Shamans, Sacraments, and Psychiatrists

Psychedelic drugs have declined in psychiatric research because social reactions led to their classification as controlled substances. Three historical paradigms for their use are reviewed: the psychotomimetic approach, which aimed to temporarily induce psychoses but proved limited for understanding or treating mental illness; the psycholytic approach, using low doses to reduce defenses and release unconscious material, rooted in psychoanalysis; and the high-dose psychedelic paradigm, which often produced mystical or spiritual experiences and recast the psychiatrist as a modern shaman, alienating many in the profession. Future sanctioned clinical research should learn from traditional shamanic models to assess efficacy and safety.

Study at a glance

Abstract

This article reviews the role of psychedelic drugs as potential tools for psychiatric research and practice. The decline in the utilization of these substances is linked to social reactions, which led to psychedelics being scheduled as controlled substances and consequently unavailable for human research. Three different paradigms for the use of psychedelics in psychiatry are reviewed: the psychotomimetic, the psycholytic, and the psychedelic approaches. The psychotomimetic paradigm, which viewed hallucinogens as agents for temporarily inducing psychoses, proved to be of limited value to the understanding and treatment of mental illness. The psycholytic approach, which was derived from the psychoanalytic paradigm, is a technique employing low doses of psychedelic drugs to reduce psychological defenses and to release unconscious information. The high-dose psychedelic paradigm frequently produced reports of mystical or spiritual experiences, thus recasting the psychiatrist as the modern-day shaman. This paradigm has alienated many in the psychiatric profession and has led to a reaction against the use of psychedelics in psychotherapy. If the opportunity should arise to pursue sanctioned clinical research with these unique psychoactive substances, however, it will be imperative to learn from the traditional models of shamanic healers in order to optimally assess true clinical efficacy and safety.