Saturday, August 22, 2009

Healing Through the Veil: Field Notes on Psychedelic First Aid

Anyone who has spent time accessing other states of consciousness -- whether through fasting, meditation, ecstatic dance, magic, plant medicine, or synthetic chemicals -- knows that the worlds we enter on the other side of the veil are very real, and so are the dangers we face there.

Psychedelic plants and chemicals can rapidly bring people to realms that practitioners spend years trying to reach through other means. This can make them very efficient tools for deep transformational work. But it also means that they can bring people who don't have the well developed psychic defenses of a trained shaman to worlds subtly but powerfully different from anything they have experienced before -- a potentially dangerous situation.

Working as an herbalist at festivals where a lot of psychedelics are moving through the crowd, I have begun to develop both a model of what is happening inside a person who is having a "bad trip" and some protocols to help them through what they are struggling with. What follows are some notes on my approach and understanding that will hopefully spur more discussion among herbalists and other healers working with people who use psychedelic plants and chemicals.

A Biological Model

Psychedelic compounds move the plants, animals, and humans that ingest them into a highly creative nonlinear state of consciousness.(1)

In humans they seem to operate by opening the sensory gating channels that bring information about sights, sounds, sensations, tastes, smells, and electromagnetic field fluctuations from the heart and the other sense organs to the neocortex. The neocortex works to extract meaning from the signals it is receiving. In this heightened state of sensory awareness, the neocortex has to work harder to extract meaning from the information coming in from the world around it, forcing it into a state of nonlinear creativity.

For some, though, this flood of sensation and information coupled with the discovery of new meanings in once mundane things can trigger acute anxiety. And for those who have been severely traumatized in this realm, that feeling of anxiety can bring back body memories of their original traumas (in some combat veterans and some survivors of sexual trauma, even Cannabis, with its milder psychedelic qualities, can trigger full scale dissociative episodes.)

The sense of metaphysical vertigo can be traumatizing in and of itself -- and can have lasting effects when a person returns to "ordinary" consciousness. My interpretation of "acid flashbacks" is that they have nothing to do with residual chemicals in the spine, but rather are PTSD (Post Traumatic Stress Disorder) related dissociations brought on by external triggers that remind someone of some aspect of a moment of terror on either side of the veil.

A Magical Model

The purple-blue tinge of the bruised flesh of mushrooms of the Psilocibe genus is a signature of the opening of the Third Eye and the Crown Chakra.

The sudden and dramatic opening that the medicine of these mushrooms and the similar medicines of various other plants, fungi, and chemicals bring on can open someone to states of consciousness that reveal the existence of other worlds, other orders of reality.

These worlds are populated by their own flora and fauna and even societies with complex behaviors, rules of etiquette, and feeding behaviors.

Shamanic and magical traditions prepare people to navigate these worlds through years of practice in sensing and moving energies. Just as a city dweller suddenly dropped into the middle of the desert or the forest would be at a loss for how to survive, those who have not prepared for a journey on the other side of the veil between worlds can find themselves stumbling into difficult and dangerous situations. The fact that the territories of these worlds overlap and layer over each other can lull travelers into a false sense of familiarity and security.

As one teacher of mine says, not all beings without bodies have our best interests in mind. Beings that prey on us have been known to wear very seductive forms on the other side of the veil.

In helping people struggling with acute panic during a psychedelic trip its important to acknowledge the reality of what is happening in and around her -- her experiences are not metaphorical, they are lived experiences that occur in another world.

Handling an Acute Psychedelic Crisis

My first response when someone is panicked but lucid during a psychedelic trip is to get the person to a physically comfortable place, preferably accompanied by one or two friends, verbally let her know that she is in no physical danger and that she will come back from the place where she is, and encourage and model slow, calm breaths. Then I offer a calming tea.

During a festival I always keep a big pot of tea going containing Skullcap/Blisswort (Scutellaria spp.), Passionflower (Passiflora spp.), and Wood Betony (Stachys officianalis.) Note the violet/blue color of these flowers.

