The Religious Science of Johns Hopkins: The Power of Suggestion

In part three of a series on a psychedelic clergy study, the psychedelic elephant isn't only in the room.

This is the third part of a series detailing spiritual missions, hidden issues, and unexamined consequences of a psychedelic clergy study. Each day this week, I will share a new piece on a different part of its story.

In part one, I laid out the high-level view of what I have come to see as a disturbing picture of psychedelic research on religious professionals.

In part two, I explored the spiritual beliefs and cultural agendas driving the research.

In this piece, I will talk about how psychedelics’ ability to increase openness to suggestion has more to consider than just how what happens during the trip might affect data. The impacts of social environment and power dynamics raise important questions about the ethics of belief shifts during trials, leading one Hopkins researcher to warn about clinicians “playing guru” in 2021.

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The sheer suggestibility of psychedelics is one of their defining characteristics, so in one sense it is no wonder that so many of the first cohort of volunteers at Hopkins had powerful mystical experiences: the experiment was designed by three men intensely interested in mystical states of consciousness. (And it is likewise no wonder that the European researchers I interviewed all failed to see as many instances of mystical experience in their subjects as the Americans did in theirs.)

Michael Pollan, How to Change Your Mind, 2018¹

In the previous piece, I talked about the spiritual beliefs of the primary researchers of the Johns Hopkins religious professionals study. There is nothing wrong with scientists having religious beliefs about anything. But given the nature of psychedelics to make one very vulnerable to suggestion, where subconscious influences in environment and in researchers may be transmitted, there is a heightened responsibility to attempt to take account for these influences. At minimum, this is to ensure scientifically interesting data is gathered, a notoriously difficult problem in this field. But to date, psychedelic research has often neglected to account for the full ethical scope of this suggestibility factor. In particular, there has been relatively little awareness given to the ethics of research-induced belief changes in participants. Is it a risk of research to lose one’s worldview in favor of a researcher? How do we quantify the risk to our agency? With the long-term impacts that such belief changes could accrue, what do people need to know about the power of suggestion?

In this piece, I will explore a couple of implications for psychedelic hypersuggestibility on power dynamics in psychedelic research, how it has shown up in at least one previous Hopkins psychedelic study, and how it may have impacted the religious leaders study in particular. I will also share a warning offered by a former Director for the Hopkins psychedelic center on suggestibility, belief changes, and researchers acting as gurus and priests.

Suggestible “Set and Settings” — Beyond the Trip

The experience of psychedelics is powerfully influenced by one’s expectation; no other class of drugs are more suggestible in their effects.

Michael Pollan, How to ChangeYour Mind, 2018²

The “set and setting” has been a known consideration of psychedelic research since the 60s. Yet while suggestibility is often discussed in terms of how a given psychedelic subject’s mood and mindset (set) and environment (setting) will impact their acute psychedelic experience, psychedelic hypersuggestibility means a “set and setting” also has powerful impacts on a participant’s power dynamics with therapists, identity shifts, and longterm belief transmissions. Suggestibility factors can also linger in the day after a trip, in what’s sometimes called an “afterglow,” and be further impacted by social context. Each can have impacts far beyond the acute effects of the drug into a subject’s long-term life trajectory. 

Power Dynamics

In a 2023 article for Nature, Dr. Carolina Seybert and other authors argued how suggestibility has significant impacts on informed consent, increased vulnerability, and boundary transgressions:

The extent to which suggestibility and vulnerability may be enhanced in a psychedelic setting, through the drug-induced altered state of consciousness, should not be underestimated. The patient should be informed about the possibility of feeling closer or more familiar to the therapist when under the influence of the substance. Ultimately, the therapist or equivalent, rather than mitigating psychological risks associated with the psychedelic experience, can be the agent of a boundary transgression. Information regarding the nature of this increased vulnerability of the patient must be provided as part of enhanced informed consent procedures.³

Likewise, in 2021, Dr. William Smith and Dr. Dominic Sisti called for an “enhanced informed consent” process in psychedelic research in part because of suggestibility, because “psychedelic experiences often lead to significant changes in a patient’s personality and worldview.”⁴

Given the long-term impacts of such personality and worldview shifts, there should be heightened ethical caution for interpersonal entanglements and multiple-role relationships between researchers and patients. 

