- What Do Psychedelic Medicine Companies Owe to the Community? - June 11, 2020
María Sabina, the curandera who revealed the psychedelic mushroom to the Western world, ultimately died in poverty.
Venture capital is betting big on the potential of psychedelics to transform into lucrative medicines. More than a half billion dollars have been poured into for-profit psychedelic ventures. Yet, natural psychedelics come from the humblest of origins. María Sabina, the curandera who revealed the psychedelic mushroom to the Western world, ultimately died in poverty. As psychedelics are made into corporate medicine, are we repeating a shameful history? What lessons can her history teach us?
The discovery of psychedelic mushrooms by the West can serve as a parable to help us understand what psychedelic medicine companies owe to the community. I will use this history to illustrate some ethical and pragmatic reasons why psychedelic users should be recognized as stakeholders by companies developing psychedelic medicines. One implication of this is that formal structures and processes are needed to include these stakeholder interests in the work of psychedelic companies so that we can together create truly transformative healthcare.
How the West Was Shroomed
In the summer of 1955, a vice president from the J. P. Morgan Bank and a New York fashion photographer made history by becoming the first outsiders to participate in a sacred mushroom ceremony. The ceremony was held by the locally-respected curandera María Sabina in Oaxaca, Mexico.
The experience shook the banker to his core. Gordon Wasson saw, more clearly than he ever could with his mortal eyes, the newness of everything, as if the world had just dawned. It overwhelmed and melted him with its beauty. And, all the time that he was seeing these things, the wise woman María Sabina danced and sang, not loudly, but with authority.
Wasson had gone to Mexico seeking a religious experience and he was not disappointed. For the first time, the word “ecstasy” took on real personal meaning for him. For the first time, ecstasy did not mean someone else’s state of mind.
Wasson seems to have been a genuine seeker with good intentions, yet his religious exaltation was achieved through questionable power dynamics and subterfuge. Sabina had agreed to meet with Wasson and conduct a ceremony because she had been asked to by a local authority. She did not believe she had a choice.
Once they met, Wasson attempted to mislead her in order to be allowed to partake in a ceremony. María Sabina primarily held her ceremonies to cure the sick. Wasson, therefore, told her what must have seemed to him a white lie, that he was concerned about the health of his son. No doubt, he was as concerned as any parent would be when traveling without their child. But traveling parents usually aren’t concerned enough to see a doctor or priest.
After he returned to New York, Wasson described his adventures in a now-famous article in Life magazine. Wasson gave María Sabina a pseudonym, to lightly disguise her. However, I know of no evidence he warned her of his intentions to publish, nor does it appear he sought permission to publish photos showing her face.
The 1957 article coined the term “magic mushroom” and helped open the floodgates of the psychedelic revolution. People began coming to Mexico to experience God. To Jonathan Ott (1993), the mushrooms were rescued from oblivion at the moment when their use had almost disappeared.
The effects of the psychedelic revolution on María Sabina were mixed at best. She became well known and was visited by musicians, poets, and celebrities. Yet, her house was burned down, she was raided by federales, and she was forced, for a while, to leave her hometown. She saw others start offering psychedelic mushroom experiences for money without following the traditional ways. María Sabina later described the results with heartbreaking matter-of-factness:
But from the moment the foreigners arrived to search for God, the niños santos lost their purity. They lost their force, the foreigners spoiled them. … Before Wasson, I felt that the niños santos elevated me. I don’t feel like that anymore.
María Sabina died in 1985 at the age of 91. She had never owned shoes.
Lessons for Today?
Today, big money is seeking big returns by developing psychedelics as products. Will prestigious bankers again prosper while curanderas remain barefoot?
It may seem hyperbolic to compare unsanctioned users of psychedelics to María Sabina. Yet, the history of María Sabina is still relevant and illustrates two important truths. First, the communities that originate psychedelic practices need to be considered in ethical calculations because they may experience adverse effects from commercial or research activity. Second, a crucial part of the therapeutic power can be lost in translation when a psychoactive substance is removed from its cultural context.
Principles for Partnering with Source Communities
In modern terms, Wasson was exploiting indigenous knowledge without getting adequate consent when he publicized María Sabina’s ceremony. Even considering the context of his time, we can say he should have been less coercive and more honest in his actions. He seemed to recognize this in 1976, when he wrote that he regretted how his actions affected Sabina. But, even when he wrote those regrets, it was still not too late for him to intervene; yet he did nothing.
What should Wasson have done? The only way to know the right answer would be if he had asked. And this is the core of the problem: Wasson treated María Sabina as a resource instead of as someone who should be allowed to make decisions for herself. Ultimately, he should have treated María Sabina—and the residents of her village—as partners. In this section, I discuss how adequate partnering requires “Free, Prior and Informed Consent” (often abbreviated FPIC), and how entire communities should often be recognized as stakeholders.
“Free, Prior and Informed Consent” has emerged as an idea in work on the rights of indigenous peoples to self-determination.
“Free, Prior and Informed Consent” has emerged as an idea in work on the rights of indigenous peoples to self-determination. It means that a non-coercive process should be used in advance to inform a group and allow them to choose and direct their participation in a proposal that uses their resources or otherwise affects them. This overlaps with the practice of informed consent in research ethics. Ethical research requires that participants understand study procedures, risks, benefits, and alternatives before freely agreeing to be in a study.
A key difference between the ideas of FPIC in indigenous human rights and informed consent in scientific research is the focus on community in the first and individual in the second. However, this difference is shrinking. While clinical research ethics has traditionally focused on individual participants, there is increasing recognition that non-participants can also be harmed by research. A study that identifies a genetic risk of developing Parkinson’s disease in participants will also suggest the same risks exist in relatives, who may not wish to have this knowledge revealed to themselves let alone others. And studies that withdraw people from HIV medicines in order to test a new potential treatment can expose sexual partners of the participants to increased risk of contracting HIV. Scientists designing these studies therefore need to consider potential benefits and harms to non-participants.
