Vitalism and Naturopathy in Psychedelic Medicine

Abstract

Psychedelic therapy is witnessing a rapid rise in popularity both in clinical research and in the greater culture. Since it involves the use of drugs, psychology, and spirituality, professionals from a variety of backgrounds such as physicians, psychotherapists, chaplains, etc. are increasingly becoming interested or directly involved. In this article, the authors describe why naturopathic doctors, with additional training, are well suited to provide psychedelic therapy. Naturopathy is rooted in the non-materialistic metaphysics of vitalism, which is consistent with the concept of inner healing intelligence, which is widely accepted in the psychedelic therapy community. In addition to the compatible foundational philosophies, naturopaths also possess a wide range of clinical skills including herbalism, pharmacology, and counseling, among others, that can be directly applied to psychedelic therapy and integration.

Introduction

There is a growing international interest in psychedelics with the emergence of research demonstrating their clinical utility in the treatment of psychiatric ailments.¹ Awareness of their power to heal demonstrates to conventionally trained practitioners what naturopaths have always known, that the mind and body are not separate. Participants are receiving deep, often spiritual, benefits that transcend traditional boundaries of diagnoses and pathology, leading to the overall improvement in well-being and expansion of consciousness.² While there are a growing number of naturopaths receiving education to become psychedelic therapy providers as well as those providing education on the topic, none so far have articulated in the peer-reviewed literature the compatibility of the philosophical underpinnings of naturopathic and psychedelic medicine.

Discussion

Psychedelic and Entheogenic Medicine

The origin of the use of psychedelic (greek: mind-manifesting) or entheogenic (greek: generating the divine within) medicine precedes recorded history and spans numerous cultures on every continent.^3–5 A wide variety of plants, mushrooms, and, today, synthetic compounds are used in as many varieties of traditional and newly forming practices. This includes animistic paradigms held by many indigenous peoples, religious or spiritual use of all varieties, as well as secular therapy and recreational approaches. It is beyond the scope of the present article to fully describe the nuanced differences between traditions and substances, and thus we refer to “psychedelic medicine” in the general sense. To acquire a wider insight into the topic, we suggest reading the references cited throughout the article, including a few noteworthy works.^6–11

Nonetheless, nearly all traditions, including modern medicalized models, include a guide of some sort who screens and prepares participants, administers the session, and facilitates some form of what is commonly referred to as integration, implying how an individual processes their experience. Currently, most psychedelic substances are illegal for reasons that remain controversial in most places in the United States, and in most circumstances outside of approved clinical trials and some religious settings, warranting careful consideration of how, when, and where clinicians should involve themselves.

In the medical and psychological literature of the West, the term “inner healing intelligence” is widely used to describe the psychological mechanism of healing that takes place. This term was coined by Stanislov Grof, the transpersonal psychologist and pioneer of psychedelic therapy.¹² It has more recently been manualized in the training of 3,4-Methylenedioxymethamphetamine (MDMA) therapists by Michael Mithoefer and others.⁹ The concept is that every human being has an innate capacity to heal which they must learn to trust. The role, therefore, of a therapist or a substance is merely to help facilitate the patient’s access to this healing potential. As we will describe later, this is a vitalist concept that comes as no surprise to a naturopath.

Metaphysics

To understand the bridge between psychedelic-inspired forms of healing and naturopathic medicine, we have to understand the basic metaphysical assumptions of our culture and the conventional medical paradigm. Metaphysics is one of three pillars of philosophy, the other two being epistemology (theory of knowledge) and axiology (ethics and aesthetics). It is called metaphysics because Aristotle first wrote about it meta (after) his work titled ‘Physics’. The almost synonymous term ontology has a more descript meaning, the Greek ontos means ‘being’ or ‘existence’, thus ontology (metaphysics) is the study of the fundamental nature of existence itself. The metaphysical discourse can be purely intellectual, or it can include subjective experiences, which must be account for. Mysticism, on the other hand, can be doctrinal as in the case of hierarchical religion, or it can be experiential. This becomes an important subject in the context of psychedelic and entheogenic states which precipitate mystical experiences, though not always, cause people to question the nature of reality. Therapeutic effects have been correlated with the intensity of these mystical experiences.^2,11

