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5 Questions to Answer Before Trying Psychedelic Medicines

Part 2 of my conversation with my daughter Evacheska on Ayahuasca, Integrative Therapy, and the difference between psychedelics and entheogens.

We are increasingly hearing from mainstream sources what many of us have known for decades about the demonstrated value of psychedelics in a therapeutic context. More and more people are even finding legal options for taking psychedelic medicines. Anyone considering taking this course of treatment would be wise to ask certain critical questions about themselves and the specific psychedelic medicine they choose. The current buzz around psychedelics can make it hard to know what information to trust. I recently sat down with my daughter Evacheska deAngelis – founder of Temple Sotto Luce – to discuss my perspective based on my years of professional experience as a psychologist, as well as both professional and personal experiences with psychedelics.

Below is a summary of part 2 of our discussion, followed by the complete transcript (for subscribers only). The podcast will remain free of charge.

Part 1 - Listen / Subscribe

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Part 2 - Listen / Subscribe

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Listen now (55 min) | PART 2- Picking up where we left off, I continue the discussion with my daughter about psychedelic medicine and its place in our lives. This week, Evacheska has the opportunity to ask me more about my own experience and preferences. We talk about MDMA, LSD, Ketamine, Ayahuasca, and how I have used them in my life. Evacheska will be a reoccurring cohost …
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1. What are some potential downsides of taking psychedelic medicine?

As Evacheska points out, it is crucial to treat psychedelic substances with great respect, with sanctity, and reverence. Otherwise, you limit the potential value you get out of the experience.

There’s a reason we’re speaking of psychedelic medicine and not psychedelic drugs.

You may find that you are not a good match for a particular substance, or that you encounter unpleasant side effects that others won’t. 

Ayahuasca, for example, can be taxing on the kidneys. MDMA can put patients with a heart condition at a higher risk of arrhythmia. Those with bipolar disorder or who are predisposed to psychosis should avoid taking psychedelics all.

With those caveats stated, it’s also easy to find counterexamples. I know two families that have taken MDMA for many years with no deleterious effects. Inform yourself about these side effects first and bring up any medical history with your therapist before deciding your direction.

It’s also possible that certain psychedelic medicines – Ayahuasca and peyote – will have side effects, aka unwanted complications, like regurgitation. I avoid referring to unwanted complications of medication as “side” effects, since they affect the whole body and hardly just the side. Whether you interpret those effects as your body rejecting a poison or as a mental purging may depend on your personal beliefs and physiology.

All of this suggests that you need to inform yourself beforehand and be aware of the specific risks of the medicine you choose.

2. How will you integrate your psychedelic journeys into everyday life?

This leads us to a bigger issue related to all psychedelic medicines, Ayahuasca, psilocybin, MDMA, LSD, etc. No matter which one you and your therapist or guide choose, it is imperative that you allow space and time for integration work. 

In an integration session, your therapist or guide takes you back to the profound discoveries, so that you can apply them to your everyday life. Have a plan. Use these substances as the medicines they are.

Consider that your psychedelic journey may interrupt your daily rhythm – especially given the fast pace of modern life. The indigenous cultures that have been using psychedelic medicine for centuries exist within a context where these substances are omnipresent and treated with great respect. They don’t have a nine-to-five, and they don’t need to squeeze in a session before they hit New York City traffic.

Make ample room for healing and learning before your journey.

We all know stories of people who can navigate reality relatively normally during a psychedelic experience. Dock Ellis famously threw a no-hitter under the influence of LSD. However, you shouldn’t expect your body to respond the same way on every journey or exactly as others do.  This is yet another reason why the guide is so important.

During one ceremony, you may feel capable of operating in everyday life, only to find yourself needing help just to get to another room the next time.


3. Which psychedelic medicine is right for me?

Not all psychedelic medicines are created equal. Be aware that some may not be for you and some may require more intentional preparation.

I have found my Ayahuasca experiences to feel like I’m watching television in super-fast forward – like a light show with various colors, that wasn’t really teaching me anything. I got nothing out of it, other than regurgitation, which I found very unpleasant.

It’s possible that my intention going into the journey was too broad, as I have discussed with my daughter Evacheska. It’s also possible that this specific psychedelic medicine is just not for me. It may be a solution for you and others. Do your research on potential side effects and try to learn from other people’s reports.

Also, be prepared for your body to reject the psychedelic medicine of your choosing. It’s possible that you will experience regurgitation or irregular defecation.

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4. What counts as a psychedelic, and how does that matter to me?

We often group mind-altering substances very casually, leading to broad generalizations. So if you decide to embed psychedelic medicines in your treatment and personal life, it is in your interests to learn as much as possible.  

For instance, we know amphetamines are addictive, although we do not have evidence of people becoming addicted to MDMA which has amphetamine in it. If you take MDMA repeatedly, the effect wears off—unlike with substances such as heroin or cocaine.

Ketamine, while often mentioned alongside psychedelics, is inherently a form of anesthesia or tranquilizer. Ketamine is a dissociative but not a psychedelic substance. Unlike the other medicines mentioned, it doesn’t have the psychedelic mind-expanding effects but it does create unique effects in consciousness. We know of pioneering work with ketamine at the Sage Institute, in Berkeley, California, which is able to function because unlike psychedelic substances, it is a legal prescription medicine.

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5. Should you go on psychedelic journeys with your family?

Once you’re aware of the therapeutic advantages of psychedelic medicine and its effects on interpersonal and intrapersonal communication, you might consider sharing that experience with your loved ones, which leads to other questions.

If you have children and you want to include them, you obviously want to make sure they’re of an appropriate age to address deep issues. 

My daughter, Evacheska, was in her mid-20s when we first began using psychedelics as a family. To her, that point in time still makes sense.

Both Evacheska and I emphasize that you should always be assisted by a licensed therapist or another qualified person who can serve as a travel guide if and when a difficult emotion or other obstacle surfaces.

In conclusion, going on a psychedelic journey can be a life-altering experience, never to be treated lightly. Work with people you trust and inform yourself beforehand. Understand that the outcome of your experience will ultimately be determined by your set and setting, your personal history (what Betty Eisner calls “the Matrix”), and the choices you make along the way.

All of the preparation and subsequent integration will increase the likelihood that your trip will move you forward on the path to healing self-actualization and creativity that so many of us have experienced.

Full Transcript

Developing a relationship with the ayahuasca experience

Dr. Richard Miller

I'm fascinated by your deep interest in Ayahuasca. To me, it felt like a wild ride at a carnival that went on for a lengthy period of time, with tremendous visual images but no depth I could take away.

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Mind Body Health & Politics
Psychedelic Wisdom
Psychology, Medicine, and Spirituality
Richard L. Miller