Tuesday, 21 July 2009

Psychedelic Psychiatry

Can psychedelics have a role in psychiatry once again?


The Park Hospital, Old Road, Headington, Oxford OX3 7LQ, UK. E-mail: drbensessa@hotmail.com



Psychedelic or hallucinogenic drugs such as lysergic acid diethylamide (LSD), 3,4,5-trimethoxy-ß-phenethylamine (mescaline), psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), N,N-dimethyltryptamine (DMT) and their relations occur in abundance throughout the natural world, and have been used by humankind for thousands of years.

In some cultures they are important tools for spiritual experiences, whereas in others they are labelled as dangerous drugs of misuse. What is less well known about these substances is the role they played in psychiatry for a brief historical interval. This article offers a short overview of this period and questions whether interest in these compounds might be emerging again.


Despite their history, psychedelics have dropped out of psychiatric dialogue for today's trainee psychiatrists (Strassman, 2001). In my own training, references to compounds like LSD, psilocybin and MDMA were usually followed by statements such as ‘have no medical use’. But I was taught about the acute emergencies and social problems associated with their misuse.

Yet in the years between the first synthesis of LSD in the 1930s and the disappearance of psychedelic research by the late 1960s, there was a furious growth of scientific interest in these substances. Many pioneers gave their careers to this field, hoping that psychedelic drugs could be to psychiatry what the microscope is to biology or the telescope is to astronomy: an essential tool to explore the parts of the internal world that are usually inaccessible (Grof, 2001).


The Swiss chemist, Albert Hoffman first synthesized LSD-25 while studying derivatives of the fungus ergot for use as potential medicines. When he accidentally absorbed some LSD during a laboratory session there followed an intense experience of perceptual and emotional effects (Hoffman, 1980).

By the late 1940s psychiatrists were beginning to experiment with LSD as a tool, and in 1951 it was the subject of a presentation at the annual conference of the American Psychological Association. Initial work explored the possibility that psychedelics might be used as ‘psychotomimetics’, to mimic the mental states of patients with schizophrenia (Osmond, 1957), and many health professionals were encouraged to partake in self-discovery or shared psychedelic experiences with their patients. Other research looked into using psychedelic drugs as adjuncts to psychotherapy. The therapy took the form of two broad types: first, psycholytic (‘mind loosening’) psychotherapy involved taking low doses of LSD as part of ongoing psychoanalytical therapy. The drug had a loosening effect and facilitated the exploration of repressed material. The second type, psychedelic (‘mind manifesting’) psychotherapy involved preparation sessions without LSD, then one single large-dose session that encouraged an intense reaction, followed by further non-drug sessions to explore the meaning of the material that emerged (Grinspoon & Bakalar, 1997).

By 1965 over 2000 papers had been published describing positive results for over 40 000 patients who took psychedelic drugs with few side-effects and a high level of safety (Masters & Houston, 1970). The techniques were applied to the treatment of anxiety disorders, obsessive-compulsive disorders, depression, bereavement reactions and sexual dysfunction, among others (Newland, 1962; Grof, 2001). In the treatment of addiction, repeated controlled experiments demonstrated a consistent recovery and 6-month abstinence from drinking in 50-90% of participants after brief psychedelic therapy (Abramson, 1967; Hoffer, 1970). Another area where therapy was used successfully was in relieving pain and anxiety in terminal cancer (Kast, 1964).


Despite the volume of publications from this period, most of the published material refers to anecdotal case reports that are of little value by contemporary research standards because they lack sufficient follow-up and control participants (Grob, 1994). Even though results appeared promising, by the 1970s, under pressure from the US justice department, virtually all research had ended. LSD had leaked from the scientific community to a wider audience. By 1966 LSD misuse had become a problem and its possession was made illegal. This prompted the scientific community to distance themselves from interest in such substances. Governments clamped down on research licences, and increasing reports of adverse reactions to psychedelics taken recreationally as opposed to those used in controlled, scientific circumstances (which remained safe) appeared in the literature (Strassman, 2001). As a result, research use ceased while illicit use remained, fuelled by a growing criminal distribution and financial system.

Until very recently, research on psychedelic drugs has been severely restricted, which explains the current lack of knowledge among psychiatrists.


Since the 1970s, MDMA psychotherapy has seen an emerging underground use by analysts. MDMA, strictly speaking an ‘empathogen’ rather than a psychedelic drug, is less intense and shorter-acting than LSD. It appears to offer a similar therapeutic potential for lowering a patient's defences and aiding the psychotherapeutic process (Holland, 2001).

A lifting of the government ban on psychedelic research in Switzerland between 1988 and 1993 allowed a brief recommencement of psycholytic psychotherapy using LSD and MDMA for patients with personality disorders, affective disorders and adjustment disorders. There are currently projects under development in Spain, Israel and the USA looking at MDMA-assisted psychotherapy in the treatment of post-traumatic stress disorder and as a treatment for anxiety and depression associated with cancer. Between 1990 and 1995 extensive studies of DMT, a strong but short-acting agent, were conducted with human participants in the USA (Strassman, 2001). Other research includes a double-blind placebo controlled study in Russia using ketamine in the treatment of heroin addiction, which has demonstrated improved rates of abstinence, maintained at 2-year follow-up (Krupitsky et al, 2002). Also in progress are studies looking at psilocybin in the treatment of obsessive-compulsive disorder and for reducing anxiety and pain in cancer patients. All of this research is well summarised on the Multidisciplinary Association for Psychedelic Studies (MAPS) website (http://www.maps.org/).


Although drug misuse remains a growing phenomenon in our global society the public and governments are suspicious of psychedelic research. The image of psychedelics, severely damaged by the 1960s drug culture, is further spoiled by drug use in today's ‘rave’ scene. Finding unbiased information about psychedelic research is often difficult.

However, many of the early pioneers of psychedelic research continue to promote it for the field of mental health. Dr Humphrey Osmond, the British psychiatrist who, in communication with the author Aldous Huxley, coined the term ‘psychedelic’ in the 1950s, strongly supported psychedelic research until his death last year aged 86 years, when he received a fitting tribute in the BMJ (Hopkins Tanne, 2004). Albert Hoffman, who celebrated his 99th birthday this year, maintains contact with organisations promoting scientific research into medical uses for psychedelic drugs, such as MAPS and the Heffter Research Institute (http://www.heffter.org/).

Researchers believe these drugs are important tools for further academic study. Their recognised psychological effects fit well into an approach looking for the neurobiological links between mental and physical states. Also from a clinical point of view, the practice of traditional psychedelic psychotherapy - using the drugs as an adjunct to brief, time-limited psychotherapy - has much in common with the current practice of cognitive-behavioural therapy.


Perhaps it is surprising that there remains such considerable ignorance about the potential of these substances from within psychiatry itself. As with Galileo's telescope and Darwin's suggestion of our ascendancy from apes, radical scientific challenges tend to take the form of an attack on the anthropocentric model of the world. In the light of this, research that explores alternative states of consciousness and then offers a viable neurobiological substrate for the very human experience of religious encounter is bound to meet with objection from a generation of psychiatrists who have been conditioned to consider such work as ‘mysticism’. Perhaps a more dispassionate criticism based upon scientific reasoning and not influenced by social or political pressures is called for if we are truly to investigate whether these substances can have a useful role in psychiatry today.