Peter Stostedt-Hughes¹³ suggests that psychedelic integration therapy should at least offer a participant the opportunity to analyze their experience in metaphysical terms. For this purpose, he created the Metaphysical Matrix Questionnaire which aims to help people ground what might otherwise be dismissed as bizarre, drug-induced fantasies, with the rigorous terms of philosophy. We highlight the topic here because an unexamined metaphysics is an assumed metaphysics. We all believe something about reality as we perceive it regardless of our ability to articulate those beliefs. While, few outside the discipline of academic philosophy could describe the difference between transcendent realism and monadic idealism, a basic understanding of metaphysics will help the practitioner answer the questions, what causes suffering and illness? and, how do we heal?

The dominant paradigm of Western academia and medicine is physical materialism (physicalism for short). As the name implies, this theory supposes that the world is entirely physical. This has many downstream implications including how to account for consciousness which philosopher David Chalmers first referred to as the “hard problem of consciousness” in 1994.¹⁴ In short, physicalism maintains that phenomena of the mind arise exclusively from the physiology of the brain. More broadly, the physicalist paradigm in medicine often contributes to a mechanistic approach to medical treatment where the goal is simply to keep the body running, resulting in poor end-of-life care and very little emphasis on health optimization. Conversely, a vitalistic perspective results in treatment paradigms that emphasize quality of life and mental, emotional, and spiritual well-being as fundamental to the overall health of a person. But before we turn to the subject of vitalism, let us examine how psychedelics cause people to change their perspectives.

How to Change Your Mind¹⁵

Several studies have attempted to quantify the resultant changes to belief, personality, and behavior following or correlating with the use of psychedelics. One study found that psychedelic use correlated with more liberal political views, openness, and nature-relatedness.¹⁶ A study that recruited psychedelic microdosers (those taking sub-hallucinogenic doses regularly) from online forums found that microdosers when compared to non-microdosing controls, had lower levels of dysfunctional attitudes and negative emotionality and higher level personality traits of wisdom, open-mindedness, and creativity.¹⁷ Another survey study queried people who reported having a “God encounter” (or Ultimate Reality) experience and compared those induced by a psychedelic drug against those not induced by drugs. They found that a significant proportion of both groups who reported being atheists before their experience were not atheists after, however, the psychedelic group was less likely to identify with a religion, was more agnostic, and more likely to identify as being the same as that which was encountered.¹⁸ While many of these studies demonstrate correlation, they carry significant biases in their study populations. However, more recent research is beginning to elucidate possible mechanisms for these changes. An imaging study found that recreational psychedelic users showed frontal serotonin transporter binding, which was positively associated with the trait of openness to experience and with lifetime use.¹⁹ Another study found that intensity and duration of ayahuasca use were inversely correlated with the thickness of the posterior cingulate cortex, a key node in the default mode network, and positively correlated with the trait of self-transcendence.²⁰

The Imperial College London Centre for Psychedelic Research investigated whether psychedelics cause shifts in metaphysical beliefs using both a prospective online survey and a clinical trial comparing psilocybin-assisted therapy versus escitalopram.²¹ Both data sets demonstrated the same findings, namely that beliefs shifted away from physicalist (materialist) views toward more idealist views (idealism, in the language of philosophy, is the view that all phenomena arise from the mind, consciousness, or spirit). A John Hopkins University survey of over 2300 psychedelic users asked participants about belief-changing psychedelic experiences before, after, and at the time of the survey, and the response was on an average of 8.4 years after the experience. Though it comes from a biased sample, 87% of participants reported the experience as changing their fundamental conception of reality. This included increases in non-physicalist beliefs such as reincarnation, telepathy, and animism.²²

