psychedelics in these clinical trials is but a very small sliver of the ways in which psychedelics are used. It has its own practices. It has its own rationale. And that may not be equivalent to other forms of use. And again, I think this cannot be emphasized enough that the effects of psychedelic drugs are unusually dependent on the context in which they are used. So I think, first off, I will state that this is rather historically novel. I mean, I think it's noteworthy that therapeutic use of psychedelics did not begin with the Western discovery of psychedelics. Peyote was, you know, discovered by the West in the late 1800s, but it was with synthetic LSD that you really see the takeoff of medicalized psychedelics. LSD, people tend to forget this, but it was sort of very much part of the pharmaceutical revolution along with the antipsychotics and antidepressants. These discoveries were kind of being made at the same time. And before the widespread availability of effective medications of any kind for psychiatric conditions, I mean, there were such practices as administering the drug such as barbiturates or amphetamines alongside psychotherapy in order to catalyze a psychotherapeutic process. That is kind of what we do with psychedelics. It's really the only example of it now, though. There used to be many others. So this is sort of like a little bit of history encased in amber. Okay, so the rationale. People that are coming to psychedelic trials for depression, for smoking cessation, for OCD, typically have what they'd consider an individually construed psychological problem. And the drug or the intervention is believed to be the thing that causes change, whether by a biological or a psychological mechanism. And one thing that's kind of interesting here, though, is that this allows for a variety of explanatory models on the part of the patient. So, I mean, I can tell you that some people that come to these trials simply have just tried everything. They feel that they're willing to try this next strange treatment if it'll work. Other people are very much opposed to conventional psychiatric treatments and are able to find totally different rationale. But psychedelics kind of, in the context of these trials even, can serve as biological, traumatic, psychospiritual rationales for what the patient believes to be their problem. It's an enormously flexible therapeutic modality in that way that allows for a variety of explanatory models. And so, in that sense, it can kind of pair with a lot of different types of psychotherapy. So, let's contrast this with, you know, I'm saying traditional indigenous use, but that, that kind of papers over, I mean, that's a lot of different types of use, as you've now heard. But let's focus on specifically the use for healing purposes. So, I'll give you a case, but this type of use very often involves a specialist or shaman taking a psychedelic in order to engage with unseen forces and has what you might consider a non-materialist rationale. And this is often equivalent to practices that may occur without a psychedelic. Brabec de Mori, the anthropologist of the Shipibo that Manvir was talking about, has like an anecdote that the most powerful healers would often not use psychedelic at all, and that simply is a very different worldview than the drug is the thing that is effecting change. So, in contrast with these clinical trials, you first have extensive, what basically is psychotherapy sessions beforehand, sometimes cumulatively about eight hours before there's any dose. And the purpose of that is to have the therapist try to really understand the patient, develop a sense of rapport and trust, but begin to also just for safety purposes explaining what might happen and how to handle it. But there's also some narrative building that occurs. The dose itself, the patient takes the drug, which is obvious, right? But that is actually not the case in all use of psychedelics, and there's a very internal focus. And then afterwards, lots of psychotherapy in order to make sense of the experience. So, huge psychological wrapper. And contrast that, again, for healing purposes. The patient would rarely take the drug. You don't necessarily have psychological prep and integration in the way that we do in these trials. So, and something that's kind of happening more recently is a interplay between both of these models. So, Bradbeck DeMori, the anthropologist of the Shipibo who talks about the double discourse of this is how ayahuasca is described or used within the community. This is how it's described and used without. You are seeing what he calls the psychologization of ayahuasca use. In other words, sort of this therapeutic individual psychological kind of stuff being applied to the use of ayahuasca, and it's sort of transforming. But also, you have, again, like people who take psychedelics in clinical trials and benefit from them sometimes come away with an understanding of that did something to my brain or that helped me understand, like, fundamentally a psychological process or sometimes a spiritual kind of thing. It allows for many different rationales in a way that other treatments may not. And again, I want to emphasize that there are quite a few people who come to these trials who otherwise reject traditional psychotherapy or biomedicine. All right, so let's talk through three, two cases. So, first one is a man in his 30s, Piaroa. So, this is the ethnic group kind of Colombia, Venezuela, border, the Orinoco, with the sudden onset malevolent presence. And then I'll talk about the other one in a second. So, for sudden onset malevolent presence, for a month, he felt this invisible presence near him that he felt meant to harm him. He was hearing its voice. he had trouble eating, sleeping, couldn't function day to day, lived in constant fear. As far as I'm aware, there's no prior history of anything like this. And this man believed that this may have been caused by a shaman of his own