Practitioners and researchers often claim it is “not my place” to integrate Indigenous knowledge, raising questions about whose responsibility it is to ensure ethical reciprocity.
What was once known as the “free-love” movement has been recategorized and upholstered to the announcement of a renaissance era of psychedelics (Dupuis and Veissière, 2022). Within this re-emergence comes the demand for answers of how its mechanisms will be different, in terms of epistemic authority, ethical parameters, and equitable access. How can we expect that demand to be met? Commonly, with a redirection of responsibility and more questions to be asked.
Epistemic Authority and Psychedelic-Assisted Therapy (PAT)
The expectations of all agents involved in psychedelic-assisted therapy (PAT)—including participants, clients, and the psychedelic substance itself—intersect and influence the therapeutic process. Psychedelic research often undervalues the impact of expectations, a key non-pharmacological factor shaping the set and setting of PAT (Hartogsohn, 2022). The identities of each agent and the epistemic values brought into medicine in a collision with traditional practices, illustrate how cultural influence further shapes these dynamics.
Different waves of introducing psychedelics into Western power structures brought attempts at restraining the free use of natural medicinal and ritual practices in Indigenous communities (Gearin and Sáez, 2021; Feeney and Labate, 2013; Ona et al., 2021). This restraint reinforces the assumptions that the Western approach holds epistemological power where “all nomenclature tends to make any item of knowledge more exoteric”—causing what is understood as epistemic injustice (Ludwik Fleck, 1979, pg. 114). Research often borrows elements such as music and environmental considerations to enhance therapeutic outcomes, yet are selective in acknowledging Indigenous influence on the set and setting of PAT. This influence extends to maintaining a mediating variable for the success of the treatment; this being consuming psychedelics strictly with the attendance of therapy with a Shaman or guide (Johnson et.al, 2008; Noorani, 2019; Hofmann, 1980). However, the suppression of acknowledgements in research and academia reflects a broader colonialist framework, where Western epistemological power dictates what constitutes valid knowledge and appropriate therapeutic practice. The psychedelic renaissance mirrors this pattern (Ona et.al, 2021; Feeney and Labate, 2013). Incorporating shamanic techniques and long-lasting knowledge, requires an approach that avoids cultural appropriation and promotes fairness to those that aid in this emergence.
Incorporating shamanic techniques and long-lasting knowledge, requires an approach that avoids cultural appropriation and promotes fairness to those that aid in this emergence.
To begin finding an approach that addresses these parameters, researchers from London universities and practicing psychotherapists from the United States share their own epistemological frameworks, as well as their perceptions of those available, presented, and prioritized for other agents of PAT. A qualitative research method of interviews and reflexive thematic analysis was pursued to navigate the landscape moving from traditional practice and self-experimentation to research and therapeutic practices.Some argue traditional practices can’t legitimately be incorporated into academia. I disagree and urge further discussion.
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Informed Consent
A key concern among practitioners is ensuring that clients provide fully informed consent before entering an altered state of consciousness (ASC). When navigating through an experience that is often described as ineffable, it is essential to communicate both the known and unknown about a psychoactive substance. For example, clients may enter a session anticipating a “natural medicine” and later learn that the psychedelic used has been pharmacologically synthesized—what one participant described as “made in a lab in Switzerland, so it’s got a very different vibe” (Participant Y).
Psychotherapists perceived their role as guiding their clients through the integration processes of PAT, answering questions and concerns and mediating any outlying expectations and misconceptions formed by client epistemological frameworks. While accessible media plays an important role in constructing these frameworks and simultaneously demystifying the experience, it also introduces expectation biases that shape how clients approach therapy. One researcher described this phenomenon succinctly: “the media hype sustains about five years’ worth of additional expectation bias, and then, when that hype drops, the efficacy of the drug also drops” (Participant V). This aligns with previous studies suggesting that expectation inflation can lead to exaggerated perceptions of therapeutic potential, followed by disillusionment when experiences do not align with idealized narratives (Szigeti and Heifets, 2024). Would we begin to influence the sustainability of a global panacea if we didn’t allow the same Western, pharmaceuticalization process to happen? As such, ensuring accurate, nuanced, inclusive, and diverse knowledge dissemination is crucial to maintaining the integrity and efficacy of PAT.
The content of informed consent materials directly correlates to agents’ regulation of expectations to the experience. The content within the information sheet outlines the nature of the psychedelic substance, its effects, risks, and the therapeutic process, providing clients with the necessary information to make an informed decision about their participation. The sources and perspectives included in these materials—and just as importantly, those excluded—reflect who holds epistemic authority in the field. Currently this authority is dominated by Western structures and male perspectives, thus determining whether the knowledge and practice are respected at their origins. The Indigenous influences of clinical PAT “set” is largely disregarded here.