Much of the academic literature is concerned with the neurology involved when it comes to explaining the causal factors of change caused by and the benefits of psychedelics. The most widely discussed framework is the REBUS (RElaxed Beliefs Under pSychedelics) model²³ which focuses on the downregulation of the default mode network which is associated with self-referential thinking and perception processing. This, in addition to its neuroplastic effects,²⁴ are credited for most of the benefits of psychedelics. While there are still many unknowns in the neurological mechanisms of psychedelics, what we do know is well established. A contention in the field, however, is an ontological one. The dominant paradigm in science and medicine, physicalism, holds that all phenomena arise from physical material, thus consciousness is a product of the brain. This fails, however, to account for the experiences of many psychedelic participants,²⁵ not to mention psi phenomena,^26,27 a subject beyond the scope of the present paper.

It is important to briefly mention the ethical implications of these findings. While some studies have shown or suggested that this trait of openness and change in beliefs correlates with positive mental health outcomes,²¹ it also means that patients are more susceptible and vulnerable to not only abuse but also the unintentional transmission of beliefs and biases of practitioners and other components of the set and setting.²⁸ Thus, while informed consent is always the standard in providing ethical healthcare, its importance is greatly enhanced in this field. This may necessitate a discussion of the metaphysical assumptions or beliefs of the provider not because it is necessary to have shared beliefs with a client, but because a client has a right to know in advance the potential influences they may be under.

It is beyond the scope of the present paper to provide a detailed critique of the physicalist ontology. Our purpose in highlighting it as the dominant paradigm is that the conflict does not persist in a vitalistic ontology. Naturopaths, like conventionally trained medical professionals, are of course heterogeneous in their belief systems. However, unlike conventional medicine, the naturopathic profession is defined, at least in part if not entirely, by its philosophy rather than its methods. Nevertheless, it has been our anecdotal experience, which we share in the absence of data regarding the metaphysical beliefs of any group of healthcare professionals, that naturopathic doctors have either long supported psychedelics or more easily integrated or understood their purpose in a healing process. This is in contrast to many conventionally trained colleagues who, upon familiarizing themselves with psychedelic literature, encounter the concept of inner healing intelligence⁹ and find it to be an entirely novel concept.

Vitalism and the Inner Healing Intelligence

Although outwardly many may think of naturopathy as a set of natural therapies (herbalism, hydrotherapy, etc.) it is the philosophical underpinning of naturopathy that differentiates it from conventional allopathic medicine. Vis medicatrix naturae, the healing power of nature, being the first and foremost principle of naturopathy, has its origins in vitalism, a concept first described in ancient Greece.²⁹ Though debated from the start and having many variations, vitalism is the concept that life originates from a force that is not physical or chemical; thus, a medical paradigm that only addresses the material elements of health will be necessarily limited in its ability to heal. The vis, or the vital force, is often compared to prana, qi, and other energetic forces described in Ayurveda, Chinese medicine, and other paradigms.²⁹

Naturopaths utilize a wide range of therapies to enhance the vital force and help the body move in the direction of optimal health. These include hydrotherapy, lifestyle counseling, physical medicine, herbal medicine, pharmacology, nutrition, and homeopathy. These modalities can be applied to any level of the therapeutic order³⁰ to remove obstacles that impede the healing process, stimulate the vis or self-healing mechanisms of the body, restore and regenerate weakened systems, correct structural integrity, use natural or synthetic substances to allopathically manage pathology and symptoms, or use invasive means to suppress pathology.

As naturopathic philosophy is guided by the foundational belief in vitalism, the foundation of many psychedelic therapies is a belief in inner healing intelligence: a force that is mobilized inside each person’s psyche and spirit that directs the process of healing.⁹ An often used phrase by naturopathic doctors and others is “holistic medicine”, which is to say, a form of healthcare that encompasses the whole person including root causes of illness, prevention, and “mind, body, and spirit.” By comparison, Grof coined the term holotropic, meaning “oriented towards wholeness,” originating from the Greek words holos, for whole, and trepein, meaning moving towards or in the direction of something.³¹