  1. Abramson, H. A. (1967) The Use of LSD in Psychotherapy and Alcoholism. New York: Bobbs-Merrill.
  2. Grinspoon, L. & Bakalar, J. B. (1997) Psychedelic Drugs Reconsidered. New York: Lindesmith Center.
  3. Grob, C. (1994) Psychiatric research with hallucinogens: what have we learned? In Yearbook for Ethnomedicine (eds C. Ratsch & J. Baker). Berlin: Verlag für Wissenschaft und Bildung.
  4. Grof, S. (2001) LSD Psychotherapy. Sarasota, FL: Multidisciplinary Association for Psychedelic Studies.
  5. Hoffer, A. (1970) Treatment of alcoholism with psychedelic therapy. In Psychedelics, The Uses and Implications of Hallucinogenic Drugs (eds B. Aaronson & H. Osmond). London: Hogarth Press.
  6. Hoffman, A. (1980) LSD: My Problem Child. London: McGraw-Hill.
  7. Holland, J. (2001) Ecstasy: The Complete Guide. Rochester, VT: Park Street Press.
  8. Hopkins Tanne, J. (2004) Obituary for Humphrey Osmond. BMJ, 328, 713 .[Free Full Text]
  9. Kast, E. (1964) Pain and LSD-25: LSD-25: A theory of attenuation and anticipation. In LSD: The Consciousness Expanding Drug (ed. D. Solomon), pp. 241 -256. New York: GP Putman.
  10. Krupitsky, E., Burakov, A. & Romanova, T. (2002) Ketamine psychotherapy for heroin addiction. Journal of Substance Abuse Treatment, 23, 273 -283.[Medline]
  11. Masters, R. E. L. & Houston, J. (1970) Therapeutic applications of LSD and related drugs. In The Uses and Implications of Hallucinogenic Drugs (eds B. Aaronson & H. Osmond). London: Hogarth Press.
  12. Newland, C. (1962) My Self and I. New York: The New American Library.
  13. Osmond, H. (1957) A review of the clinical effects of psychotomimetic agents. Annals of the New York Academy of Sciences, 66, 418 -434.[Medline]
  14. Strassman, R. (2001) DMT: The Spirit Molecule. Rochester, VT: Park Street Press.
Received for publication January 27, 2004. Revision received November 12, 2004. Accepted for publication November 21, 2004.

Prairies, psychedelics and place: The dynamics of region in psychiatric research

Prairies, psychedelics and place: The dynamics of region in psychiatric research

Erika Dycka, E-mail The Corresponding Author

aDepartment of History, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5A5

Received 20 January 2009;

accepted 2 February 2009.

Available online 20 February 2009.


In 1957, the word ‘psychedelic’ entered the English lexicon from a rather unexpected location: an asylum superintendent working on the Canadian prairies in one of the provincial mental hospitals in Saskatchewan. During the 1950s Saskatchewan-based researchers engaged in political and psychiatric reforms that brought international attention to their work in a relatively isolated geographic location. This article considers the influence of location on the development of a medical theory that challenged prevailing ideas about the causation and treatment of mental illness and addiction. Drawing on perspectives from historians, political scientists, sociologists and geographers, this case study explores the historical meanings of region and place and combines older historiographical traditions, which define region in political terms, with concepts borrowed from other disciplines, which offer a more nuanced view of cultural geography, to examine the development of psychedelic research in the post-World War II period.

Keywords: History of psychiatry; Saskatchewan; LSD; Socialised medicine

Article Outline
Region and the Canadian West
Place and psychiatry
Case study
Reforming the province
Psychedelic psychiatry

In 1957, the small prairie city of Weyburn, Saskatchewan boasted that it had attracted international attention for being home to cutting-edge psychiatric theories and treatments. The local newspaper proudly reported that its own mental hospital superintendent, Humphry Osmond, was “fast gaining in national prominence in psychiatric work,” under the headline that claimed “world hears progress of mental health treatment carried out at Weyburn.” (Weyburn Review, 1957). Although Osmond had been born and trained in England, he moved to Saskatchewan in 1951 and soon put Weyburn on the international map for his daring experimentation in psychiatry. Most notably his studies with the hallucinogenic drug, LSD, led him to coin the term psychedelic; a word that would later be wrested away from psychiatric medicine, much to Osmond's chagrin. While his self-experimentation with this drug encouraged him to reconsider spatial conceptualizations within the asylum, his capacity to conduct internationally significant research from a relatively isolated and rural location also draws historical attention to the geo-political influences on medical experimentation. This article explores how elements of local pride, provincial political commitments and psychedelic drugs together produced a scientific approach to the treatment of mental illness with a distinctly regional character. The specific historical geography of Canada, which has lent particular economic, political and cultural inflections to the constructs of region, place and territory, has entered into a complex relationship with the conceptual frameworks of academics seeking to make sense of the substantive processes in all manner of fields, the medical-psychiatric included.

In the 1950s medical researchers in this Canadian prairie province experimented with psychedelic drugs in an effort to institutionalize a new therapeutic paradigm for conceptualizing and treating disorders such as schizophrenia and alcoholism. While they were not alone in their desire to use “mind-manifesting” chemicals to stimulate research in psychiatry at this time, their efforts gained them international notoriety and their programs became a source of local pride. The reception and support of their studies at home shielded them from professional marginalisation and allowed their work to develop differently from that of their contemporaries who often faced stern opposition from colleagues, states and communities (Mills, 2007). The relative success of the Saskatchewan researchers, in terms of sustaining their research efforts, allowed them to contribute to mainstream debates in psychiatry well into the 1960s. Consequently, they did not feel that their work was radical, and did not adopt a position outside of psychiatry in an attempt to publicise their views. Their experiences and the history of LSD experimentation in Saskatchewan draw particular attention to the importance of the location of medical investigations and emphasises how non-medical, indeed environmental and cultural, factors influenced the development of psychedelic psychiatry.

Region and the Canadian West

The Canadian West has been repeatedly reconceptualized according to competing political and cultural justifications.1 Wild, exotic and even commercial, were words used to describe the West in early 18th century fur-trader accounts that recalled encounters with Natives along river routes and at trading posts (Podruchny, 2006; Gillespie, 2007). Empty, vast and fertile referred to a late 19th century Canadian west surveyed by botanists inquiring into its settlement and cultivation capabilities (Owram, 1980; Friesen, 1987). Competing conceptions of, and the rapid politicization of, western Canadian spaces contributed to the demarcation of territories into different kinds of geo-political places, such as creation of the Reserve system for Native Canadians (Harris, 2002). The specific historical geography of Canada, which has lent particular economic, political and cultural inflections to the constructs of region, place and territory, has entered into a complex relationship with the conceptual frameworks of academics seeking to make sense of the substantive processes in all manner of fields, the medical-psychiatric included.

In 1905, the Canadian federal government established two new provinces in the West, Alberta and Saskatchewan, marking a new set of boundaries that carved up the region along political lines and established a formal arrangement between the newly created provincial entities and the nation state. Region then in the 20th century context gradually shifted away from territorial spaces characterized by social groupings, soil types and vegetation and instead increasingly referred to provincial identities, which carried political connotations. The residents of the new provinces gradually organized to register their displeasure with what they perceived to be the heavy hand of the federal government. New political parties formed in these regions to challenge the traditional parties of the East and to articulate a different set of economic and social objectives. Historians and political scientists have examined the kinds of political expressions found in the United Farmers of Alberta (Rennie, 2000), the Social Credit Party (Finkel, 1989), the Cooperative Commonwealth Federation (Johnson, 2004; Lipset, 1968), while others have looked more broadly at the distinct political, economic and cultural character of the region (Laycock, 1990) in defining the West. While environmental, economic and sovereign considerations continue to stimulate discussions among historians, interrogation beyond political entities helps to locate communities, ideas and experiences in more nuanced ways.