Passionflower is specifically indicated for "irritation of the brain, nervousness, restlessness, sleeplessness with muscle twitching, or circular thinking"(2) -- symptoms typical of the overstimulation brought on my psychedelic plants and chemicals. While some practitioners are concerned about the theoretical possibility that as a mild MAO Inhibitor, Passionflower could be dangerous for someone taking a Selective Seretonin Reuptake Inhibitor (eg.Prozac), I have not been able to find any documented cases of this kind of negative drug interaction, and my experience and that of other herbalists I have talked with suggests that Passionflower is generally safe for most people. However since depending on someone's degree of coherence during a psychedelic trip, it may be difficult to ascertain whether that person is taking an SSRI, those concerned about the theoretical risk the interaction presents might choose not to use the herb in this kind of situation.

The inclusion of Blisswort is more a product of intuition and habit than a carefully reasoned decision -- she tends to be an excellent adjunct to Passionflower and as a nervine that is not sedating she has an ability to help level off energies without bringing someone "down" too hard and too fast.

Wood Betony serves multiple purposes in this instance. As an herb with a strong affinity for the solar plexus, it is strongly grounding, helping to move consciousness into that region of the body, anchoring it to a degree in the physical world. Darcey Blue French writes that Wood Betony "helps to ground people here on earth, for those stuck in repetitive mental patterns, or in mind/head stuff who need to come down and think from their center, and be in their body."

Wood Betony is also a traditional herb of exorcism and psychic protection. French writes:

"Stachys has long been used as an agent of protection from evil ‘spirits’, nightmares and visions, and to repel venomous creatures like snakes. It was planted in churchyards as protection against evil, and the Greeks said, 'it shields him against visions and dreams.' It is claimed in folklore when surrounded in a ring of wood betony leaves, snakes would fight and kill each other. Those who wear it as an amulet would find 'good against fearful visions, and driving away devils and despair.'"(3)

Yarrow Flower Essence or an energetic dose (a few drops) of a Yarrow flower tincture may also offer a degree of psychic and energetic protection.

Occasionally if the tripping person seems mired in dark thoughts I add Lavender flowers to the tea. Tulsi (Ocimum sacnctum) might also make sense here because of its ability to disperse stuck thoughts and emotions.

For cases of more severe emotional trauma, bordering on and moving into dissociative states, some members of the Anemone family can be of great assistance. In an article on using various Anemone species to treat panic attacks, 7Song describes using Anemone to treat people having "bad trips" and people having trouble sleeping after taking LSD at Rainbow Gatherings.(4) Michael Moore used Pasque Flower (Anemone pulsitilla) to treat these conditions.(5) Buhner suggests that Pasque Flower works to regulate the sensory gating channels. (6)

It is important to note that in a small number of people, primarily those with constitutional tendencies toward excess heat, Anemone species can be agigating rather than calming.

So far, I have worked exclusively with a tincture of Anemone tuberosa. In mild cases, a 2 or 3 drops of the tincture will often help to calm a person immensely. In one more severe case, I gave 30 drops of Anemone tuberosa tincture and 5 drops of Monotropa uniflora tincture in water to an agitated, incoherent, and borderline violent 200 pound man who had taken a large dose of LSD, and he was docile within 10 minutes of drinking the water he was docile, within 30 minutes he was asleep.

I made the decision to include Ghost Pipe (Monotropa uniflora) in the formula I administered in this case based on Ryan Drum's reported success using the plant to calm an agitated and menacing man whose state was brought on by "sleep deprivation, dehydration, too much recreational medication, and no real food for many days."(7) and my intuition that, like Anemone pulsitilla and Anemone tuberosa, Monotropa uniflora acts on the sensory gating channels.

The plant's form suggests both the spinal column and brain stem and a tunnel between worlds. The irridescent violet of the tincture suggests an affinity for the Crown Chakra. Energetically it is cooling.