The main objective of the holotropic strategy of therapy is to activate the unconscious and free the energy bound in emotional and psychosomatic symptoms, which converts these symptoms into a stream of experience. The task of the facilitator or therapist in holotropic therapy then is to support the experiential process with full trust in its healing nature, without trying to direct it or change it. This process is guided by the client’s own inner healing intelligence. The term therapist is used here in the sense of the Greek therapeutes, which means the person assisting in the healing process, and not an active agent whose task is to “fix the client.”³¹

Psychedelic therapists, like naturopaths, seek to trust in the healing power of nature and act as skillful guides in creating the necessary conditions for the vital force to restore health to the organism.

Psychedelic medicine can be applied to several levels of the therapeutic order and are in alignment with the principles of naturopathic medicine, making them a natural fit in the repertoire of naturopathic treatments. Naturopaths are well equipped to begin implementing psychedelic therapies, as they are already trained in the use of botanical medicines, drug-plant interactions, basic psychotherapy, acting as teachers, and treating the whole person. Furthermore, psychedelics are not without medical and psychological risks that warrant the level of skill to which a naturopathic physician is trained. While many naturopaths are not currently trained in the specific methods of administering and facilitating psychedelic experiences, with so many foundational skills in place, the motivated naturopath can easily acquire competency in harm reduction and counseling on psychedelic therapies, if not offering the therapy themselves, depending on their level of dedication to specialization in the field and legal frameworks to do so.

Psychedelic Medicine and the Therapeutic Order

The principles guiding the naturopathic approach to treatment are described in the Therapeutic Order (Figure 1), which was proposed by Jared Zeff and Pamela Snider in 2006.³² This seven-level model is mirrored upon what is thought to be the body’s innate processing of healing via the vis medicatrix naturae. These guiding principles have been adopted in 42 countries that practice naturopathic medicine/naturopathy, thus accounting for their ubiquity across the profession.³³ With the foundational principle of vitalism driving both naturopathic and psychedelic medicine, we find that psychedelics can be used by specially trained naturopathic doctors at multiple levels of the therapeutic order as seen in Table 1.

Figure 1.

The Therapeutic Order. Adapted from Zeff JL, et al. A Hierarchy of Healing: The Therapeutic Order, 2013.

Table 1.

The Seven Level Therapeutic Order and Psychedelic Medicine

Level One- Establish the foundation for optimum health

Naturopaths believe that health is the natural state of the human being and that disturbing factors (environmental, physical, behavioral, social, spiritual, cultural, etc.) lead to disease over time. Removing these disturbing factors, or obstacles to cure, is accomplished by the patient themselves or within a community. Self-responsibility for one’s wellbeing is paramount to this stage. Psychedelic medicine has the potential to inspire an individual to take responsibility for their own wellbeing. A naturopath can play a vital role in helping someone using psychedelic therapy to identify the behaviors in their life that are acting as disturbing factors or obstacles to cure. The naturopath can then guide the patient in implementing lifestyle-based therapies to help them establish the foundations of health.

Level Two- Stimulate self-healing processes

At this level, self-healing is promoted by stimulating the body’s vital force. This approach is founded on the belief that living systems have inherent wisdom and intelligence that directs them towards the healthiest expression of homeostasis and function. The healing forces already present within our natural environment can revitalize the inner healing intelligence of the human being. Mystical experiences, frequently occasioned by psychedelics, open people to their innate healing intelligence. Naturopaths can then implement the healing forces of nature (air, water, sun, forests bathing, etc) or other modalities (homeopathy, flower essences, acupuncture, meditation, hydrotherapy, etc) to continue to strengthen the vis without applying any external substance to the system.