Geographical and cultural landscapes have received scholarly attention as worthy subjects of study in terms of defining regions, spaces, places and communities and attempting to understand the relationship between places and experiences (Friesen, 2001; Waiser, 2003; Wardhaugh, 2001; Barman, 1991). As Canadian historian Gerald Friesen has argued, the very idea of region in Canada continues to evolve and exhibits tensions between region and nation, while the growing importance of geography, culture and memory also contributes to the social meanings ascribed to spatial and temporal relationships (Friesen, 2001 G. Friesen, The Evolving Meanings of Region in Canada, Canadian Historical Review 82 (2001), pp. 530–545.Friesen, 2001). Region, Friesen contends, historically connoted a politically defined relationship within a federal framework, particularly on the Canadian landscape, but this somewhat static definition does not adequately convey the sensations that the more ambiguous term, place, offers. The vocabulary of place, it seems, helps to depoliticize the analysis and remove the concerns of federalism from the discussion. Nonetheless, Friesen and others have questioned the continued utility of region as an analytical tool for exploring political tensions, as regions are increasingly replaced by provincial identities on the political landscape. In addition to this narrowing process, region then continues to convey a political expression, while ignoring the social experiences that may be better understood through analyses of gender, class and ethnicity; thus, dismissing region as part of an older historiographical tradition of political history or parochial investigations (Wardhaugh, 2001).

Within the history of health, medicine and science, scholars have provided useful theoretical frameworks for examining the ways in which place, freed from some of its political connotations, influences the process of discovery, the evolution of particular therapies, or the delivery of health services (Livingstone, 2003). By combining some of the political characteristics associated with region along with an appreciation for the ways in which place is articulated by inhabitants of a particular location, such scholars have attempted to reconcile regional analyses with cultural histories. For example, Davies (2000) applied a regional analysis to a study of the medical profession in 19th century British Columbia, arguing that region is critical for explaining the development of medical services. Davies moves away from the use of region as a term denoting a community's relationship to nation and instead promotes a more nuanced application of the term as it relates to the ways in which medical services are defined by their communities. Her conscientious use of the term “region” demonstrates an attempt to combine geographical and cultural experiences, while continuing to downplay the specific political connotations of the term.

Place and psychiatry

Within the history of psychiatry, scholars have shown the importance of geography as it pertains to institutional environments and the subsequent treatment regimes engendered by locations, often rural or pastoral ones (Philo, 2004; Rothman, 1971). The various institutional histories of asylum-based psychiatry emphasise the importance of space both within and beyond the walls of treatment facilities, and many even consider the relationship between the environment and the cause or aggravation of mental disease (Goffman, 1961). Region in these kinds of analyses is more often a feature of the professional distance between psychiatry and medicine, or that of patients in an asylum in a relatively isolated setting and their dislocation from mainstream (often urbanized) society. Moving away from institutional accounts and focusing on 20th century psychiatry amid dramatic debates over new forms of treatments (psychopharmacological in particular) along with new kinds of accommodations (care in the community/deinstitutionalization), spatial considerations take on new meaning.

At mid-century, as psychiatric medicine assumed different and competing orientations, place and affiliation also influenced the reception of new ideas within the profession. Somatic therapists, psychoanalysts, behaviouralists, neurologists and psychopharmacologists jockeyed for scientific validity in a field searching for new directions (Braslow, 1997; Healy, 2002; Pressman, 1998; Campbell, 2007; Shorter, 1997). The ability to institutionalize methods, theories, or treatments, and thus gain some degree of professional credibility, depended not only on the scientific integrity of an idea, but also on access to resources, funding, professional cooperation and local support. In short, the cultural geographies of psychiatric research units played an important role in affecting the reception of new ideas.

In a particularly instructive example of this interplay between research and place, sociologist Nick Crossley examined two contemporaneous sets of psychiatric experiments from the 1950s and shows how their intellectual, political and temporal environments shaped the construction and reception of the research. Crossley, argues that R.D. Laing's experimentation with LSD in Glasgow gained him unfavourable notoriety within the local medical community. The lack of collegial and intellectual support seemed to harden Laing's resolve that LSD offered critical insights into the experiences of psychotic patients, but the unreceptive research environment in which he operated encouraged Laing to position himself against the medical establishment, which ultimately characterized Laing as radical, even an anti-psychiatrist. Crossley argues that Laing had to conscientiously struggle to cultivate an intellectually supportive environment where he could carry out his studies; according to Crossley, Laing had to build a “working utopia,” a place where “imaginative projections achieve some degree of concrete realization (Crossley, 1999).” Crossley builds upon Thomas More's idea of utopias as “places ‘which have no place,’ or perhaps more positively, as places which exist in the imagination.” As a result of Laing's determination to resist established views on psychiatry and more orthodox approaches to drug experimentation, he became an outsider to mainstream psychiatry. His attempts to generate intellectual space for exploring new ideas radicalized him, his work, and his reputation as an individual who worked against contemporary trends. Crossley concisely demonstrates, as several historians of science have already shown, that culture and science have an intimate relationship that is often mediated by place (Livingstone, 2003).

Case study

In stark contrast with Laing's experience, researchers such as Abram Hoffer who were engaged in similar kinds of explorations, including conducting LSD experiments as a vehicle for understanding patients’ experiences, were never characterized as anti-psychiatrists, nor were they seen contemporaneously as particularly radical. They did not have to create a “working utopia” in order to bring their experimental ideas to fruition in the local medical community. Place, in this context, arose primarily as an ideological and psychological construct, where ties to region, geography and environment become secondary to the intellectual space that captured the imaginations of medical researchers drawn within the provincial boundaries. During the 1950s, Saskatchewan-based LSD researchers became part of the medical establishment at a time when the province experienced dramatic shifts in its political and cultural identity. Individuals who moved to Saskatchewan to participate in the medical experiments commented on the political and intellectual attraction of the place. In this case, individuals involved in LSD research acknowledged the importance of place in terms of the supportive research environment, the optimistic intellectual atmosphere, and the receptive medical and lay community. This conceptualization of place, as an intellectual space or a psychological construct, is infused with older historiographical notions of region and political expressions of identity tied to state borders and partisan affiliations.

Reforming the province

In 1944, Saskatchewan elected a new government. The ruling party, the Cooperative Commonwealth Federation (CCF) led by Tommy Douglas, campaigned as an activist government, committed to radical experimentation in public policy as well as in domains of science, medicine, agriculture and technology. The party remained in power for five consecutive terms until 1964. Throughout its 20 year mandate, the CCF government expressed a commitment to nurturing innovation. In particular, this government became known throughout Canada as the first provincial jurisdiction to enact a programme of publicly funded health care, a system that the federal government eventually adopted in 1966 (Mombourquette, 1991; Shillington, 1972; Tollefson, 1964; Ostry, 1995; Badgley and Wolfe, 1967; Taylor, 1978; Naylor, 1986). Although it was not the only region that developed a new political party at this time (Finkel, 1989; Morton, 1967), the popularity of the CCF demonstrated the willingness with which Saskatchewan residents welcomed change in the post-war period. The shift in political outlook also set the province apart as a region identified by political borders instead of a region characterized by prairie geography or a staples economy.

The CCF government directly contributed to this shift in identity by embarking on a series of policy reforms that it hoped would also create social changes for residents in the province. One of the major planks of their reform platform was to establish a publicly funded system of health care. In addition to the implications of the policy changes, the lead up to its implementation attracted medical researchers. Enticed by research grants, professional autonomy and an opportunity to participate in the formation of North America's first program of socialised medicine, the province became home, if even temporarily, to a number of medical investigators. The erosion of the region's professional class during the depression had created a professional vacuum. Local residents readily embraced recommendations for new and replenished services in communities that had struggled to retain professionals during the depression. The CCF government recruited doctors and medical researchers to fill senior positions in the rapid expansion of a provincial civil service, as part of its mandate to build a publicly funded health care system. This combination of regional memory and provincial-government initiative meant that Saskatchewan became a place with an allure for medical professionals interested in assuming authoritative positions and who were curious about the ideological implications of socialised medicine.

