Integrating ayahuasca into western healthcare: an interview with Milan Scheidegger

Milan Scheidegger is one of the most interesting young researchers in psychedelics, because he integrates several different perspectives. He's a clinical psychiatrist at the University of Zurich, who's spent a decade studying the effect of psychedelics on subjects in a laboratory, and on a meditation retreat. He's also done field-work on the use of psychedelics in indigenous rituals, and is preparing the first study of the effects of ayahuasca in Switzerland. He's written a philosophy masters on deep ecology. And he's a musician, who's worked with the Sound Trance Institute on using music to induce trance states. He brings all these perspectives together: music, nature, psychedelics and healing, in the Re-Connect Foundation, which he hopes will be a leading Western psychedelic therapy clinic. In the first part of our interview, we compared western psychedelic lab research to American indigenous use of psychedelics.  Here is part 2, in which we discuss translating specific aspects of indigenous psychedelic ritual into the context of western healthcare. 

How did you get into researching altered states of consciousness?

I have long had an interest in understanding the nature of the human mind and altered states of consciousness. My first altered state I experienced through music - ecstatic improvisation on the piano – as if a resonance field emerges between the musicians and the instruments. It's also an experience of going beyond the self - creating a field, losing yourself in the field, and you don't know if you play the instrument or the instrument plays you. It's an ecstatic state of self-transcendence.

After that, in scientific research, my vision was to understand the mind from the molecule up to the psyche and all the levels of integration, from physics to molecular biology to anatomy and physiology up to psychology and philosophy. My interest in understanding the architecture of the human mind was particularly inspired by psychedelic states of consciousness. For my PhD I researched the antidepressant effect of ketamine in depressed patients, and the role of ketamine-induced experiences to facilitate therapeutic transformation. As a pilot test subject in my own neuro-imaging study in 2009, I had a self-experience with ketamine – and for the first time, I was immersed in an out-of-body experience, and discovered an entirely new perspective of how informative it can be to examine altered states of consciousness from the inside. For a deeper understanding of consciousness it is important to integrate this first-person phenomenal experience with the third-person accounts from neuroscience.

Tell me about the ketamine experience and its therapeutic potential.

Ketamine was promoted in the last fifteen years as a rapid-acting anti-depressant. Studies show that a considerably high proportion of patients with treatment-resistant depression responded to ketamine after only a single administration. But the antidepressant effects are not really long-lasting and return to baseline within 1-3 weeks. There's a lot of research going on about how to prolong the effects.

And it provokes transcendent experiences?

Compared to classical psychedelics, ketamine is less likely to induce a profound psychospiritual experience. It's more like an out-of-body experience, but it has a somehow detached and nihilistic quality to it. Ketamine is more likely to deconstruct reality.

So not so much sense of sacredness or connection to the divine?

It is more related to what Buddhist meditators call “emptiness practice”. You have to let go of all meaning and all concepts, and this can be very liberating. When the ego has to just let go of everything, this transition into the void can sometimes be experienced as disconnection, aloneness, fear, and lack of meaning. After this experience of ego-disintegration you start to re-identify with yourself as a person, and with the world, which can provide novel insights into the fabric of reality. In contrast, with psychedelics like psilocybin or ayahuasca, the sense of truth and meaning is generally over-emphasized - you can find yourself in a place of hyper-meaning and deep insightfulness.

In Christian mystical terms, you could say ketamine is apophatic - it's a state of unknowing - while other psychedelics are more kataphatic - full of meaning and presence.

Yes, I hadn't come across that distinction, but it resonates with my clinical observations.

Does ketamine therapy also work through a dissolution of the ego's normal patterns, creating the ability to let go of ingrained ego-beliefs?

Yes, ketamine therapy can relieve human suffering which, in the Buddhist notion, originates from too much attachment to ego-centric drives and cravings. When the ego is dissolved during the altered state of consciousness, this ego-centered suffering goes away. What I teach my patients on ketamine is exactly this process of letting go, not identifying with narrow self-limiting beliefs, emotions, and thought constructs. When patients learn to relax their everyday consciousness in a similar way, they suffer less from anxiety, depression and addictive cravings. A lot of clinicians administer ketamine just as a biomedical drug: Mostly it is injected in a sterile hospital setting, there is not much talk about the experience, and no integration afterwards. But I believe that there is more than just a pharmacological effect, I see a great potential to use ketamine as a psychotherapeutic tool. That is why I want to work out therapeutic protocols for the clinical use of psychedelic substances.