In my view, hospitalization is to be avoided unless you are unable to prevent a person from being violent toward herself or others, the person may have ingested a toxic substance while tripping, or the person has sustained physical injuries. Emergency room treatment for a "bad trip" will always involve taking a frightened and disoriented person with heightened emotional, sensory, and energetic awareness and putting that person into a place full of frightened people, many of them in extreme pain. It will often involve physical restraint and/or the administration of heavy anti-psychotic drugs designed to bring the patient quickly back into consensual reality -- a potentially traumatic ripping from one world into another. It will usually involve the administration of treatment by people who do not acknowledge the reality of the experiences the patient is having and are not concerned about the possibility that the person may have been subjected to psychic attacks.

Thoughts on further treatment

As an herbalist administering first aid at festivals, I seldom have a chance to follow up with the people I have helped in the midst of psychic and emotional traumas connected with the use of psychedelics. But I would like to offer a few thoughts on follow-up treatment for people recovering from a traumatic psychedelic experiences:

-- It is of the utmost importance that the person be given an opportunity to integrate her experiences. When she is ready to share them she should be treated with the same respect and support as a survivor of a traumatic event that took place in ordinary reality

-- Two herbs seem likely to be of great benefit to someone recovering from this kind of trauma:
Tulsi (Ocimum sanctum) is useful when the "patient is fixated on a specific traumatic event, and complains of fatigue and mental fog" according to David Winston. (8) Pam Montgomery writes that "Besides being a great protector plant it helps in soul retrievals, as it is able to locate exiled souls and bringing them home."
-- Wood Betony (Stachys officianalis) may help to address some of the lingering energetic attachments from time spent in other worlds. In his monograph on the plant, Jim McDonald writes:

"Another of Wood Betony's virtues, [. . .] is it's ability to dispel evil and ward of spirits of ill intent. The manifestations of that need not be supernatural (though I think it good protection from bad magic and those who deal in that and Matthew Wood has used it on several occasions for those suffering PTSD from alien abductions) sometimes we may know or be related to such people. To access these more esoteric virtues, one might carry the herb with them in a medicine bag, or rub doses of the tincture into their wrists or temples. Sure, this may make you question how very weird your belief system is becoming, but when you see situations change around you in a way that reinforces this usage a few times, you can just flow with it. It's quite likely, after all that your friends and family already think you a bit 'eccentric.'" (10)

Its worth noting that "alien abduction" may be a modern interpretation of the ancient and universal experience of being taken or led by strange beings into other worlds. It stands to reason that a plant that helps survivors of these experiences would also be of assistance to those who enter those realms voluntarily but return scarred.

The flower essence of Eastern Skunk Cabbage (Symplocarpus foetidus) is, in my experience, specific to smoothing the transition between worlds.

-- In some cases, especially when someone's personality or behavior seem dramatically changed after a traumatic psychedelic experience , the assistance of a shaman or root worker may be necessary to retrieve parts of the self left behind in other worlds or to dispell spirits and energies that have attached themselves to a person.
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UPDATE -- OCTOBER, 2010

With another season of festival first aid under my belt, now seems like a good time to make some updates.

For cases of mild to moderate anxiety associated with psychedelics where the person doesn't necessarily want to "come down" I'm now generally using variations on a formula including Wood Betony (for grounding and protection), Mimulus spp. (for feelings of dread), Passionflower (for circular thoughts and to cool the mind), and Schizandra (to calm disturbed Shen, especially where breathing is fast and shallow.) If there are strong heat signs or if there is an edge of anger to the anxiety I'll sometimes add Melissa. If there is fixation on a particular negative thought or emotion I'll add Holy Basil. If the heart is racing I'll add Motherwort.

I realize there is some concern that Passionflower as a possible MAOI may further potentiate tryptamines, but a) I have never seen this happen at therapeutic doses and b) if a person is merely hitting a rough spot in a journey, the goal is to bring grounding and protection, not necessarily to abort the trip, so further potentiating tryptamines is not necessarily a bad thing in and of itself.

Phyllis Light mentioned to me at the Traditions in Western Herbalism Conference that she has calmed people on LSD by having them drink a glass of milk. When Darcey and I recently had a phone call from someone who was having a bad trip and didn't have access to the herbs we would normally use we had her drink a glass of milk and put her feet in warm water. This succeeded in calming her to the point where she was able to lie down and sleep it off.