The optimism and political stability generated by nearly 20 years of CCF governance made Saskatchewan an attractive destination for individuals interested in participating in a culture of experimentation at various levels. One observer remarked: “It was an age of bold experiments. …The pioneering spirit went beyond art and Medicare, though, it dared to explore the brain, the psyche and dimensions that passeth all understanding. In the late 1950s, Saskatchewan was home to the largest LSD experiments in the world (Labounty, 2001).” In the 1940s the province busied itself establishing the groundwork for reforms that would eventually make Saskatchewan a world leader in psychiatric experimentation.

Part of the post-WWII vision for psychiatric services in Saskatchewan involved recruiting psychiatrists to the region and facilitating the development of an active research program. Government officials and psychiatrists alike felt the criteria for reaching this objective in Saskatchewan's post-war political climate had to focus on scientific research initiatives. The shortage of professionals in combination with social stigmatisation in psychiatric services meant that mental health care often languished as a medical speciality and remained a low priority for public spending. Premier Douglas expressed a desire to focus on mental health reforms in a manner that would stimulate interest in the field, in part by investing in psychiatric research and providing researchers and administrators in mental health with significant levels of professional autonomy.

By the mid-1950s Saskatchewan housed over 4000 patients in its two provincial mental hospitals; one in Weyburn and the other in North Battleford, and both hospitals lay on the outskirts of these urban communities comprised of fewer than 10,000 residents each (see Fig. 1 and Fig. 2). These provincial institutions, similar to other asylums across North America, remained relatively self-sufficient with their own staff quarters, laundry and power facilities, farms and even competitive sports teams (made up mostly of staff members). Staff, including doctors and their families, and patients could conceivably live within these institutional communities with very little interaction from members of the nearby towns. The towns themselves were approximately 120 km from the larger urban centres of Saskatoon and Regina, with the first housing the only university and the latter being home to the provincial legislature, and both cities offered the nearest commercial airports. Although the province was proud of its post-war modernization, urban cultural amenities and anonymity were in short supply and became the source of complaints, especially from some of the doctors’ wives who had arrived in the province from large urban centres in the UK and the US.

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Fig. 1. Colour image of Weyburn Mental Hospital (courtesy of Penny Dyck).

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Fig. 2. Photograph courtesy of the Soo Line Museum, Weyburn.

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The environmental conditions on the prairies also affected the rhythms of institutional life; with long stretches of harsh winter conditions, patients, staff and doctors spent more time inside than residents of a more temperate climate might be inclined to do. For research-oriented individuals, such as Osmond, this suited his desire to spend time writing letters to colleagues, publishing articles, and engaging in long conversations with non-psychiatrists working at the institution. His prolonged interactions with others, including patients, are reflected in his articles and in his strong desire, after arriving in Saskatoon, to work closely with allied professionals, including architects, psychiatric nurses, graduate students, psychologists and others (many of whom he eventually co-published with). For others, however, relative confinement and isolation produced feelings of anxiety, a desire to leave the region, and a frustration with the local conditions.

Psychedelic psychiatry

Dr. Humphry Osmond arrived in Saskatchewan, after working in London at Guy's Hospital on a series of mescaline experiments. Within a year after arriving on the prairies Osmond met Abram Hoffer, an MD with a PhD in agricultural chemistry. Hoffer had been hired by the Saskatchewan Department of Public Health that year to establish a research program in psychiatry for the province (Saskatchewan Archives Board, Hoffer Papers). Hoffer and Osmond soon joined forces and began collaborating on their mutual research interests in biochemical experimentation that matched their initial underlying belief that mental illnesses resulted, in part, from some combination of biochemical dysfunctions.

Within a few weeks of arriving in Saskatchewan, Osmond prepared to set up a mescaline study. He volunteered to take the first mescaline samples himself, at home. His reaction to the drug confirmed his belief that he might learn a lot about patients’ experiences with psychoses. He quickly fixed upon this idea that schizophrenia was fundamentally defined by a distortion in perception, an idea he borrows from Carl Jung. If the senses are thus impaired, Osmond reasoned that an individual with a perceptual impairment was more likely to respond to social and environmental cues in ways that seem irrational, illogical, or even “sick.” This theory became the other guiding principle in his work on schizophrenia.

In addition to exploring the distortions of perception, either pathological or stimulated by hallucinogenic drugs (a state he called a “model psychosis”), Osmond also began considering the therapeutic applications of drugs such as mescaline and LSD. Working closely with Hoffer and others, they began testing the therapeutic possibilities associated with the stimulation of a temporary psychosis ([Dyck, 2006] and [Dyck, 2008]).

The most publicised and allegedly successful application of these studies existed in the field of alcoholism. Although investigators did not originally anticipate its use as a therapeutic agent, trials with “normals” revealed LSD's capacity to produce feelings of self-reflection, suggesting that it had some therapeutic properties. These findings led researchers to apply their psycho-biochemical theory of mental illness directly to alcoholism, which was itself being recast by the medical profession as a disease entity. Psychedelic psychiatrists treated alcoholics using LSD and claimed unprecedented rates of success; routinely claiming over 50 percent recoveries, exceeding the rates of recoveries available from other treatments at the time (Chwelos et al., 1959).

As the investigations moved from primarily experimental to a therapeutic application, researchers relied extensively on non-medical participants and exposed the research to a wider audience. In addition to publishing reports in medical journals, the therapeutic trials also relied on recruiting individuals from the community to volunteer for the experiments. Furthermore, a 2-year follow-up period in the alcohol trials forced researchers to identify community contacts, including families, friends, employers, community and religious organizations, in an effort to stay in touch with released patients. This widening of community investment in the experiments served the Saskatchewan researchers well, as it helped to conscript support for the individuals undergoing treatment but it also lent support to the experiments themselves. Reports in local newspapers indicated that the local communities in Saskatchewan expressed pride in the kind of research being conducted in their province. In part this pride was related to the idea that these studies attracted international attention, but also because the research-intensive atmosphere helped to attract medical professionals to communities that had struggled to retain doctors in the past.

While Saskatchewan offered individuals such as Hoffer and Osmond a supportive environment to conduct experimental investigations, psychiatric research in other jurisdictions also began developing new psychiatric theories. The ideological context shaped the research programme in Saskatchewan as well as its local reception, but their medical theories were not altogether inconsistent with broader developments in the field of mental health. The increasing use of drugs in psychiatry during this period had a significant influence on mental health treatments in the second half of the 20th century, and this trend relied, to a large extent, on changes in the theory and practice of psychiatry (Healy, 2002; Shorter, 1997; Montcrieff, 1999; Valenstein, 1998).

Psychiatric practice at mid-century has often been described as existing at a crossroads; institutionally based practitioners often relied on somatic or bodily interventions that seemed outdated or problematic; community-based psychoanalysts used approaches that did not seem to work, particularly with severe mental illnesses, and lacked a biological foundation. More recent studies have shown that psychiatry at mid-century cannot simply be characterised by these two poles, but that practitioners often borrowed liberally from multiple traditions in an effort to tailor treatments to the institutional or individual needs they encountered. Some psychoanalysts, for example, augmented their sessions with pharmaco-therapies, while somatic therapists and psychopharmacologists also experimented with psychotherapy that relied on techniques developed by psychoanalysts.

