How to Change Your Mind

Yet even as psychedelic therapies are being tested by modern science,
the very strangeness of these molecules and their actions upon the mind
is at the same time testing whether Western medicine can deal with the
implicit challenges they pose. To cite one obvious example, conventional
drug trials of psychedelics are difficult if not impossible to blind: most
participants can tell whether they’ve received psilocybin or a placebo, and
so can their guides. Also, in testing these drugs, how can researchers hope
to tease out the chemical’s effect from the critical influence of set and
setting? Western science and modern drug testing depend on the ability
to isolate a single variable, but it isn’t clear that the effects of a
psychedelic drug can ever be isolated, whether from the context in which
it is administered, the presence of the therapists involved, or the
volunteer’s expectations. Any of these factors can muddy the waters of
causality. And how is Western medicine to evaluate a psychiatric drug
that appears to work not by means of any strictly pharmacological effect
but by administering a certain kind of experience in the minds of the
people who take it?
Add to this the fact that the kind of experience these drugs sponsor
often goes under the heading of “spiritual,” and you have, with
psychedelic therapy, a very large pill for modern medicine to swallow.
Charles Grob well appreciates the challenge but is also refreshingly
unapologetic about it: he describes psychedelic therapy as a form of
“applied mysticism.” This is surely an odd phrase to hear on the lips of a
scientist, and to many ears it sounds dangerously unscientific.
“For me that is not a medical concept,” Franz Vollenweider, the
pioneering psychedelic researcher, told Science magazine, when asked to
comment on the role of mysticism in psychedelic therapy. “It’s more like
an interesting shamanic concept.” But other researchers working on
psychedelics don’t run from the idea that elements of shamanism might
have a role to play in psychedelic therapy—as indeed it has probably done
for several thousand years before there was such a thing as science. “If we
are to develop optimal research designs for evaluating the therapeutic
utility of hallucinogens,” Grob has written, “it will not be sufficient to
adhere to strict standards of scientific methodology alone. We must also
pay heed to the examples provided us by such successful applications of
the shamanic paradigm.” Under that paradigm, the shaman/therapist
carefully orchestrates “extrapharmacological variables” such as set and