Is ketamine very responsive to set and setting?

I'd say it's less sensitive than other psychedelics because - due to its numbing effect - patients disengage more from the setting.

You started working with psilocybin at Franz Vollenweider's laboratory in Zurich. When was that?

Three years ago. I started working on ketamine in 2009, then moved to psilocybin research, and right now, I'm about to start a research project on ayahuasca and DMT at the University of Zurich. Inspired from my ethnobotanical expeditions to South America - Mexico, Brazil, and Colombia, where I studied the indigenous use of psychedelic medicines, it is my goal now to further explore their therapeutic potential. However, it remains a great challenge to translate the traditional use of these indigenous medicines into the western medical model.

What kind of rituals have you taken part in?

My first encounter with psychedelic medicines was in the Wirikuta desert in the north of Mexico, where the Huichol cultures use peyote, a mescaline-containing cactus, in their ceremonies. My experience with peyote was deeply revealing of why the Huicholes call Wirikuta the ‘womb of mother earth’. I found myself in an insanely-vast desert plane with just hills on either side, with just the sky above. It's pure stillness full of wonder and awe. During that night I really felt like becoming part of the universe, or the universe became part of me. I could experience myself as a cosmic fractal transcending time and space. But what does it really mean to be a tiny little fractal of this cosmic dance?

I had other expeditions to Colombia and Brazil, where I have participated in many ayahuasca ceremonies with different indigenous tribes. That was really far out of the comfort zone. Indigenous people usually live in poor conditions, with comparably low hygienic standards and only basic food. I remember the first night we arrived, it was a broken house, we hung our hammocks outside, it was raining. We had our first ayahuasca ceremony in a space that looked more like a garage than a ceremony hall – with petrol canisters and broken motorcycles. There was no trace of any Western neo-shamanic romanticism that often comes with a new age type of spiritual ambience, but just the brutal reality of being exposed to the archaic forces of simple life in poverty and wilderness. It was more of an exorcism ritual, where the shaman tried to clear us from bad spirits, really believing that the bad spirits are there and need to be expelled. That was quite intimidating!

The indigenous setting works more on the dualistic spectrum – an archaic fight between evil forces and the shaman, who has special powers to protect and to heal you. It has nothing to do with mysticism, it clearly belongs to the realm of magic. Magic is very much directed towards action - 'I need to do something to get rid of an unpleasant state' - while mysticism is not at all directed to action, because the subject of action is completely dissolved in the mystical state. There is no polarity, no fight, no tendency to act in any way, no need to protect yourself from anything. In the dualist shamanic world-view, there is struggle and fight that can be only brought under human control through magic. It was interesting to experience how ayahuasca works in different contexts.

I felt the same. I was really surprised by the gap between the western idea of ayahuasca as a benevolent life-coach goddess who heals you through self-acceptance and forgiveness, and the indigenous sorcery model of illness as described by anthropologists like Stephan Beyer, where ayahuasca helps you discover who spiritually attacked you and then get maybe revenge on them.Anyway, speaking personally, one of the things I found helpful about ayahuasca was it got me out of my head - out of my obsessive rational analysing - and into my heart.

Yes. I'm also a very intellectual person, and after taking ayahuasca, my immediate realization was 'why did I spend the last ten years reading so many philosophical books, while through ayahuasca you get so intimately close to the mystery of life, which I could never reach through intellectual enquiry?' Drinking ayahuasca is like searching for the Philosopher's Stone. But that might be dangerous, if you fall into the illusory trap of 'oh wow, now I've understood everything'. Then you are probably just kept in another illusion!

What's your experience on ayahuasca? Do you get a sense of being guided by something? Do you have encounters? Do you have a sense of being taught?

With ayahuasca, I had this experience of facing another presence or intelligence. It's as if you're entering a dark temple hall, and you can't see anything, but you feel there is somebody present. There is a feeling of otherness, as if another intelligence intentionally takes control over your conscious space, which can be overpowering sometimes, even evoking a feeling of spiritual devotion. Because ayahuasca and its active ingredient DMT are likely to induce spiritual experiences, they are also used as religious sacraments in some Brazilian churches. Compared with other psychedelic molecules, the epistemological sense of “truth” might be specifically altered by DMT - everything that you experience seems unquestionably true. Actually that is the essence of non-dualism – when the subject and object of perception become one, there is logically no possibility for doubt anymore. But that's maybe also the source of the DMT illusion - by hijacking your epistemological capabilities, any critical distance towards truth is suspended for a while. So the epistemological question remains - is DMT just another way of brainwashing, or is it revealing real truths?