Belief Transmission

Other researchers have pointed to increased suggestibility as leading to increased belief transmission. In 2021, Dr. David Dupuis offered abundant evidence for the ability of psychedelics to impart belief transmission, depicting a more complex view of hypersuggestibility than simply “brainwashing” to include social impacts: “as much as the power of the psychedelic experience in the dynamics of belief transmission [is] the central role of social interactions and institutions in the maintenance of adherence.”⁵ In other words, new psychedelic beliefs can be strengthened in the context of ongoing relationships with others sharing those beliefs.

As a result of this combined effect—psychedelic effect and social interaction—Dupuis further argues for the need for deeper ethical considerations:

The concept of suggestibility… raises indeed ethical concerns about the kind of influence therapists, shamans and other facilitators are having over their clients, even when therapy goes well…While it may drive therapeutic benefits, the ability of psychedelics to induce hypersuggestibility as feelings of reverence and revelation might lead to problematic effects in the absence of ethical guidelines regulating their use, especially considering the blurry distinction between accepted and forced persuasion.

Again, what Dr. Dupuis is arguing is not for a simple narrative of “brainwashing”—psychedelic agency is more complex than that, and the potency of new beliefs can be reinforced (or diminished) over time based on social context. This probably goes for any religion; if you want to be more Christian, you should probably hang out with other Christians. But it also seems the blurry line of belief transmission—from guides to subjects—sometimes gets blurrier when relationships deepen and complexify.

Identity Shifts

Besides suggestibility leading to a notable impact on power dynamics and belief transmission, a review of a recent Hopkins trial led by Dr. Roland Griffiths indicated that psychedelic suggestibility can not only induce belief shift, but identity shift, adding another dimension of ethical complexity.⁶ According to Dr. Neşe Devenot and other authors of the paper, an analysis of a Hopkins smoking cessation study indicated that participants underwent identity shifts from “smoker” to “non-smoker” as part of the study, which appears to have been induced based on some of the preparation literature given to participants. The authors advocated for stronger ethical considerations for “therapeutic frameworks [which] interact with the psychedelic substance in ways that can rapidly reshape participants’ identity and sense of self.”⁷ What was in the religious leaders study preparation material? I do not know.

While noting this identity shift ended in a positive result for smoking cessation, the authors of the analysis also note that “as psychedelic medicine becomes mainstream, consensual and evidence-based approaches to psychedelic-assisted identity shift that respect patient autonomy and encourage empowerment should become areas of focus in the emergent field of psychedelic bioethics.” 

In the case of smoking cessation, this identity shift appeared apparently benign and related to a desired health outcome. Such shifts are harder to ethically justify among healthy volunteers not seeking treatment. The worldview and identity stakes involved in a religious professionals study seem intrinsically more meaningful than the worldview and identity stakes involved in smoking cessation. After all, unless you’re a Parisian artist or a New York City line cook, smoking is probably not intrinsically part of your job.

Afterglow

Suggestibility does not only impact participants during the session, but in the days immediately after a treatment. According to Kylea Taylor, LMFT, author of The Ethics of Caring, “That extra-suggestible state can often continue past the effect of the psychedelic, because of the association of trust that the experiencer has had with the Responsible Party or the context.”⁸ As bioethicist Joseph Holcomb Adams further notes, “many psychedelic veterans [say] there is an ‘afterglow’ period where people can still be suggestible.” This view was shared by many psychedelic practitioners I used to work with.

I cannot confirm the timing of all follow-up interviews for the religious professionals study, but according to Dr. Bill Richards’ book in 2015, most Hopkins research studies conduct immediate follow-up interviews the day after treatment, with volunteers bringing in a pre-written outline or rough draft of their experience.⁹

Social Loops

Suggestibility effects are sometimes amplified by a factor of psychedelic research even less understood—the social climate that emerges out of a study, creating feedback loops. In a recent paper by Dr. Tehseen Noorani and other authors, many people don’t know that many psychedelic clinical trials often develop “dark loops,” social worlds of their own. As the authors point out, these social groups are not always negative. Sometimes, they may act as ongoing support groups for patients with a unique shared experience. There may be a need to help process what can be unique aspects of the experience. It may even help with whistleblowing behavior, such as with a “MAPS Participants” group.