ethnic group. And so he went to a different ethnic group and underwent a yopo ceremony. This was not communal. This was the shaman taking yopo, while the patient, this man, did not. And the details are actually a little light after that. I don't think we, but in summary, the shaman during the ceremony identified the spirit and then did something in order to vanquish the spirit. Next day, he's better. And so a lot of, obviously there's a lot of details missing there, but this man had what you might consider a psychotic depression and underwent a psychedelic ceremony, which he did not take the drug that had powerful healing effects. That is not at all like what we do. And I'll skip this. There's another example, too, of his wife underwent a ceremony when she had depression, which sounded very much like major depressive disorder after the birth of a child. Kind of a similar story. So they do use psychedelics for circumstances that we might consider to be a psychological problem, but the rationale and the way it's used is very different in contrast. We have a man in his 30s in a trial of psilocybin for major depressive disorder, alcohol use disorder, who chronic depression, but moderate alcohol use disorder, but functioning in his work responsibilities, taking care of his family. Basically it's not terribly function impairing, but chronic depression. And this is somebody who had maybe six plus months of CBT, found it to be somewhat helpful, but couldn't quite get it, if that makes sense. And during this person's experience, and this study has an open label component, the patient, and this was a very visceral visual type experience, witnessed himself in a funhouse mirror, you know, the kind of thing that distorts the way you look, and this kind of represented his negative normal self-cognitions, discovered he was able to, and again, very visceral experience, step to the side of the funhouse mirror, see that it was still there, but that he could experience himself without these kind of normal negative thoughts, and in doing so began to experience himself the way his loved ones do, felt this flood of compassion, and came away with a practicable emotional skill that actually looks a lot like what you might do with CBT. And the guy had a good outcome, but the point is, these are quite different uses for what are in some ways pretty similar conditions, in some ways. So, I will just echo that modern psychedelic trials thus far have recruited quite non-diverse populations, and so there's a remarkable need to do this research in other countries, and in other contexts, including within our own country, right? I mean, this is mostly well-to-do, educated white people, and it's not entirely clear that there would not be major differences with other population groups, and the role of patient cultural expectations is relatively underexplored, especially with the positive media environment about psychedelics right now, that can certainly affect the way that these, it can affect the results, and the role of the patient's working model of psychedelic efficacy is underexplored. Again, some patients feel like this is just doing something to my brain, others have psycho-spiritual rationales, they kind of come in with different ideas, and so more research needs to be done. I think, in the interest of time, I'll actually skip over the belief chain stuff, we'll end here, and move on to questions. Hi, I'm Gustavo Perdomo, I'm an attending psychiatrist in Bogota, Colombia. Thank you for the wonderful insights that your conference has brought to us today. My comment, or my question, arises a former problem in psychedelic research in Latin America. Some extremely radical groups close to indigenous themes says that this type of research goes from, or touches, a problem about cultural appropriation. This is a big question to me, because I'm pretty interested in psychedelic research in Latin America, but this question arises when these people feel that there is a bunch of white people, white institutions, trying to instrumentalize and get information from aboriginal and indigenous cultures, and there is no any kind of benefit or going back benefit to them. So, I don't know if there, maybe there is some insights about this topic, because thinking about Latin America research, it will be a problem for trying to negotiate with this type of thoughts. That's a commentary, a question. I don't know if you guys can help us. Yeah, thank you, thank you. That's a great point to bring up, and I can tell you how we've been thinking about it, and engaging with it, and you can let me know what you think. So, we first got in touch with Colombian anthropologists to find communities that they've had long-term relationships with, and we were introduced to this Piaroa community through one of these anthropologists, and so we've now, we spent, we visited them last May, and then again in November, and so far we actually have not collected data. Our trips have almost exclusively been negotiating over what a long-term relationship looks like, so they've been, we have a contract written up where they've been very clear about the benefits they want, which are like, they want us to help them bring more tourists, they want English lessons, they want any products of any research that we do to take forms that can be distributed in the community, so like a poster or a picture book. Oh, and then they want mental health, like assistance with mental health, so actually much of the last trip was like Sandeep and my wife interviewing people about what are salient mental health problems that they would want, they would want us to run workshops for. So yeah, the model that we have taken has been like being very clear about we, you know, want this to be a relationship, not some kind of helicopter thing where we just come in, take whatever, and leave, and having them really articulate what they want, what a long-term relationship looks like, and this is actually something that