LSD research in Saskatchewan fit into these broader developments in psychiatry and pharmacology. Ideas arising out of the LSD trials suggested that mental illness had biochemical and psychological precedents, requiring medical interventions that recognised both aspects of the disorder. LSD treatments offered individuals a conscious experience that initially seemed to support practices from a variety of theoretical traditions. Hoffer and Osmond developed a psychedelic therapy that used chemicals to trigger new perceptions of self. The psychedelic experience affected individuals differently; some approached it philosophically, others insisted that the experience invoked changes in spirituality, and still others felt it modified their epistemological worldview. Regardless of the interpretation of treatments’ subjective meaning, individuals regularly believed that the LSD experience fundamentally modified their being. In this way, LSD treatments differed from most other psychopharmacological therapies devised to treat a particular disorder. In short, during the 1950s, psychedelic psychiatry promised a consciousness-raising, identity-changing therapy within a medically sanctioned and scientifically rigorous environment. Moreover, psychedelic psychiatry offered an approach to understanding, accommodating and ultimately treating mental illnesses (and addictions) in a manner that matched the political goals of the region.

Unlike some of the other LSD investigators in the 1950s and early 1960s however, the Saskatchewan-based researchers did not have to fight an existing medical establishment to develop a supportive intellectual research environment. Instead, they played a role in the contemporaneous political and cultural reforms that contributed to the transformation of the province. Before leaving his post at Weyburn, in July 1961 (Regina Leader Post, 1961; Saskatchewan Archives Board, Hoffer Papers), Osmond wrote a letter to Tommy Douglas describing his faith in the psychiatric research being done in the province. In this letter, he affirmed that:

The research is making really encouraging progress. [Ten years ago] it seemed wholly improbable that our idea would last more than a year or so. It is now becoming the centre of more and more attention and gradually confirmation is seeping in…. I could not have done it alone …. I’m not sure what the social implications will be of a measurable, visible, biochemical schizophrenia but it is, I think, (and one can always be a bit premature) very close round the corner (Saskatchewan Archives Board, Douglas Papers).

In addition to a justification for his decade-long investigations, this letter also acknowledged Osmond's appreciation for the political support he received in Saskatchewan.

Like Osmond, by the early 1960s several of the medical investigators central to psychedelic research left Saskatchewan, signifying the slow demise of LSD experimentation in that province. This professional exodus weakened the existing medical research network and the internal support for LSD therapies. By the time LSD became known as a street drug in the 1960s, and later an illegal substance, in the latter half of the decade, many of the psychedelic psychiatrists had dispersed to various destinations throughout North America. In the 1950s the region provided something of an ideological sanctuary for political and medical experimentation with like-minded colleagues. By the mid-1960s many of the original medical researchers remained in contact through correspondence, but few continued to work out of the same institutions. The scattering of these individuals left them more vulnerable to attacks, from within the profession as well as from outside the medical community.

By the early 1960s, the political climate in Saskatchewan also began changing in ways that weakened enthusiasm for supporting a culture of experimentation. On 7 November 1961, Tommy Douglas resigned as premier of Saskatchewan to lead the newly formed national political organization, the New Democratic Party. His replacement as CCF leader and premier in Saskatchewan, Woodrow S. Lloyd, continued promoting health care reforms but the transition in leadership accompanied a number of personnel changes throughout the civil service and several key individuals left the province (Badgley and Wolfe, 1967; Johnson, 2004). After more than a decade of pursuing a reform agenda, the momentum behind the political experimentation had declined. The radical political agenda of the 1950s Saskatchewan government, however, had shielded psychiatrists in that region from larger debates in psychiatry by providing the political and institutional space necessary for establishing a supportive network of colleagues and studies. The embryonic institutionalization of psychedelic psychiatry achieved international recognition for its contributions to a field in search of coherent methodological strategies as a direct result of the local support that allowed it to develop.


Post-World War II experimentation with psychedelic drugs conducted in Saskatchewan may seem radical in hindsight, but considered within the contemporary regional context, these studies appear congruent with broader reforms and attempts to institutionalize psychiatric research in that province. Environmental and social factors that might have seemed unfavourable to some individuals, created fertile conditions for developing a research agenda that required inter-professional cooperation and the time and space to gestate with minimal interference. Saskatchewan provided that kind of research sanctuary. The political support for reforms in health care generated an international appeal to researchers and professionals interested in participating in the North American socialist experiment. It also meant that many of these individuals were hired as part of the provincial civil service, tying researchers to the government and institution-building programs in a direct way. The dual investment of researchers in the political and the scientific experiments unfolding in 1950s Saskatchewan served in part to silence critics within the region. Research that might otherwise be considered unorthodox continued with support from the provincial government, local endorsements from residents eager to garner international attention for progressive programs, and from the researchers themselves who felt free to explore the frontiers of the mind in this environment.


I am grateful to Chris Philo and John Pickstone for inviting me to participate in this collection. An earlier version of this article was published in the Journal of Canadian Studies (2007), and I thank guest editor Peter Twohig for granting me permission to republish sections of it here. Lastly, I thank the Western Canadian Reading Group at the University of Alberta for continually stimulating me to think about how to conceptualize the meaning of ‘place’ in historical scholarship.


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The globalization of ayahuasca: Harm reduction or benefit maximization?

The globalization of ayahuasca: Harm reduction or benefit maximization?

Kenneth W. TupperCorresponding Author Contact Information, a, E-mail The Corresponding Author

aDepartment of Educational Studies, University of British Columbia, BC, Canada

Received 9 June 2006;

accepted 1 November 2006.

Available online 4 December 2006.


Ayahuasca is a tea made from two plants native to the Amazon, Banisteriopsis caapi and Psychotria viridis, which, respectively, contain the psychoactive chemicals harmala alkaloids and dimethyltryptamine. The tea has been used by indigenous peoples in countries such as Brazil, Ecuador and Peru for medicinal, spiritual and cultural purposes since pre-Columbian times. In the 20th century, ayahuasca spread beyond its native habitat and has been incorporated into syncretistic practices that are being adopted by non-indigenous peoples in modern Western contexts. Ayahuasca's globalization in the past few decades has led to a number of legal cases which pit religious freedom against national drug control laws. This paper explores some of the philosophical and policy implications of contemporary ayahuasca use. It addresses the issue of the social construction of ayahuasca as a medicine, a sacrament and a “plant teacher.” Issues of harm reduction with respect to ayahuasca use are explored, but so too is the corollary notion of “benefit maximization.”

Keywords: Ayahuasca; Entheogen; Hallucinogen; Religious freedom; Benefit maximization

Article Outline
Ayahuasca and its effects
Contemporary ayahuasca uses
Constructing ayahuasca—ontology
Ayahuasca, globalization and public policy

In February 2006, the United States Supreme Court ruled that religious freedom may trump U.S. drug laws with respect to the ceremonial use of ayahuasca, a tea indigenous to the Amazon and long revered by its peoples (Hollman, 2006). The case of Gonzales v. O Centro Espirita Beneficente União do Vegetal (UDV) addressed the question of whether ‘hoasca,’ which contains the Schedule I substance dimethyltryptamine, could legally be consumed as a sacrament by the Brazilian-based UDV church according to the provisions of the Religious Freedom Restoration Act (RFRA). Passed by Congress in 1993 in response to the question of whether the Native American Church had the freedom to use ceremonially the scheduled drug peyote, the RFRA established that the limits of drug laws in the United States were at the boundaries of religious liberty.

The U.S. ayahuasca case is just one of several similar ones in countries such as Australia, Italy, the Netherlands and Spain. The issues raised by these court actions centre not only on religious freedom, but also on the substance in question: ayahuasca. Although somewhat obscure in pantheon of psychoactive substances, ayahuasca has begun to thrive beyond the Amazon. Practitioners, policy-makers and researchers face significant challenges in responding to psychoactive substance use that resists traditional conceptualizations and categorizations of illegal drug “abuse.” In this article, I briefly describe ayahuasca, its effects and its traditional and contemporary uses. I next explore some philosophical and policy issues raised by the “globalization” of ayahuasca, the burgeoning world-wide interest in and use of the tea. This discussion leads to a questioning of the deficit model of drug use implicit in the term “harm reduction” with respect to ayahuasca, which arguably warrants a re-framing such that policy discussions address the corollary concept of “benefit maximization.”