But even if it’s a positive effect, the authors argue it’s something that, at minimum, must be acknowledged as part of understanding the context of psychedelic science. When it happens, it should be described in thick detail so that the possible effects of these social impacts can be contextualized when reading study outcomes.

It should also raise significant ethical concerns—in what other scientific research fields are clinical trials regularly producing their own social world? Yes, there are patient advocacy groups that emerge, and sometimes there are funders of studies who fund those, but those are usually patients seeking treatment of a particular issue—say, US Veterans seeking expanded MDMA research to find a new treatment for PTSD. What about when patient groups form that are not advocating for a new treatment, but for a new religious experience? Maybe that’s unusual just because, well, it’s a pretty rare and weird situation that scientists are studying the effects of their own spiritual beliefs on volunteers.

Whether such social groups emerge as a benefit or detriment to the research and participants, Noorani says this needs to be accounted for in some fashion—either minimized with higher scrutiny, or much more richly described in further detail. Or perhaps we shouldn’t try to bother with concerns around patients and researchers getting socially entangled with high suggestibility drugs that impact worldviews. Perhaps the power dynamics should not be mitigated, but amplified, harnessed, “valorized.” Because it might even be that these “chemosocial” effects, as Noorani calls them, can be leveraged into creating healthier outcomes—and I think this healthier boost likely happened here in the clergy study. Not all participants stayed in close touch as professional contacts, but it seems to have been a deeply supportive and nurturing experience for some who did, and that should not be discounted at all. It just means when it comes to the social environment of any psychedelic study, things are complicated and need to be thought about consciously.

Priming and Confirming

One [Hopkins] volunteer—the physicist—told me that the “mystical experience questionnaire” he filled out after every session also planted expectations. “I long to see some of the stuff hinted at in the questionnaire,” he wrote after an underwhelming session—perhaps on the placebo. “Seeing everything as alive and connected, meeting the void, or some embodiment of deities and things like that.”

Michael Pollan, How to Change Your Mind, 2018¹⁰

Many psychedelic studies face issues of expectancy bias confounding results. This has been recently reminded by Dr. Jacob Aday alongside other authors in 2022,¹¹  with Dr. Griffiths discussing in December 2022 that trials currently face “huge, huge expectancy effects.” While this has continued to grow in recent years to further bias data, it has long been a dilemma of balancing priming with safety concerns in recruiting for psychedelic trials.

The religious professional study was no different: from it being open-label, to the way it advertised for participants, to the growing atmosphere of psychedelic cultural hype each year of the study offering confirmation, to the unique sets of circumstances in the trial (at least three of the participants had previously been friends and colleagues for years), I sincerely wonder how much scientifically meaningful data could be ascertained.  

The study was primarily advertised to Christian religious professionals through the magazine Christian Century, which also ran a 2015 article by Don Lattin at the start of recruitment. Lattin says he is aware of several participants who found the study through reading his article first, but I do not know how many participants heard about the study through this article, through a flyer, through word of mouth, or some other means. The Christian Century article publicized the researchers’ intentions to “induce mystical experiences,” with Dr. Richards discussing “profoundly spiritual alternate states of consciousness” in plugging his book, asserting that “sacred experiences also can be occasioned [with psychedelics] with a high degree of reliability,” invoking the chance to meet “the really real God,” all carried with the prestige around Johns Hopkins’ institutional reputation. The open-label status would have only increased any priming effects that occurred in the recruitment and the trial process.

If Dr. Dupuis’ and Dr. Noorani’s hypotheses are correct—that suggestibility is reinforced through not just the drugs but the social environment around them—there were ample opportunities for suggestibility reinforcement in the study in the immediate aftermath to the present day. For one, the researchers’ beliefs were in the public domain, including in Dr. Richards’ book, and only got increased media attention every year from the study until now. The so-called “Michael Pollan Effect” observed by David Carpenter in the wake of Pollan’s best-selling book amplified this further. The ensuing friend groups could have socially reinforced each others’ experiences in a personal way.