In cases of severe anxiety marked by agitation I have stopped using Anemone in part because I am concerned about the potential of paradoxical reactions -- I've not seen this happen in a situation related to psychedelics but I have seen people who tend to run hot become more agitated by a very small dose of Anemone tuberosa, and given that the kind of aggressive agitation I have seen in some cases of people having "bad trips" feels like a Pitta excess to me I'd rather play it safe and use other herbs instead.

What I've been using in its place has been Ghost Pipe. In a dozen or so cases in which someone has come to the first aid tent because she wants her trip to be over or someone has been brought to the tent because he has become aggressively agitated on LSD, and in one case of someone experiencing tremors and terror from PCP, I've seen 30 drops of Ghost Pipe tincture administered between one and three times calm people down to the point where they are able to relax and usually sleep (and then wake up without any major disorientation.)

I have seen two cases in the past year of men in their early twenties becoming physically violent and completely dissociated while on LSD. In both cases they were men who had always seemed kind and gentle to their friends (which I believe because in both cases their kind and gentle friends helped us hold them over the course of several hours and never lost their tempers.) In both cases we later found out these men were also on Adderall. In both cases the things the men were shouting about while trying to attack people suggested the strong possibility of childhood sexual trauma. And in both cases multiple health care practitioners involved felt the very clear sense of another entity partially controlling their actions.

The Adderall connection feels important here for two reasons. The first is that I think PTSD in young men is often misdiagnosed as ADHD, and the suppressive therapies used to treat their symptoms may prevent emotional release, worsening the underlying condition. Secondly I theorize that when LSD brings up buried trauma, a stimulant like Adderall may act to further stimulate the adrenals and to increase physical energy and stamina increasing the likelihood of physical aggression.

In the first case, we were able to administer Ghost Pipe orally, and we watched as our patient's pupils contracted and his eye motion became more responsive to external stimuli. But he continued to kick, bite, and scream for another several hours. We made the choice not to evacuate him because getting him in an ambulance would have required police assistance and we did not want to see him face charges of assaulting a police officer. Once he was physically exhausted his friends took him to a hospital.

In the second instance, we were unable to administer any herbs orally in doses capable of making a difference -- a few sips from a water bottle with various herbs added was the best we could do. We initially applied Rescue Remedy to the temples and wrists and smudged with Tobacco, Osha, and White Sage. Eventually we were able to get the patient to smoke a combination of Skullcap, Tobacco, and Cannabis (an Indica-dominant strain) and chew a small piece of Calamus root. This combination seemed to have a calming effect, and he was eventually able to leave with his friends still tripping but no longer aggressive. Several of us had side conversations with his friends about the importance of encouraging him to seek counseling in some form.

Ironically, in both these situations, I could see entheogens in a controlled, ceremonial situation under the guidance of an experienced healer being useful medicines for helping the patient work with the repressed trauma. But clearly the chaotic setting of a festival is not the right place for that work to begin.

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(1) Stephen Harrod Buhner. "The Ecstatic Journey and the Sacred Teachings of Plants" workshop at Sage Mountain, East Barre, VT, June 26-28. The subsequent information about sensory gating channels and the neocortex reflects my own extrapolation from Buhner's comments.

(2) David Winston. "Differential Treatment of Depression and Anxiety with Botanical Medicines." (C) 2006, Revised 2007. http://www.herbaltherapeutics.net/Differ_Treat-Depression.pdf

(3) Darcey French "Wood Betony: Stachys officianalis." Unpublished monograph, March 2008.

(4) 7Song. "Herbalists's View: Anemone for Panic Attacks." http://7song.com/files/Herbalists%20View-%20Anemone%20for%20Panic%20Attacks.pdf

(5) Darcey French, personal communication.

(6) Buhner

(7) Ryan Drum. "Three Herbs: Yarrow, Queen Anne's Lace, and Indian Pipe." http://www.ryandrum.com/threeherbs.htm#IndianPipe

(8) Winston.

(9) Pam Montogmery. Plant Sprit Healing. Rochester, VT: Bear & Company, 2008.

(10) Jim McDonald. "Wood Betony -- Stachys officianialis." http://herbcraft.org/betony.html

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