Ayahuasca and its effects

“Ayahuasca” is a word from the language of the Quechua people, a group indigenous to the Amazonian regions of Peru and Ecuador (Metzner, 1999). Translating as “vine of the soul,” ayahuasca refers both to Banisteriopsis caapi, a liana found in Western parts of the Amazon basin, and to a decoction prepared from B. caapi that typically contains other admixture plants. One of the most common admixtures to the ayahuasca tea is the leaf of Psychotria viridis, a plant from the coffee family. To avoid confusion, in this article the plant will be referred to by its botanical name, B. caapi, and the common tea preparation of the combination of B. caapi and P. viridis simply as ayahuasca.

The synergy between the respective psychoactive chemicals in B. caapi and in P. viridis is a remarkable pharmacokinetic interaction. The B. caapi vine contains harmala alkaloids, such as harmine and tetrahydroharmine, which are short-acting reversible monoamine oxidase (MAO) inhibitors. MAO inhibitors are a pharmacological class of antidepressant chemicals that function by preventing the breakdown of the monoamine neurotransmitters in the brain (Julien, 1998). P. viridis contains dimethyltryptamine, or DMT, a potent hallucinogen which is active when taken parenterally, but not orally (Shulgin, 1976). This is because the gastrointestinal tract also contains the enzyme monoamine oxidase, which metabolizes orally ingested DMT long before it can reach the brain. However, when DMT is ingested in conjunction with an MAO inhibitor – as is the case with the ayahuasca tea – its immediate metabolism is delayed, thus enabling it to reach the brain (McKenna & Towers, 1984; Ott, 1999). From a biomedical perspective, then, ayahuasca's unique effects are a function of the combination of DMT and the potentiating psychoactive harmala alkaloids ([Callaway et al., 1999] and [McKenna et al., 1984]). In contrast, the explanation of ayahuasca's effects by Amazonian indigenous peoples reflects a paradigm involving spiritual domains and supernatural forces, an account corroborated if not validated by the phenomenology of the ayahuasca experience.

The extensive range of ayahuasca preparations in the pharmacopoeias of different indigenous peoples throughout the Amazon region indicates that its use long predates first contact with Europeans. The variety of names given to B. caapi, such as yagé, caapi, natem, oni, nishi, also suggests widespread historic use (Luna, 1986). However, the legacy of colonialism in South America, as with so many other parts of the world, has irredeemably impacted indigenous peoples and their traditions, including cosmologies in which ayahuasca has played a central role (Whitten, 1981). Colonial and religious authorities tended to condemn ayahuasca shamanism as diabolical and discouraged its practice ([Taussig, 1986] and [Vickers, 1981]). Nevertheless, the ritual use of ayahuasca among indigenous peoples of the Amazon continues to the present day, albeit with varying degrees of Christian syncretism through past and present influence of missionaries in the region (Luna, 1986). Likewise, cross-cultural transfer of ayahuasca healing knowledge among indigenous peoples and to non-indigenous people continues to occur ([Gray, 1997], [Luna, 2003] and [Pollock, 2004]); this includes mestizo vegetalistas who offer alternative health treatments to urban dwellers in countries such as Peru (Dobkin de Rios, 1973).

The specifics of traditional Amazonian ayahuasca practices – as with the name for the tea itself – vary across different cultural groups, but there are some common elements, most notably a ceremonial context for its consumption. Rituals are conducted by an experienced healer, or ayahuascero, who has undergone many years of training to become adept in administering the brew. Preparation for this role includes long periods of isolation, sexual abstinence and adherence to strict dietary taboos involving certain foods or meats. Some of these behavioural directives apply also to participants in the ritual who will drink, as they risk invoking untoward spiritual forces if these are violated. Rituals invariably incorporate chanting or singing of icaros – special songs through which healing, divination or connecting with spirits may be effected – and often include an accompanying use of other sacred plants, such as tobacco ([Demange, 2002] and [Luna, 1986]). In many respects, ayahuasca is a paradigmatic entheogen, or psychoactive substance used for spiritual purposes (Ruck, Bigwood, Staples, Ott, & Wasson, 1979; Tupper, 2002).

Ayahuasca's psychoactive effects are qualitatively similar to those of other drugs from the same pharmacological class, such as LSD and psilocybin, yet they are also phenomenologically unique. The effects generally begin 30–40 min after ingestion, peak by about 2 h and have completely subsided by 6 h (Riba et al., 2003). Ayahuasca produces moderate cardiovascular stimulation, including moderate increases in heart rate and diastolic blood pressure (Riba et al., 2003). Users report sensations of visual or auditory stimulation, synaesthesia, psychological introspection and strong emotional feelings ranging from occasional sadness or fear to elation, illumination and gratitude (Shanon, 2002). The tea itself has a bitter taste and cannot be described as pleasant to drink. Emesis, or vomiting, is not uncommon during the ayahuasca experience, an effect which is generally regarded as a spiritual or physical cleanse.

The long-term effects of ayahuasca on regular drinkers have not yet been well studied by medical scientists, as the tea has remained relatively obscure until the last few decades of the 20th century. Preliminary small-scale investigation on members of Brazilian ayahuasca churches suggests that the tea is not physiologically or psychologically harmful when used in ceremonial contexts (Barbosa, Giglio, & Dalglarrondo, 2005; [Callaway et al., 1999] and [Grob et al., 1996]; Riba & Barbanoj, 2005). Shanon (2002) has analysed the phenomenology of the ayahuasca experience from the perspective of cognitive psychology, work that suggests many avenues of future psychological research. Evidence for ayahuasca dependence is lacking; indeed, some have suggested ceremonial ayahuasca use may have therapeutic applications as an adjunct to treatment for addictions ([Mabit, 2002], [McKenna, 2004] and [Winkelman, 2001]).

Contemporary ayahuasca uses

In addition to continued ayahuasca use among traditional indigenous and mestizo denizens of the Amazon, other types of ayahuasca practices have arisen in modern times. The inevitable mixing of indigenous and dominator cultures in South America over time has resulted in hybridities of ayahuasca use that continue to evolve through the forces of globalization. Brazil has been the source of several syncretistic religious movements that combine elements of indigenous ayahuasca use, African spiritualism and Christian liturgy. These include the Santo Daime, founded in the 1930s by Raimundo Irineu Serra; the União do Vegetal, founded in 1961 by José Gabriel da Costa; and the Barquinha, a group, which split from the Santo Daime in 1945 (MacRae, 2004). As with traditional indigenous ayahuasca practices, these modern groups incorporate a strong ritual context in their uses of ayahuasca. Towards the end of the 20th century, chapters of the Santo Daime and the União do Vegetal started to be established beyond Brazilian borders, in such countries as in Australia, Canada, France, Germany, Japan, the Netherlands, Spain and the United States.