Further confounding was the long drawn-out nature of the trial that spanned across a rapid rise in psychedelic popular media coverage. For instance, a participant who had an experience-to-follow-up session spanning from 2016-17 would have a far different environment than a participant who was in the trial from 2018-2019 after the release of Pollan’s book, which seemingly anyone casually interested in psychedelics read in the aftermath of its release. The book (whose quotes are featured here) highlights extensive coverage bordering on hagiography of Dr. Griffiths, Dr. Richards, and Bob Jesse. 

This increasing hype-climate around psychedelic science in the past decade has been observed by many psychedelic researchers to become increasingly difficult to ascertain meaningful data. The primary goal seems to be to generate headlines to increase public acceptance and open up new cultural avenues. The overall research climate has repeatedly developed a revolving door of new trial success stories, including US Veterans who have felt used when they were no longer cooperative with researchers’ PR goals.

Former Hopkins researcher Dr. Katherine MacLean wrote that there was already some awareness that Dr. Richards’ guidance of every Hopkins psilocybin patient was responsible for its theological results: “We even joked that maybe Bill and Mary [Cosimano] were the ones responsible for the mystical results, not the drug.”¹² Later, Dr. MacLean further described how Dr. Griffiths and Dr. Richards had little problem introducing overtly religious preparation sheets for its ostensibly secular studies of mysticism, describing an earlier pre-2013 study in this way:

But Roland and Bill ultimately went with a Christian-inspired practice called “passage meditation.” Each participant in the study memorized the “Prayer of St. Francis” and recited it to themselves for ten minutes every morning. As the study went on, people started choosing other passages that aligned more with their personal views, but St. Francis’s prayer was the foundation: “Lord, make me an instrument of your peace . . .” Looking back, I can totally understand why some people think we were biased toward spiritual outcomes.¹³

I don’t know if this kind of thing was part of the religious leaders study preparation—it’s possible it wasn’t (UPDATE: A participant reported “we were not” required to read the Prayer of St. Francis). Still, it is hard for me to read this as anything other than the Hopkins team having a habit of not only avoiding mitigation of suggestibility for their research, but actively encouraging it. Why?

Is Suggestibility a Tradeoff of Safety?

This past June, during his portion of the study’s debut presentation, Dr. Griffiths spent a lot of time emphasizing “catastrophic” risks, stressing cultural caution and patience.

The Hopkins concern about the risks of psychedelics has always been taken into some consideration, and balancing suggestibility concerns with safety concerns is a challenge in all psychedelic research. Back in 2008, Hopkins developed protocols taking this balance in mind according to safety documents authored by Dr. Matthew Johnson, Dr. Griffiths, and Dr. Richards. These documents show concern to mitigate the chance of a “bad trip” through building increased trust and other social ties with participants. One might be tempted to argue that increased suggestibility is necessary for safety. 

But in my opinion, these protocols lack attention to how such socially-bonded safety measures might heighten impacts on power dynamics and the impacts on participants’ identities, beliefs, and relationships. 

In the safety guidelines, the Hopkins authors emphasize:

With this class of compounds, it is critical for investigators to implement appropriate and conservative safeguards… Careless research that lacks attention to the unique risk profile of hallucinogens may not only endanger the safety and well-being of the research participants, but may also jeopardize future human research with these scientifically fascinating compounds.

Pursuant to these goals, the Hopkins authors argue the need to develop stronger-than-normal trust relationships: “It is difficult to overemphasize the importance of the interpersonal atmosphere created by study staff in influencing a volunteer’s response to a hallucinogen…we recommend providing additional attention to volunteer rapport beyond what is customary in general human behavioral pharmacology practice.” Despite consciously ramping up the interpersonal ties, it does not appear to me that the authors focused on the ethical implications of stronger-than-normal trust relationships.