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“Flavour and Culture”
While trying to discuss the integration of Indigenous practices within modern psychedelic research, there is a tendency to prioritize recent data over historical context. As Participant Y points out, recent data is considered more relevant to biomedicalization (meaning medicalization with techno-scientific and pharmaceuticalization considerations) and valid to the research community. Furthermore, the incorporation of Indigenous context varies for each substance, as Participant Z notes that external factors like sponsors and protocols influence the “flavour and culture” surrounding each substance. Different research institutions support and project objectives that will be more influenced by Western medicine, monetization, and integration through policy. The “flavour and culture” shifts when other research institutions prioritize sharing the value of research outcomes with diverse communities. Consciously extending the importance of the role of identity to the medicine contributes to the therapeutic efficacy. For example, one researcher noted that clients often view psilocybin as a “spiritual teacher” and MDMA as an “empathogen,” shaping how they approach their sessions. The cultural notes attached to each substance contributes to the set of the experience, further reinforcing the dynamic relationship between expectations and outcomes.
This prioritization of biomedicalization over historical context not only shapes research validity but also influences how individuals working within psychedelic research orient themselves to Indigenous context of the medicine.
This prioritization of biomedicalization over historical context not only shapes research validity but also influences how individuals working within psychedelic research orient themselves to Indigenous context of the medicine. A few of these participants shared that their first exposures to psychedelics were through explorations and observational studies within Indigenous, shamanic spaces. After finding their passion with entheogens, they returned to Western landscapes to further their experiences. I probed how they brought the value of their observations and reflections of shamanic practices into their work now. While they admirably admit that Indigenous influence should be used sparingly as to not over-exploit the tradition, they also must adhere to a Western protocol to fit what is accepted as valid literature in modern medicine—where “all nomenclature tends to make any item of knowledge more exoteric.” The question must be asked, with what epistemological framework will there be willingness to challenge the notion that avoiding exploitation is more important than Indigenous reciprocity?
A common answer given is that it’s “not my place.” This phrase was used to describe my participants’ separation from guiding in Indigenous settings and to clarify that they did not impose their exposure to shamanic methods in clinical environments. After commodifying knowledge derived from thousands of years of Indigenous practices and reintegrating into a biomedicalized landscape, they struggle to assert a role in advocating for Indigenous representation in research.
This sort of orientation to the research and development—both quantitative and qualitative—of psychedelics is replicated in almost every niche. My own research experience lends itself to this argument in which I fall short of using my position to encourage acknowledgement of the historical significance of psychedelics in shaping where we are now and where we aim to go. As a fresh graduate, I find myself conducting qualitative research with Western clients who have sat with psychedelic medicines in Central America in collaboration with an honoured organisation. However, I also found myself disregarding the importance of examining whether information about the community, land, and history of these medicines and spaces contributed to their integration process. What can be found is whether clients believed such knowledge would help them better understand the often-described spiritual or mystical-like experience, especially beyond the boundaries of Western frameworks. To deepen research and to expose gaps, asking further questions is essential. Reflexivity must extend beyond individual therapeutic sessions and into research design and policy.
As Jacob Bronowski says “That is the essence of science: ask an impertinent question, and you are on your way to a pertinent answer” (Carhart-Harris and Goodwin, 2017, pg. 2107). While recognizing this approach is unique to other therapeutic designs, with additional barriers to overcome, the important questions are those of reflexivity: How can researchers ensure that acknowledgment of Indigenous contributions extends beyond tokenism and towards meaningful reciprocity? Will this panacea-ideologic mental health remedy mitigate unrealistic expectations or increase them? What would our world look like if everyone went on a trip? (Pollan, 2020). If it’s “not my place,” whose is it?
The psychedelic renaissance presents an opportunity for greater reflexivity in how knowledge is constructed, disseminated, and integrated into clinical practice.
Ultimately, this research argues that managing expectations is crucial in the biomedicalization of psychedelic-assisted therapies. The psychedelic renaissance presents an opportunity for greater reflexivity in how knowledge is constructed, disseminated, and integrated into clinical practice. Through bridging epistemic frameworks—Western scientific rationalism and Indigenous knowledge—PAT can evolve in a way that honours its historical roots while ensuring ethical and effective therapeutic applications. This study advocates for further interdisciplinary exploration, including diverse voices, and expanding qualitative methodologies to ensure that the evolution of PAT remains as transformative as the medicines themselves.
Art by Fernanda Cervantes.
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