The Santo Daime is both the oldest and the most internationally active of the syncretistic Brazilian ayahuasca churches. Its origins trace back to the 1920s, when its founder – a Brazilian rubber tapper named Raimundo Irineu Serra or Mestre Irineu – encountered the tea through contact with Amazonian indigenous peoples in remote forests of the Brazilian frontier state of Acre (Alverga, 1999). The Santo Daime remained obscure and geographically isolated in the rural Amazon for many decades. However, when Mestre Irineu died in 1971, the church split into several different factions, one of which – the Eclectic Center of the Universal Flowing Light, or CEFLURIS – has been central in the Santo Daime's subsequent expansion (MacRae, 2004). From the 1970s, CEFLURIS has attracted middle-class Brazilians and international visitors to its rituals and established chapters in urban Brazilian centres and more recently overseas (MacRae, 1998). After a period of legal vicissitudes, in which the status of ayahuasca was uncertain, the Brazilian government in 1991 determined that the benefits of its ritual use outweighed any potential risks and recognized the rights to sacramental use of the tea by groups such as the Santo Daime and the UDV.

As a result of expansion into countries unprepared for the policy conundrums posed by non-indigenous entheogenic substance use, the Santo Daime and its adherents have faced legal action in several different countries in the past decade, including the Netherlands, Spain and Italy. In the Netherlands, as with the UDV case in the United States discussed above, the courts ruled in favour of religious freedom and the Santo Daime was granted the right to use its sacrament legally in Holland (Adelaars, 2001). In Canada, a chapter of the Santo Daime in the province of Quebec has applied for an exemption to the Canadian Controlled Drugs and Substances Act in hope of obviating a costly legal battle; the Canadian government is still considering the application (J.W. Rochester, personal communication, February 7, 2006). These cases epitomize the struggle between groups seeking the legitimation of the sacramental use of ayahuasca and governments in liberal democratic states endeavouring to uphold both religious freedom and punitive drug laws.

The forces of information and communications technology have also provided avenues for the expansion of use of ayahuasca-like preparations. A quick Internet search results in scores hits for websites selling live cuttings or dried samples of B. caapi, P. viridis and numerous other plants, such as Mimosa hostilis and Peganum harmala, that are botanical sources for dimethyltryptamine and harmala alkaloids. The Internet also abounds with information (and misinformation) about how to prepare ayahuasca-like brews and “trip reports” of first-hand accounts of experiences individuals have had with these ([Bogenschutz, 2000] and [Halpern and Pope, 2001]). Predictably, some amateur psychonauts or self-styled kitchen shamans have harmed themselves through experimenting with ayahuasca analogues in recreational contexts (Brush, Bird, & Boyer, 2003; Sklerov, Levine, Moore, King, & Fowler, 2005). However, it should be noted that reported adverse outcomes are extremely rare and have been sequelae to uncontrolled use of non-traditional preparations (Callaway et al., 2006).

Ayahuasca tourism has also become a cultural phenomenon in the Amazon at the turn of the 21st century. With growing awareness of ayahuasca in developed Northern countries has come the concomitant desire among some to seek “authentic” ayahuasca experiences in countries such as Peru, Ecuador and Brazil ([Dobkin de Rios, 1994] and [Winkelman, 2005]). The effects of ayahuasca tourism on both the local people and the economies of these regions are open to interpretation, but are significant and continuing to grow. Some indigenous healers in the Amazon have expressed concern about the ill-trained or manipulative locals who may exploit naïve or undiscerning travellers and potentially cause inadvertent harm through careless administration of ayahuasca (Dobkin de Rios, 2005).

The expansion of ayahuasca use can be expected to continue as public awareness of the tea grows and as it becomes further available both through commercial sales and through spiritual communities. Accounts of ayahuasca experiences and the tea's purported spiritual and health benefits are beginning to appear in mainstream English news media stories ([Creedon, 2001], [Montgomery, 2001] and [Salak, 2006]). Some of the effects of ayahuasca – for example, its tendency to provoke vomiting and its sometimes heavy emotional and psychological effects – may discourage casual experimentation. However, its relative obscurity and lack of negative associations from the demonizing of such hallucinogens as LSD, psilocybin and peyote in the late 1960s and early 1970s, as well as growing interest in alternative medicines and therapeutic practices, may increase ayahuasca's uptake among the general public. Thus, ayahuasca presents unexpected challenges to judicial systems and policy-makers, who struggle to balance tensions between criminal justice, public health and human rights interests.

Constructing ayahuasca—ontology

One of the conundrums ayahuasca presents for contemporary drug policy is ontological. Ontology is a branch of metaphysics that involves the philosophical analysis of existence and the categorization of reality. Modern drug laws and policies are ontologically predicated on a mechanistic view of the universe, as they are socio-political extensions of the modernist project of scientific materialism. According to this view, drugs and their effects can be wholly explained by the sciences of biochemistry and psychopharmacology. Reinarman and Levine (1997) identify this as pharmacological determinism, the belief that a drug's effects are caused solely by its pharmacological properties, irrespective of psychological idiosyncrasies or social context. However, a constructivist perspective acknowledges that beyond this, drugs are powerful cultural constructs. The effects they produce on human consciousness and behaviour are functions not just of their biochemistry, but also of the rich symbolic and social meanings they are given.

From a constructivist perspective, drugs cannot be fully understood merely by analyzing their chemical structures and how these interact with neurophysiological systems. One needs to consider also the meanings underlying their growth, production, preparation, consumption and categorization, all of which can vary across cultures and over time. For example, the concept of “medicine” is a cultural construction that in contemporary Western societies is given meaning through the powerful institutions of medical practitioners and systems. Particular substances are deemed medicines not by any properties inherent in them, but by virtue of their being blessed as such by members of powerful professional classes (i.e. physicians and pharmacists). Lysergic acid diethylamide (LSD) had this blessing in the 1950s and early 1960s, when it was considered a promising psychiatric medication, but was quickly delegitimized when its non-medical use became headline news and the subject of moral panic ([Dyck, 2005], [Littlefield, 2002] and [Sessa, 2005]). Alcohol was also once deemed a medicine, whereas today in most societies it is a recreational (or sometimes ceremonial) substance, except in some Muslim states, where it is a dangerous prohibited drug ([Baashar, 1981] and [Heron, 2003]). Indeed, the common phrase “alcohol and drugs” betrays a lingering implicit ontological commitment to the notion that alcohol is something other than a drug.

Ayahuasca quintessentially defies the simplistic categorization of being merely a “drug”—or, in the terminology of the U.S. National Institute on Drug Abuse, a “drug of abuse.” Indeed, ayahuasca has been culturally constructed by its various users as a medicine, a sacrament and a “plant teacher.” In the Amazon, ayahuasca is considered a master plant, both a diagnostic tool and a force for healing ([Demange, 2002] and [Luna, 1984]). Along with tobacco, it is one of the most important substances in the pharmacopoeias of Amazonian folk healers (Bennett, 1992). Yet ayahuasca has also come to be culturally constructed as a sacrament by religions such as the Santo Daime and the UDV. For their adherents, the tea is considered a divine gift allowing contact with forces and energies from which humans are ordinarily cut off in our quotidian lives. And ayahuasca is quintessentially a “plant teacher,” a natural divinatory mechanism that can provide esoteric knowledge to adepts skilled in negotiating its remarkable effects. These conceptualizations pose a challenge to modern Western drug policies and laws, which are premised on a rationalist/positivist ontology that constructs psychoactive substances essentially as chemicals and their effects as simply mechanistic.

Ayahuasca, globalization and public policy

The policy implications of contemporary ayahuasca practices can be usefully explored by regarding them as a cultural manifestation of globalization. By the term globalization, I refer to the economic, political, technological and cultural transactions and integrations resulting from the increased ease of movement for people, goods and ideas at the turn of the 21st century. As Collier and Ong (2005) observe, “[g]lobal phenomena … have a distinctive capacity for decontextualization and recontextualization, abstractability and movement, across diverse social and cultural situation and spheres of life” (p. 11). Thomas (2005) cites the resurgence of religion – including the spread of new religious movements and cultural and religious pluralism – as one of the “megatrends” of the 21st century. In response, states and faith communities alike “are being forced more than ever before, to define, defend or redefine the social boundaries between the sacred and the profane in the face of modernization and globalization” (Thomas, 2005, p. 26). The evolving spiritual practices whose nexus is the ayahuasca tea exemplify well these trends and tensions of globalization.