like this Bureau group, having worked with this previous anthropologist, is super thoughtful of. So yeah, that is the tack that we've been taking, which is also kind of building on new developments within anthropology about how to have equitable relationships, where the groups also contribute to the research, and where the research goes. So that's on the anthropological research side, but perhaps a more difficult question that you may be asking is, is psychedelic research, psychedelic medicine appropriative? And this actually is an issue that like many, many, many, many drugs are derived from plants that have medical uses in the context in which they are. For example, the discovery of paralytics is from the use of dart poisons in the Amazon, and there's endless, endless examples. But this is kind of where I draw the distinction of like, it's actually what is being done in the context of these clinical trials is quite distinct, and bears actually remarkably little copying, I should say. And so I don't have a good answer for your question, but I think it's sufficiently distinct. It's also another issue, which is that there are a lot of different kinds of psychedelics, some of which have been synthesized in Switzerland, for example. Others have histories of indigenous use. It seems like the substance also matters in these conversations. But it's an important issue to reflect on, and maybe an excuse to reflect more deeply on reparations more generally, rather than just psychedelic-based kinds of reparations. Thank you so much. Hi. I'm a community psychiatrist, and I really appreciated the talk today at the different facets that each of the speakers brought up. I think, you know, the question that came to my mind is taking the model of research, and I think Sandeep's presentation about the case of where the patient was given the psychedelic, and we're studying the patient. But I think from your talk before, I think the experience of oneness and spirituality and all that, and where the shamans are the ones that actually intake it and use the process to help the patients that come, like as your first case. So is there some movement in the thinking for the psychiatrist to kind of come to the place of being shamans and understanding, by taking this in a, you know, under a study format, to be able to connect with the patients, to be able to help them, just as culturally the shamans are assumed to be in that position to just as culturally the shamans are assumed to be in that position to help the people. Is that question? Yeah, I don't think there's any thought about that at all. I mean, I think that would be definitely direct appropriation, and there's no plausible psychological or biological mechanisms through which there could be healing that, at least that we think of as mechanisms that are common in our understanding. Yeah. Well, I should say that's being, once you remove so many of the elements that are standard in these trials and then add so many of the elements that are, like, you now have something very different that is being done that's not being done in the context of psychiatric trials or biomedicine. You have a completely different, I mean, there are the ceremonial use of psychedelics of that type all the time. But if you're seeing, like, the historical evidence of that and hypothesis and modulating a research plan, I mean, aren't we missing the boat where we're, like, using the model of the shaman and then we're kind of, like, using that on the patients? There's, like, a disconnect if you use that hypothesis. I mean, you could study that. I mean, I'm convinced that there are, well, it's not just psychedelics, right? It's all kinds of, you know, healing ceremonies that are able to mobilize, perhaps, forces of expectation and others, but there are dramatic improvements in, for example, psychosomatic illnesses or mental health. You could study that. I do not know of anyone who is attempting to do that with psychedelics now, though. You think the FDA would approve that? I don't think the FDA would approve that. No, they might. I mean, they might. I'm kind of joking. I don't think it would. Again, but you just now have something that's so far removed from science, normal scientific practice, that it's something else, I think. Thank you. Hey, hello. I'm Logan. I'm a psychiatry resident. So, I think it's fair to assume that, you know, we're concerned about our patients being in these suggestible states and they're more prone to, like, sexual abuse and other types of abuse. I'm curious, you know, did you run across this in the historical studies in these indigenous peoples? What lessons can we learn from that? Was this possibly ignored in history? Because we oftentimes ignored sexual abuse much previously or much more than we do now. Thank you. Just one note. In this room a couple hours ago, we had a whole talk on this. So, we weren't ignoring it. We didn't mention it as much in this talk, but it's a really important issue. That's certainly not something we ignore, but I am interested in this question as well. So, towards the question of whether, like, specialists, magical religious specialists, like shamans, exploit their position for sexual gains. Definitely, yeah. So, for instance, I was recently reading an ethnography of the Saura, a group in India recently, where a shaman took this, but was possessed by a young widow's dead husband. And then the shaman said something like, in the voice of the dead husband, now you should have sex with me in this shaman's body. Which, you know, maybe that's not, maybe, it depends on how we think about it, but that's, is plausibly the shaman kind of exploiting the position. And there's also, this has been studied and described extensively among Arctic populations, where shamans would often use their position to get sexual favors from patients. I mean, actually, even, so Michael Harner, who has written a lot about the shwar and ayahuasca use in the shwar, he doesn't talk