In his book Sacred Knowledge, in my opinion, Dr. Richards also gives little attention to ethical concerns of psychedelics while emphasizing his team's attempts to see participants in a more friendly way. In fairness, I learned this is not unique to him—this appears to have been a common shift among clinicians over the past sixty years to be less paternalistic and more egalitarian.¹⁴ Dr. Richards describes their approach in the following way:

Volunteers are welcomed as valued participants and colleagues on an important frontier of knowledge rather than labeled as “patients” or “experimental subjects.”...Further, once a person is accepted into a study and signs an informed consent document, he or she usually participates in a minimum of eight hours of relationship-building time with the guide or therapist who will be present during the period of entheogen action.¹⁵

The intentions seem sincere to develop relationships that minimize the acute risk of a bad trip, and it’s likely this might have successfully prevented many instances in this category of bad outcome. However, it is questionable that seeing psychedelic participants as “colleagues” sufficiently attends to the realities of the power dynamics between a researcher who has encouraged stronger-than-usual trust bonds with a participant who has then also been given a high-suggestibility drug. Does the framing of participants as “colleagues” result in paying less attention to the realities of power, transference, and countertransference involved? 

2020: Hopkins Researchers Deny Belief Shifts

Prior to the previously mentioned research, some Hopkins researchers had taken the initiative to defend against possible “alarmist reactions” that come from claims that psychedelic therapy could lead to belief changes. In a 2020 piece for Scientific American, Dr. Matthew Johnson and Dr. David B. Yaden of the Hopkins psychedelic research center pushed back against an earlier op-ed in the magazine by Eddie Jacobs, which wondered, “What if a Pill Can Change Your Politics or Religious Beliefs?” 

At the time, Dr. Johnson and Dr. Yaden argued there was no data for such changes or concerns about changing beliefs, and certainly not affiliations, arguing that they took into account proper safety measures in their studies:

Consent procedures in psychedelic trials by our research group (and by other groups to our knowledge) already warn that personality and attitude changes are a possibility…Psychedelic experiences are sometimes held as among the most meaningful in one’s life, and may be interpreted to have philosophical or spiritual import, likely depending on the orientation of the participant. Such effects present the opportunity for ethical pitfalls by clinicians. These and other challenges will call for important contributions from ethicists. However, we must also be careful to keep any given concern in perspective and convey realistic risks to the public and patients. From this perspective, we believe, based on the data, that major shifts in political or religious orientation or beliefs are not among the likely risks associated with this treatment. As psychedelic researchers, we believe it is important to remain vigilant against excesses in enthusiasm as well as alarmism.

But whether belief changes are significant to psychedelic researchers often seems to depend on who’s asking, and for what purpose: if it would advance psychedelic spiritual legitimacy, then yes, their beliefs changed thanks to the healing mystical experience. If it would potentially cause backlash and “alarmism,” then no, these mystical belief changes are trivial. But just to be clear—moving into a theological belief that drugs can help you have an experience of God is a very non-trivial religious belief change.

Would the authors still make their assertions today? 

A year later, Dr. Johnson seemed to have significantly and sharply pivoted.

2021: Hopkins Researcher Warns Against Gurus 

In 2021, Dr. Johnson—at the time the Center Director for the Hopkins Center for Psychedelic and Consciousness Research—published “Consciousness, Religion, and Gurus: Pitfalls of Psychedelic Medicine.”¹⁶ In addition to a concern about the sloppy invocation of “consciousness,” an abundant term in Dr. Richards’ theoretical framework, two of Dr. Johnson's core concerns included “inappropriate introduction of religious/spiritual beliefs of investigators or clinicians” and “clinical boundaries.” What caused such a strong shift from the previous op-ed? 

It is unclear, but the new statements were shockingly strong. Dr. Johnson offered what he called a “warning signal regarding a little-discussed danger at play in psychedelic research. This danger is scientists and clinicians imposing their personal religious or spiritual beliefs on the practice of psychedelic medicine.” He also remarked, “It would also be inappropriate to introduce meta-religious beliefs such as perennialism (the notion that the major religious traditions point toward a core truth).” As I wrote in the last piece, this view has been proudly espoused by Dr. Richards. Johnson further argued that “scientists and clinicians should not include religious icons in the session room or other clinical space,” a comment directly at odds with the religious professionals study design, which Griffiths defended in a 2022 interview with Lucid News.