Ayahuasca has begun its ascendancy into popular global consciousness at a time of unprecedented interpersonal and intercultural knowledge exchange. One issue this raises is that of cultural appropriation. I would be remiss not to acknowledge humbly that ayahuasca is an exemplar of indigenous knowledge, a shamanic technology or cognitive tool that has long been what may best be described as intellectual property of the native peoples of the Amazon. Accordingly, its commodification, commercialization and secularization are concerning trends. The issue of intellectual property came to public attention in the 1990s when representatives of Amazonian tribes formally protested against the U.S. patent office, which had naïvely granted a patent on ayahuasca to an American pharmaceutical entrepreneur—it was subsequently rescinded (Fecteau, 2001). However, dismissing the growth of interest in ayahuasca as merely appropriation is somewhat simplistic. The genesis of the Brazilian ayahuasca churches – which are in many respects primary drivers of ayahuasca's globalization – was arguably a by-product of cross-cultural fertilization (MacRae, 2004). There is also reason to believe that, in the age of wikis, file-sharing and the open source movement, the concept of intellectual property is rapidly becoming a quaint anachronism, a development that concerns corporations and academics as much as it does indigenous peoples.

Curiously, in the 1960s, ayahuasca largely stayed off the Western cultural radar despite increased popular interest in visionary plants such as peyote and psilocybin mushrooms. Unlike only a few decades ago, however, the collective mindscape of the early 21st century is being expanded and shaped by revolutionary information and communications technologies (Friedman, 2005). Thus, insofar as ayahuasca is being variously and simultaneously culturally constructed in the (post)modern world, novel forces are at play. For example, authorities whose interests might be served by the dissemination of inaccurate or deprecatory representations of ayahuasca – as they have been countless times in the past for other illegal drugs – are hard-pressed to challenge the size and scope of factual information easily available to the lay public. The use of the Internet by ayahuasca aficionados allows for a diversity of thought and expression about the tea and its effects that poses significant challenges to policy-makers.

It is my contention that the policy issues presented by contemporary ayahuasca practices are not easily dealt with from the traditional framing of modern drug policies. Schön (1993) proposes that the framing of policy solutions for social issues is constrained by underlying, often implicit, “generative” metaphors. With respect to non-medical psychoactive substance use, two dominant constructions of the problem are identified by Marlatt (1996): drug use as a moral issue and drug use as a disease. The first constructs some drugs as intrinsically malevolent, imbuing them with agency and the power to override human free will. Implicit in this “malevolent agents” metaphor is the notion that people who use drugs are wicked and need to be punished; it is this generative metaphor that underpins the global regime of prohibition of (some) drugs. The second dominant metaphor constructs psychoactive substances as pathogens. This metaphor has become the predominant one in the field of public health, where it is prevalent in the discourses of treatment and prevention. With the “pathogens” metaphor, drug use is constructed as a disease against which youth need to be inoculated and for which people who use need to be treated.

The two dominant metaphors underlying current drug policies – “malevolent agents” and “pathogens” – are particularly unhelpful in framing policies with respect to entheogenic substance use. Ayahuasca's long tradition of uses as a medicine, sacrament and plant teacher poses a challenge to such simplistic metaphorical categorizations. Rather, I submit that a shift to a generative metaphor of drugs as “tools” offers a much more nuanced way of conceiving of the risks and benefits posed by ayahuasca practices. Rather than essentializing psychoactive substances as inherently dangerous, to regard them as tools – ancient technologies for altering consciousness ([Eliade, 1964] and [Winkelman, 2000]) – allows for a realistic assessment of their potential benefits and harms according to who uses them, in what contexts and for what purposes. To be sure, as with the use of any tool, there are risks associated with ayahuasca use, especially for those who are not prepared for its effects or who treat it as a toy. However, both traditional and contemporary ceremonial ayahuasca practices suggest benefits that the tool metaphor better accounts for in terms of policy considerations.

The philosophy of harm reduction is also further illuminated by a shift to the generative metaphor of drugs as tools. To the extent that policy-makers or practitioners emphasize a behaviour's potential risks, the harm reduction policy approach is justified. However, the tool metaphor for psychoactive substances warrants a corollary notion of “benefit maximization,” the other side of the harm reduction coin. Instead of approaching drug policy from a deficit perspective – implied by the “malevolent agents” and “pathogens” metaphors – the tool metaphor opens discursive avenues for realistic policy considerations of benefits as well as harms. Although harm reduction has been a valuable concept in challenging abstinence-based approaches to non-medical drug use and shifting policy to a more humane public health perspective, its limitations become apparent with the “drugs as tools” generative metaphor. Along these lines, the Health Officers Council of British Columbia (2005) has incorporated the concept of beneficial substance use in a recent policy discussion paper arguing for government regulation of currently illegal drugs; the paper explicitly makes reference to ceremonial use of ayahuasca (p. 5).

A traditional harm reduction approach to ayahuasca would emphasize similar general types of cautions as those for LSD, psilocybin or other psychedelic drugs. These include knowing and trusting the source of the substance, controlling set and setting (e.g. psychological preparation and physical surroundings), having a “sitter” who can be mindful of safety, not driving or engaging in other risky activities while under the influence, and discouraging use by individuals with underlying psychiatric disorders. It would also include specific cautions regarding diet and combining medications. The MAO-inhibitor effects of harmala alkaloids in the ayahuasca tea warrant dietary restrictions for foods containing the monoamine compound tyramine. Tyramine eaten in combination with MAO inhibitor drugs may result in hypertensive crisis. Likewise, selective serotonin reuptake inhibitors can have potentially harmful interactions with MAO inhibitors, so people taking these kinds of medications are advised to avoid ayahuasca (Callaway & Grob, 1998). Interestingly, indigenous ayahuasca practices in the Amazon also universally incorporate strict dietary and behavioural protocols (Andritzky, 1989).

A benefit maximization approach to ayahuasca use, by contrast, would involve the creation of policies to provide legitimate access to ayahuasca in ceremonial settings. This process would include considering a variety of policy levers at the disposal of public health authorities to ensure the minimization of risk (Haden, 2004). Such an approach might begin with the formalization of the harm reduction protocols listed above. It might also include enacting provisions to ensure ayahuasceros or spiritual leaders are skilled and competent in leading rituals (either through self-regulation or certification), inspecting and licensing facilities or centres where ayahuasca ceremonies are conducted, and regulating production of the tea to ensure it conforms to specified purity or potency (as is currently done in some countries with other natural health products). A benefit maximization approach would certainly entail further research into both the short- and long-term effects of ayahuasca and the social practices in which it is used, which may in turn provide further policy direction.


The growing interest in and use of ayahuasca by modern non-indigenous peoples poses significant conceptual challenges regarding drugs and drug policies. Ayahuasca has a rich history of use as a medicine, sacrament and plant teacher, cultural constructions that do not readily fit contemporary drug policy frames. The globalization of ayahuasca in the latter part of the 20th and the early 21st centuries is a phenomenon that demands reconsideration of some of the metaphysical and sociological presuppositions of contemporary drug policies. Already several legal cases have opened the door to granting religious freedom to the ceremonial use of ayahuasca. Accordingly, policy-makers would be well advised to consider other policy tools than criminalization to balance the competing interests of criminal justice, public health and human rights. With respect to harm reduction theory, the contemporary uses of ayahuasca lend weight to the corollary notion of benefit maximization.


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