That's exactly what I'm asking myself. In the West there is this idea that psychedelics take us beyond culture to 'the core mystical experience', to some ultimate reality. And yet that idea is itself culture-bound, it grew up in the US, through Aldous Huxley, Timothy Leary and Rick Doblin, and that idea has its own cultural agenda tied to it. I grew up in that culture, so guess what kind of psychedelic experience I have?

I notice that I have these deep experiences through psychedelics or other forms of ecstatic practice, where I arrive at a truth, but usually it's a truth I already believed, I just feel deeply confirmed in it. So on ayahuasca I got a sense of cosmic hope, that the people I know who are suffering will ultimately be OK, that we'll all be OK through multiple births and a steady journey upwards. But I believed that before - it gave me the powerful sense that my pre-existing beliefs were true. Aztecs take psychedelics and meet the Aztec gods, Shipibo Indians meet the various spirits of Shipibo culture, westerners meet a benevolent life-coach, and so on.

I was reading a lot about ayahuasca before my first-hand experience in the Amazon. And I was wondering why so many people have visions of snakes under the influence of ayahuasca. As a critical scientist, I swore to myself that 'I will never fall into this hipster trap of hallucinating snakes'. Although I set this clear intention, the first animal that appeared during my ayahuasca journey of course was a snake. And then even worse things happened: I myself started changing into a snake. I reflected on this phenomenon from a neurobiological perspective: why do so many people see snakes? I believe it's not just that we have these previous expectations about snakes - if we look into the phenomenology of elementary hallucinations, ayahuasca often evokes geometrical patterns with a diamond shape. And if you look how people move under the effects of ayahuasca, there is this sinuous movement. If you combine these two hallucinatory elements, sinuous movements with diamond shapes, what's the next semantically meaningful object category you arrive at the level of complex hallucinations? Perhaps that is why the brain has a natural tendency to hallucinate snakes under the effects of ayahuasca.

You have experience both of western psychedelic labs and indigenous psychedelic rituals. As you know, psychedelic scientists might talk about 'mystical experiences' or 'Mind-at-Large' but never talk about negative spirits. They don't consider it part of their job to protect people from bad spiritus, but of course, with shamans that's one of their prime responsibilities. What do you think?

In our studies with psilocybin and ketamine, we had very few instances of participants encountering entities or bad spirits. States of anxiety due to intimidating hallucinations are quite rare in our studies. Maybe it has to do with the setting - the subjects are medically screened and follow a strictly supervised study protocol including questionnaires and brain scanning. It's not the ideal setting for having a psychospiritual experience - we observed a much higher percentage of mystical-type experiences in our study of experienced meditators taking psilocybin in a meditation retreat setting.

Probably also the mindset makes a difference - we don't live in a world where we believe in these entities and have to protect ourselves from them. In the shamanic paradigm, if you lose your ego-boundaries, everything can spill over from the spirit world, so you need some kind of protection. In the Amazon, indigenous people don't talk much about their ayahuasca experiences - after a ceremony, they just go home. It's not common to have an integration circle and share experiences among participants. I don't know whether entity encounters are more common in indigenous populations. Usually, mostly shamans talk about spirits, because talking about them has an important function - shamans want to emphasize their power and influence and solidify their social role in the tribe. I assume that there is a lot of powerful rhetoric in their way of talking, which builds social hierarchy and control. That's how I believe the whole shamanic traditions evolved, it's comparable to the churches in the West. If you want to become a shaman you have to train with a shaman for 20 years, and take on board their belief system. Do they all really experience what they are talking about? I'm not sure if every priest really has experienced everything that he is preaching. Maybe I'm too skeptical and disrespectful, but I question the contents of the shamanic discourse for this reason, because it may be biased by the strong social function behind it. What's your perspective?

When I first read about shamanic understandings of ayahuasca, I found it funny how different it was to western understandings of it - that indigenous people had a sorcery model of illness and health,where if you're unwell it's often because someone has secretly cursed you, and you can use ayahuasca to identify the 'magic dart', remove it, and maybe send it back to the person who cursed you. My second reaction was judgmental - I thought this sounds an unhealthy way of understanding illness. I read Stephan Beyer's book, Singing to the Plants, and he talked about the culture of envidia in small Amazon communities - suspicion, paranoia, who wishes me ill. That model of illness and healing can lead to cycles of retribution killing - I think you secretly attacked me, so I attack you. I don't want to go back to the evil eye model of sickness and illness, I think that's an unhealthy model.