Level Three- Support and restore weakened systems

This level seeks to support the different systems (immune, endocrine, etc.) of the body as well as the emotional and spiritual dimensions of the whole person. Some systems can be damaged or weakened and in need of support or restoration. Others may be blocked and in need of clearing through detoxification and elimination. While others may be overstimulated and require soothing. Psychedelic medicine helps to restore balance to the bioenergetic and psychospiritual systems. Once major emotional blockages or stored trauma has been released through psychedelic therapy, a patient may be more able to implement the modalities a naturopathic doctor would recommend to continue restoring balance to different physiologic systems. This may be done through the use of a therapeutic diet, nutritional or herbal supplementation, and homeopathy. Continued psychological or spiritual therapy will also aid in supporting restoration over time.

Level 4- Restore structural integrity

Correcting structural integrity requires the application of an external mechanical force such as manipulation, acupuncture, massage, or exercise. Though traditions vary across cultures, in the Western context of psychedelic therapy physical interventions during a psychedelic experience is controversial and current ethical standards limit the scope of such practices. In most circumstances physical contact is limited to supportive touch, such as holding a hand, which is meant to be soothing and reassuring to the client during a psychedelic experience. However, after a psychedelic administration session, physical medicine is of great value and can be applied to help the patient somatically integrate the experience.

Level Five- Natural Symptom Relief

Naturally occurring or physiologic compounds are used to directly treat a specific pathological state or symptom at this level of the hierarchy. Plant-derived medicines, glandular products, and nutritional supplements are used to alleviate symptoms instead of stimulating the vital force as in early levels. The medicines are utilized for specific, often singular effects (e.g pain reliever, antidepressant, or fever reducer) instead of globally health-promoting outcomes. Similarly, within the Western biomedical model, psychedelic plants are used as therapeutic agents targeted at specific pathology or psychological symptoms, such as to treat substance addiction or suicidality.30,31 Through the framework of the Therapeutic Order, naturopaths have the ability to utilize psychedelic plant medicines as a level five intervention to treat discrete psychopathologies or on levels one through four as a holistic means of stimulating vitality and establishing the foundations for health in their patients.

Level Six- Synthetic symptom relief

Pharmaceutical or synthetically derived medicines are applied at this level to treat specific symptoms and pathologies or to alleviate the adverse effects caused by other medications. With the majority of people in the United States taking some sort of prescription pharmaceutical daily, it is important to get further training in the pharmacodynamic interactions between various psychedelics and pharmaceutical medicines. While not holistic as a single intervention, symptom reduction can be an important part of a holistic plan that enables a patient to address more foundational levels of health. Ketamine can be used as an anesthetic and analgesic at this level as well as the ketamine infusion model which treats it simply as a drug that mediates a symptom or a sick brain. However, ketamine-assisted psychotherapy, although using a synthetic substance, can be used in a holistic and psychedelic model to elicit healing experiences in alignment with levels one through three.

Level Seven- High force intervention and suppressing pathology

The highest level of intervention is to suppress symptoms or surgically correct a pathology. Suppression of symptoms has the potential to act against the vis medicatrix naturae because it omits or counteracts the self-healing process. An example of this is the use of steroids during an overactive immune reaction. The steroidal suppression of the immune response can be lifesaving or allow for enough symptom relief such that lower force interventions, directed at curing the underlying cause, can be implemented. While sometimes necessary and highly useful, symptom suppression does not remove or heal the disturbing factor. Without resolution of the disturbing factor, the disease state can be driven more deeply into the body, mind, or spirit. Psychedelic medicine is not applied at this level but can be implemented following high force interventions, perhaps to heal from the sometimes traumatizing intervention itself.

Conclusion

Outside of naturopathic medicine, psychedelic therapy is used to stimulate the “inner healing intelligence”. This can be directly likened to vis medicatrix naturae within the naturopathic medical model. Thus, psychedelics (entheogens) fit aptly into the naturopathic framework. Psychedelic medicine acts at various levels of the therapeutic order by supporting weakened systems, stimulating self-healing, providing symptom relief, and enhancing a patient’s ability to establish the foundation for optimal health by removing obstacles to cure. While naturopathic education does not currently include all the specific knowledge and skills necessary to provide psychedelic therapy, naturopaths possess many prerequisite and complementary skills and are rooted in compatible philosophical paradigms of healing.