But Dr. Johnson’s strongest comments were a criticism of “psychedelic exceptionalism” and their direct negative ethical implications:

[Psychedelic exceptionalism] believe[s] that the nature of the experiences people have on psychedelics are so sacred or important that the normal rules do not apply, whether they be the rules governing clinical boundaries, the practice of clinical psychology or medicine, sound philosophy of science, or ethics…The powerful subjective nature of psychedelic experiences can be leveraged toward explicit harm, as in the extreme case of Charles Manson and his followers. Far more likely for scientists and clinicians, however, are abuses that come from the lack of clinical boundaries, e.g., temptations for sexual or other inappropriate relationships. Even short of sexual impropriety, psychedelics might magnify the subtle abuses of differential power that can be at play in the routine practice of clinical psychology or medicine. It can be challenging to be associated with what might be one of the meaningful experiences in a person’s life. The scientist or clinician might, perhaps without explicit awareness, fall into the trap of playing guru or priest, imparting personal philosophies without a solid empirical basis.

While this would become most evident with Dr. Richards, there is also a greater context in play around Dr. Griffiths’ spiritual beliefs about psychedelics. In my opinion, Dr. Griffiths has demonstrated a cavalier attitude about the ethics of inducing a “mystical” worldview because he believes his secular views about mystical-type experiences could not constitute a belief transmission, but a reality revelation. Moreover, he seems to believe these experiences to be intrinsically positive for their meaning-bestowing properties.¹⁷ While this might be a valid personal viewpoint, this belief heavily touches on theological areas relevant to the religious professionals study. It deserves much more scrutiny.

But it is surprising that Dr. Griffiths has argued that a worldview suffused with psychedelic meaning is inherently positive. As described by member of the clergy study team Rachael Petersen, employed after her experience as a subject in a different trial, her second Hopkins trial experience when she was a research subject left her in psychological duress for months, “The very quality that made my first experience so profound—its felt sense of authority—made my second so indelibly harrowing, a trip after which nothing felt the same.”¹⁸ 

The Purpose of Suggestion is What It Does

This radical suggestibility posed a scientific dilemma, surely, but was it necessarily a therapeutic dilemma as well?...For it takes psychotherapy perilously close to the world of shamanism and faith healing, a distinctly uncomfortable place for a scientist to be.

Michael Pollan, How to Change Your Mind, 2018¹⁹

As discussed, there may be some reasons to not be overconcerned about suggestibility in some facets. Sometimes it can be an asset for building safety from acute risks of bad trips, and sometimes a close-knit social group from a study might support participants better than leaving them by themselves. And the concerns around suggestibility are clearly not isolated to this study. The Hopkins team was aware of many of them. But were they aware of enough of the ethical ramifications? Were they negligent in following ethical norms?

What many new psychonauts may not realize when they first experiment under a leader’s care is the things that leader believes about psychedelics are just their beliefs, but they can feel so potent and meaningful that they seem concretely factual, because you’ve had nothing to compare it to.

Even when I was a previously experienced psychonaut in other settings, I remember having those powerful feelings for my first ayahuasca guide the first time I sat in a curated psychedelic ceremony. I became almost instantly convinced of the cosmology of their underground church, deeply connected to the social group around it. It was both the realest thing I had ever known and the most magical. How could that have been anything other than God? Maybe it still was—certainly above my paygrade. But also, I now better understand that some of those feelings I had were simply the effects of the compounds interacting in complex ways with my social environment, even ways that were unconscious to me and everyone else—even the guide. I can see that now, but it doesn’t negate the strong affection I still have for those people; it just makes those feelings better boundaried.

There is a wide, wide variety of opinions on psychedelics out there, and I don’t know if anybody deserves to have such outsized power stacked in their favor—a guide who creates the illusion you’re a colleague on an even-power playing field, drugs you’ve never experienced before, known to induce suggestion in powerful ways you can’t possibly anticipate. I can only imagine the added power of this coming from a place with as much prestige as Hopkins has to the average person. 