But a third perspective on it was put to me by Joe Tafur. He said, yes there is a dark side to shamanic culture. But at least they admit that, compared to western New Age psychedelics, or psychedelic research, or western psychiatry for that matter, where the dark side exists but is often not admitted. I have to say, I have a lot of respect for indigenous medicine rituals - the recognition of the power of music, art, performance, group work. And their sense of psychedelics as a connection to nature, as a means to botanical knowledge.

What's tricky is that I don't know the nature of the spirit world. When I did ayahuasca, I had a sense of being in a universe filled with entities and intelligences. I don't know if there are bad entities we need protection from. We don't know. Westerners are quite new to psychedelics. Back in the Middle Ages, there definitely was this sense that there are good or bad spirits, so you need to practice the discernment of spirits. I don't know what conclusions our culture will come to on that matter.

That's where deep ecology comes into play. According to deep ecology, we can always draw artificial lines and distinctions, but in the end – from the perspective of universal metabolism - it doesn't matter so much if something significant occurs inside or outside the body. When we get rid of artificial boundaries and just acknowledge the basic ecological forces in the universe, thenthe human mind appears just as one tiny little fractal in the cosmic interplay of these powerful archaic forces. The main argument from deep ecology is to understand the relationships and the functional role and meaning they have, instead of being narrowly focused solely on the materialistic understanding of solid things.

There's still the sense of how one should relate to what one meets. You spoke of meeting a separate intelligence which wants reverence and devotion. In the intensity of a psychedelic experience it matters how one relates. One can relate in many different ways - one can surrender, one can engage erotically, one can reject it, one can try to dominate it. These different attitudes might have different consequences.

That relates to a very interesting deep ecological question: what is the evolutionary role or meaning behind the fact that when humans ingest a psychedelic plant that tickles certain brain receptors they have experiential access to profoundly meaningful altered states of consciousness? What is the evolutionary information-theoretical role of a plant molecule that interacts with specific brain receptors to give rise to a collective belief system? Naturalistically speaking, it's mind-blowing. How do we explain this?

The point you're making is the plant is ingested and it grows into a culture. It's not just an individual experience, it's a culture. You could think of a culture as like a moss or a forest. So what do you think can be brought from indigenous psychedelic healing into western psychedelic healing?

It's a challenging question because bringing ayahuasca into a western scientific context evokes a lot of resistance among traditionalists who argue that this will never work, as long as we don't adopt the indigenous belief systems or at least have a shaman guiding the process, ayahuasca alone will have absolutely no or even undesired effects. I have a different and more pragmatic opinion on this, because as a physician I have a clear ethical mission to reduce human suffering, and I believe that ayahuasca has some therapeutic potential to reduce human suffering. The West probably has to invent its own ayahuasca context - we can't just transplant the whole shamanic belief system from the Amazon into western societies. We have to find a new way how to make sense of ayahuasca in our culture, for our minds, and with our belief systems. To that, we should stay pragmatic and not dogmatic. Probably ayahuasca will work completely differently in the West compared to the traditional use in the Amazon. That's the idea behind evolution: To take something out of its original context, and put it in an entirely different context with totally different results. I have huge respect for indigenous cultures because they went through a long process of evolutionary adaptation - they experimented with ayahuasca for hundreds of years and found meaningful ways to work with that medicine. Although this body of knowledge and experience is impressive, it might not be the only meaningful way of working with ayahuasca.

So the main thing one can take is the substance rather than the culture? 

There may be ritual elements which may be universal - if a brain enters a trance state it may make sense to play some rhythmic music, or provide some sort of container or safe setting for the loss of control. These are the elements we need to adapt. I have no definite solution for this, I'm still collecting ideas at an initial brain-storming stage.

Have you started experimenting yet?

We're preparing a standardised botanical extract as an analogue to ayahuasca for our studies in Zurich. We're also preparing a psychotherapeutic framework in which ayahuasca could be used. From what I have experienced on my ethnobotanical expeditions to South America, I believe that ayahuasca has the potential to become a valuable psychotherapeutic tool. Several patients that I'm treating within the standard biomedical paradigm could benefit from an experimental psychotherapy session with ayahuasca.

Check out part 2 of our interview here, where we discuss how to translate things like the shaman, the group, the music and the natural setting of indigenous rituals into the context of western psychedelic clinics.