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International Journal of Mental Health and Addiction

22-09-2023 | Original Article

Paradigm Lost: Towards an Evidence-based Ontology in Psychedelic Medicine?

Authors: Olivia Marcus, Elias Dakwar

Published in: International Journal of Mental Health and Addiction

Abstract

Recent research into so-called psychedelic substances, such as psilocybin, ketamine, and mescaline analogues, has been hailed as a “renaissance” heralding a “paradigm shift” in psychiatry. There is hope that psychedelic-assisted therapy will be made more available to address mental and substance use health problems through existing systems of medicalization and legalization. There are important relational and epistemic concerns that must be addressed, however, before we might begin stewarding this class of substances into the medical landscape in a responsible, evidence-based manner. In this paper, we draw on our ethnographic and clinical research observations to argue that the ontological and relational commitments of traditional medicine (ayahuasca-related healing) and randomized controlled trial (RCT) (ketamine-assisted psychotherapy) practices have important and revealing overlaps; together, they bring attention to ideal ways of working with these substances, as well as to ideal forms of healthcare more generally, with implications for reimagining our healthcare system from the ground up. As such, more is needed than a circumscribed shift to a new epistemological orientation (“paradigm”). We conclude by promoting ideals in alignment with our data and observations—relationality, inter-being, and epistemological fluidity—and by exploring how these ideals might reshape the medical landscape.

Ayahuasca is a Quechua-language name for a tea made from the Banisteriopsis caapi vine and often with the leaves of a DMT-containing plant such as Psychotria viridis or Dyplopterys cabrerana, sometimes with several other plants. The tea is known by many names, such as yajé, caapi, natem, Nixie pae, oni, kamarampi, hoasca, and daime, among others. In this paper, we refer to ayahuasca as the most commonly used name in published literature for a mixture of B. caapi and P. viridis. The word “shaman” is contested etic word that is used here for similar reasons of brevity.

[OM]: I prefer to use the terms “locals” and “non-locals” or locals and “foreigners” as analytic categories to describe my participants, as opposed to indigenous/non-Indigenous. The latter is exclusive of the complex ethno-racial category of the mestizo and mestizaje, among whom I conducted my fieldwork and who practice a breadth of unique local healing practices developed over hundreds of years of colonial encounters.

Ayahuasca on its own—that is, without therapeutic support—has already been tested for treatment-resistant depression in one open-label study and one RCT as reported by Sanches et al., 2016 and Palhano-Fontes et al., 2018

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Title: Paradigm Lost: Towards an Evidence-based Ontology in Psychedelic Medicine?
Authors: Olivia Marcus
Elias Dakwar
Publication date: 22-09-2023
Publisher: Springer US
Published in: International Journal of Mental Health and Addiction
Print ISSN: 1557-1874
Electronic ISSN: 1557-1882
DOI: https://doi.org/10.1007/s11469-023-01157-0

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Paradigm Lost: Towards an Evidence-based Ontology in Psychedelic Medicine?

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