While it’s refreshing to read a more balanced article on psychedelics (Experts warn of mental health risks after rise in magic mushroom use, December 25), we should be careful about accepting the paternalistic idea that clinical setting is always the most suitable.
‘Set and setting’ – one’s mindset and the physical and social environment – have a huge influence on the psychedelic experience, and for some marginalized communities and patient groups, the medical establishment may be associated with difficult or traumatic experiences, and therefore not the ideal setting due to taking psychedelics. This is perhaps reflected in the lack of diversity of participants in psychedelic clinical trials. While this is a problem for clinical research as a whole, it is more of a problem for psychedelic studies because the psychedelic experience is very culturally specific.
Furthermore, concerns have been raised about the difficulties in obtaining informed consent for psychedelic experiences in the clinical setting. Positive clinical outcomes for psilocybin-assisted therapy have been associated with generating what has been called a “mystical experience.” One of the core characteristics of a mystical experience is that it is ineffable. If, as a physician, I cannot put the experience into words, how can my patients provide informed consent that meets robust medico-legal standards?
We must also wonder how much follow-up integrative therapy will be offered in substance-driven mental health care if psilocybin becomes a recognized treatment. Any model that focuses on preparation and support during the experience, rather than on longer-term integration, will leave questions for patients to turn to if they need additional support after a challenging experience.
It is still uncertain that psilocybin will become an approved psychiatric treatment and as studies progress, it is important that the above-mentioned issues with psilocybin in the clinical setting are vigorously addressed.
Dr. Caroline Hayes
Newcastle upon Tyne