about this. He doesn't talk about sexual stuff, but he talks about how shwar shamans would use their position to, like, not pay bride price because other people would fear their power. Nevertheless, like, none of these actually touch upon, like, shamans doing, being sexually exploitative in the context of psychedelic drug consumption. So I'm less sure. I haven't seen that in ethnography. There are, I mean, there's posts about this happening. It certainly happens. And there's many modern examples of that in ceremonial context. But I think the big picture is that this is definitely a concern. And I don't think that there are, the factors here that are relevant in terms of vulnerable patients who can be exploited are not unique to psychedelics. And the answer is actually standard clinical ethics tend to apply. Hi. My name is Kayla Compton, and I'm a psychiatrist here. And I do a lot of ketamine work. And I think, actually, I wanted to follow up on the question somebody asked. You did. Because I think we missed a little bit about it. I think when we talk about the medicine and the biological components of the medicine separated from how people perceive their spiritual experience, right? And not everybody perceives the experience as spiritual. But we can do measures. Like, you guys talked about mystical experience and the mystical experience measure, right? And we can talk about set and setting and how that's really important and really has a huge impact on people's experience. But it's an interesting moment where we don't talk a lot about spirituality and psychiatry except to say, you know, do you practice a religion? But these types of experiences and mystical experiences bring this intersection of the medical and the spiritual in a way that can be very powerful. And lots of times patients will ask in ketamine, they'll say, have you experienced this? Do you know where I'm going? Because it's a very weird and vulnerable state. And it matters to people. If they're doctors, no. And this isn't, we haven't incorporated this aspect yet in our work. But I think that's what I was hearing. Yeah, so, well, yeah, so it sounds like you're interested in spiritual experience and how that relates to psychedelic forms of therapy. So spirituality means different things to different people. For some people, it means a supernatural belief system, or it means that they have a feelings of connection to others and the world and positive emotions. There are other meanings as well. So it depends what you mean, I suppose. But it's definitely true that participants say in our clinical trials absolutely frequently call their experiences spiritual in multiple of these senses. And so it seems important clinically to at least be able to support that. Whatever the participant brings in, whether it's fully supernatural, religious sorts of beliefs, or these other deep kinds of feelings of connectedness and beliefs around that. It also seems important that there aren't ideologies imposed on participants or patients related to any of this. So related to religious beliefs, spiritual beliefs, or atheistic beliefs. And so there are well-established guidelines for this. So basically, the participants and patients will bring in these attributions and these beliefs, and it's important to support them just in the same way that someone experiencing childbirth may choose to interpret that as a miracle from God or a natural process. I think the clinician can underscore the meaningfulness of the event without needing to promote a particular kind of attribution related to a metaphysical or religious spiritual belief system or not. Maybe that answers some of your question. But if not, we can chat afterwards as well. I had a question. I'm mindful of the time. And sort of perhaps it might be the last question, but I had a question specifically for Minvir. I guess, you know, as we're sort of straddling the language around how do we talk about these experiences and then the treatment context within which they happen, from the anthropological work that you've done, have you sort of gleaned insights into what types of conditions can be treated with the psychedelics in different communities and thinking about, like, what are the boundary sort of problems that can be treated? Because I guess one of the challenges that I just can imagine and might be present and will emerge around, you know, is that are these therapeutics supposed to be a panacea for lots of things or are there specific things, you know, what sort of the boundaries that are on it? So I'd be curious to learn more. Thanks. That was a great question. So Sandeep and I are actually planning once, you know, farther down the line with the PIROA to have a, you know, understand where they think the lines are around what you can use Iopo to treat. I've done that kind of data collection for the Mentawe to understand what are the kinds of ailments that they think Sikere, these indigenous Mentawe shamans can and cannot treat. I haven't done the analyses, but just, like, anecdotally it's people mention a lot of pain. Things that they explicitly mention Sikere not being able to treat very often are things like if you cut yourself with a machete, if you have a kind of stomach illness that is quickly spreading through a community, if, yeah, I mean, those are just some of the examples that I have to do. I have to, like, actually analyze the data, but pain is something people talked a lot about in Mentawe. Pain and actually, Sandeep found this very intriguing, like temporary paralysis. A kid wakes up and their legs are paralyzed, whereas, yeah, things like being cut, having terrible diarrhea. On that note, thank you, everyone. We're out of time.

psychedelics

cultural psychiatry

psychiatric treatment

historical contexts

psychedelic renaissance

Western-centric views

randomized controlled trials

cross-cultural research

indigenous use

shamans

cultural appropriation

ethical considerations

contextual approach