None of this seemed like a big deal to me when I was involved in the “chemosocial” environment of the study. It seemed like everyone felt things were going well. But that’s one of the things about any kind of ethical norms—they often come to exist because of what happens when things don’t go well. Ethical considerations aren’t just natural instincts of right and wrong. It requires prolonged conscious effort, paying close attention to things that aren’t always obvious about second and third-order ramifications, to hidden dimensions underneath the surface. And everybody still sometimes gets it wrong.

Rather than analyzing the ostensible aim of the religious professionals study, it might be more useful to consider what systems and management scientist Stafford Beer coined with the term POSIWID: “the Purpose Of the System Is What It Does.”

In other words, instead of looking at what the religious professionals study says it would do against headwinds of suggestibility, you might look at what actually happened: under drugs that induce suggestibility, some religious leaders had their beliefs become more like the researchers, and started advancing their interests with the help of their funding. I will share more of that in the next piece.

1. Pollan, Michael, How to Change Your Mind, Kindle edition, 64.

2. Pollan, 25.

3. Seybert, C., Cotovio, G., Madeira, L. et al. “Psychedelic treatments for mental health conditions pose challenges for informed consent.” Nat Med (2023). https://doi.org/10.1038/s41591-023-02378-5

4. Smith W.R., Sisti D., “Ethics and ego dissolution: the case of psilocybin.” Journal of Medical Ethics 2021;47:807-814.

5. Dupuis, D., “Psychedelics as Tools for Belief Transmission. Set, Setting, Suggestibility, and Persuasion in the Ritual Use of Hallucinogens,” in Frontiers in Psychology, Vol. 12 730031. 23 Nov. 2021, doi:10.3389/fpsyg.2021.730031/; 

6. Devenot, Neşe, et al. "Psychedelic Identity Shift: A Critical Approach to Set And Setting." Kennedy Institute of Ethics Journal, vol. 32 no. 4, 2022, p. 359-399. Project MUSE, doi:10.1353/ken.2022.0022.

7. Ibid.

8. Evans, Jules, “Blurred Lines: Improving the ethics of psychedelic fund-raising,” March 20,2023, www.ecstaticintegration.org/p/blurred-lines-improving-the-ethics

9. Richards, William, Sacred Knowledge, Kindle edition, 189.

10. See note 1.

11. Aday, Jacob S. et al. “Great Expectations: recommendations for improving the methodological rigor of psychedelic clinical trials.” Psychopharmacology vol. 239,6 (2022): 1989-2010. doi:10.1007/s00213-022-06123-7

12. MacLean, Katherine. Midnight Water, Kindle edition, Loc. 1254.

13. MacLean, Loc. 1276.

14. Appel, Jacob M. “Engagement without entanglement: a framework for non-sexual patient-physician boundaries.” Journal of medical ethics vol. 49,6 (2023): 383-388. doi:10.1136/metaethics-2021-107580.

15. Richards, 188.

16. Johnson, Matthew W., “Consciousness, Religion, and Gurus: Pitfalls of Psychedelic Medicine,” ACS Pharmacology & Translational Science. 2021 4 (2), 578-581. DOI: 10.1021/acsptsci.0c00198

17. Yaden, David B. and Griffiths, Roland R., “The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects,” in ACS Pharmacology & Translational Science, Vol. 4,2, 568-572, Dec 10, 2020, DOI:10.1021/acsptsci.0c00194/; David Yaden, Brian Earp, and Roland Griffiths, “Ethical Issues Regarding Non-Subjective Psychedelics as Standard of Care,” Cambridge Quarterly of Healthcare Ethics 31. 10.1017/S096318012200007X/; Cheung, Katherine et al., “Psychedelics, Meaningfulness, and the ‘Proper Scope’ of Medicine: Continuing the Conversation,” in Cambridge Quarterly of Healthcare Ethics, 2023. 

18. Petersen, Rachael. “A Theological Reckoning with ‘Bad Trips’.” Harvard Divinity Bulletin. Autumn/Winter 2022, Harvard University.

19. Pollan, 158-159.