It is perhaps easy to see how Wasson might have overlooked the possible effects of his actions on María Sabina’s community. Understanding a community’s stake in some piece of knowledge or other resource can be difficult. Dutfield (2017) has pointed out that local use of traditional knowledge is often much broader than what is readily reflected in economic exchange value. We see this with Maria Sabina’s example, where there was a simultaneously increased market for mushroom trips along with a harder-to-quantify loss of sacred quality. These different uses that a community has for some knowledge or other resource make the community vulnerable to changes in the resource and thus give the community a stake in what happens to it.
If we agree that the local uses of a resource give the community some stake in the resource, it seems to follow that psychedelic users have some stake in how psychedelics are developed as medicine.
One aspect of this is that psychedelic users have, essentially, served as human guinea pigs, elucidating the risks, safety profile, and efficacy of psychedelics.
One aspect of this is that psychedelic users have, essentially, served as human guinea pigs, elucidating the risks, safety profile, and efficacy of psychedelics. Groups developing psychedelic medicines have often explicitly argued that recent and traditional human use of psychedelics means the drugs are physiologically safe and more likely to be approved as medicines than most experimental compounds. Much of this psychedelic use has been unsanctioned and illegal, placing the user at risk of loss of liberty or worse. For example, Alexander Shulgin—who invented several of the psychedelics now being studied and was one of the first to recognize the therapeutic potential of MDMA—lost his laboratory license and was harassed by the Drug Enforcement Administration because he was about two decades too early in publishing books about the benefits of psychedelics.
These relatively visible individual users are supported by and support less-visible economies and communities. These economies include those who grow, manufacture, transport, and sell psychedelics. These communities also include those who come together to use psychedelics in religious, mystical, or life-affirming ways, and those who facilitate growth or healing by conducting psychedelic therapy, integration sessions, or wellness retreats.
Often, a main motivation of people involved in psychedelic economies is to make the world a better place.
Psychedelics are somewhat unusual among illegal drugs in that the motives of many of those involved in commercial activities are not primarily financial (e.g., Henderson & Glass, 1994). Often, a main motivation of people involved in psychedelic economies is to make the world a better place. Think Sunshine Makers, not drug dealers. Now, this doesn’t necessarily mean the people maintaining these economies deserve special consideration over those who are motivated by money. But it should suggest that these psychedelic economies are fragile and have a meaningfulness that cannot be readily replaced by a legal commercial marketplace. It is unclear how psychedelic medicines would affect these economies, and it is important to consider.
Companies developing psychedelic medicines should resist building new systems that needlessly exclude community expertise.
As a concrete example of this, we might consider underground psychedelic therapists and guides. These individuals have engaged in illegal practices that, nonetheless, have helped many people. With the approval of psychedelic medicines, the skills and capabilities of these underground therapists will be greatly needed. Yet, there is a real risk that many will be shut out of the medicalized system of legal therapy: the US Food and Drug Administration is currently arguing that psychedelic therapy teams should include one person with a clinical doctorate, something most therapists have not needed. Companies developing psychedelic medicines should resist building new systems that needlessly exclude community expertise. More than that, companies should proactively seek to identify and strengthen existing community systems that support psychedelic-assisted wellness.
Companies developing psychedelic medicines should recognize psychedelic users as stakeholders and create processes for including them.
Overall, while there may be no magic, one-size-fits-all process for appropriately using knowledge from another community, there are broad principles and increasing recognition that considering impacts on the community is the ethical and right thing to do. Companies developing psychedelic medicines should recognize psychedelic users as stakeholders and create processes for including them. This could involve including these communities in early fundraising rounds. Companies could employ structures, such as cooperatives and public benefit corporations, that open the organizations to more stakeholders than just those who own shares. Deciding on these actions and structures should be done in dialogue with psychedelic communities.
Lost in Translation
Treating psychedelic users and communities as important stakeholders is not just an ethical issue; it is also a pragmatic recognition of the roles they play in maintaining health. For María Sabina, the mushrooms were not really medicine in a contemporary Western sense of the word. They did not heal like a medicine; they diagnosed and revealed truths that led to healing. The mushrooms told her the origins of any sickness and what therapeutic intervention was needed. It was then up to the curandera and her patient to do the healing.
This was largely lost on the Westerners. Wasson willfully misinterpreted what he experienced. He was looking for mystical ecstasy and clues to the origins of religion, not whether his child was sick or lost.
Today, we risk making similar mistakes. We don’t just need better, more powerful drugs; we need people in the community who can help us lead healthier lives. When research focuses on the ability of psychedelics to trigger mystical experiences, it risks glorifying brief moments of chemical ecstasy while minimizing the need to actually change and improve one’s day-to-day life.
This change is hard to do on one’s own. We need help integrating powerful experiences. This can take the form of formal integration therapy or it can be just talking to others who understand what we’re experiencing and can point us in helpful directions. These practices can go beyond supporting individual health and can help strengthen community resilience.
The success of psychedelic medicine will ultimately be dependent on community structures that adequately support efforts to change and heal. Ironically, Wasson’s efforts disrupted these community structures in Mexico. He made mushrooms more available, but healthcare less effective. Let’s not repeat that mistake today.
The author thanks Earth Erowid and Sylvia Thyssen from the Erowid Center, Ben Feinberg, and Bia Labate for their insightful comments on an earlier version of this essay
Art by Mariom Luna.
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