Abstract
In this article, we provide a genealogy of the concept of integration and a discussion of the multiplicity of practices it encompasses in the field of psychedelic medicine. Reflecting on our observations of psychedelic integration practices, we make three key observations. The first is that integration services tend to focus on the individual, at the expense of considering how societal factors lead to dis-ease. The second observation is that integration is increasingly rendered in formulaic checklists, at the expense of remaining an open-ended praxis, which runs the risk of emptying it of their potential to bring context-dependent change for people. Our third observation is that integration services are increasingly rendered as marketable services. Understanding how we got here and what is at stake requires a genealogical analysis of integration within the field of psychedelics. This critical review of psychedelic integration discusses the divergence between psychedelic practices in traditional or Indigenous contexts and contemporary psychedelic practices in Western industrialized, capitalist societies. We suggest that this divergence has to do with the degree to which psychedelic experiences are contiguous with everyday sociality and the cosmology that dominates in a given social context. Offering a viewpoint grounded in the Global South, our perspective aims to denaturalize some of the assumptions that prevail in research settings where highly individualized approaches and technological solutionism prevail, such as the USA or Western Europe. We highlighted the dangers of integration becoming too formulaic, commodified, and disconnected from the therapeutic or ceremonial contexts in which psychedelic experiences were carefully curated for millennia. Furthermore, we underscored the importance of critically examining the assumptions underlying the infrastructures of digital psychedelia and app-based integration practices.
Introduction
In this article, we discuss the origins of the concept of psychedelic integration and provide an analytic discussion of the multiplicity of practices it encompasses in the field of psychedelic medicine. Over the past decade, psychedelic-assisted therapy has drawn renewed interest within the field of mental health, as clinical trials investigating their efficacy flourish anew, having been shut down in the early 1970s (for a historical account see Oram, 2018). Psychedelic-assisted therapies are a fairly unique genre of intervention, in that they synergistically combine a pharmaceutical and a psychotherapeutic intervention, with advocates positing that their combined efficacy is superior to the sum of each. The Multidisciplinary Association for Psychedelic Science (MAPS) that spearheaded a number of the clinical trials in this field defines this treatment approach in the following manner: “the therapeutic effect is not due simply to the physiological effects of the medicine; rather, it is the result of an interaction between the effects of the medicine, the therapeutic setting and the mindsets of the participant and the therapists.” (Mithoefer, 2017)
In his comprehensive study of psychedelic integration (Aixalà, 2022), notes that psychologists use the same word “for totally different concepts and practices”. Aixalà’s book provides a superb review of the many practices that come to be understood as “integration” within the field of therapeutic psychedelics; practices that often aim to maximize the benefits of psychedelic experiences (2022: 65). This plurality is also echoed in a recent review of 24 distinct definitions of integration which found that the concept lacked a clear definition and included “a confusing range of activities” (Bathje, Majeski, & Kudowor, 2022). Gorman, Nielson, Molinar, Cassidy, and Sabbagh (2021) describe the goal of integration as “merging the psychedelic experience with the patient's daily life in a way that helps the patient live a fuller life.” As this field has grown, with trials nearing completion of Phase 3, a plethora of questions has arisen concerning the relative efficacy of different psychedelic compounds for specific pathologies, and the kinds of psychotherapeutic intervention that best accompany them. In particular, the phase that follows the psychedelic dosing session – in which patients and therapists make sense of the themes that arose during a session – has been identified as a key window of opportunity in which to “integrate” the experience. This opens up a range of empirical questions, such as: Which procedure works best in which circumstances? Are all integration practices equally efficient? Are there situations in which integration is not necessary? How do integrated or non-integrated psychedelic experiences correlate with undesirable aftermaths? And, perhaps more importantly, how much of the therapeutic results can be attributed to the integration itself rather than to the psychedelic experience? (Neitzke-Spruill et al., 2024).
Integration, as it has come to be known, includes a myriad of practices that range along a broad spectrum spanning approaches that explicitly elude standardization and emphasize skilled training and an open-ended sensitivity (Callon, Williams, & Lafrance, 2021) to more directive or fixed practices that draw on the language and practices of coaching and standardized formulas and checklists. Integration, we found, can refer to a vast gamut of practices such as psychotherapy, counseling, coaching, “sharing” about the experience, journaling, the use of somatic techniques, mindfulness techniques, a broad range of self-care practices, artistic activities (such as painting or drawing, in particular mandalas), or nature contemplation.
In this review article of psychedelic integration, we found that the semantics of integration very often emphasize and reinforce an agentic self-reflexive actor whose prime locus of agency is the “self.” Phrases such as “Process your feelings,” “What new life is growing in you?” and “What are you letting go of?” exemplify this. This emphasis on self-making obscures the intricate connections individuals have with their societal and relational contexts, including family, community, and culture. In this sense one of the core arguments we make is that integration – in much of its current iteration – presumes a bounded “self” occulting the deep ties that link individuals to their societal and relational contexts.
This article contributes to current debates around the development of psychedelic-assisted therapies through a critical analysis of the nexus known as “psychedelic integration.” It builds on a sustained dialogue across our disciplinary perspectives, in psychiatry and medical anthropology through which we have identified a common set of concerns with the direction that this field is taking, with regard to the labor of providing care. The perspective we offer is circumscribed both by our respective disciplinary engagements and by the specific locations (principally Brazil and Peru) in which our broader research activities are situated. Our goal here is not to provide a systematic analysis of “integration” in Latin America, but rather to comment, from the Latin American contexts of psychedelic research and ceremonial practice in which we are empirically situated on the emergent global discourse of “integration”.
Besides drawing on our quotidian encounters with discourses of integration in the field of psychedelic research we are immersed in, our review draws on a range of sources including a survey of websites, forums, and online resources to ascertain the diverse meanings given to psychedelic integration outside the scientific literature, a review of the burgeoning scientific literature on psychedelic integration and literature on the origins of psychedelic-assisted therapy as well as a review of our existing data, particularly ethnographic practitioner interviews, for mentions of integration in discussions of past and present psychedelic practice.
Drawing these together we develop a genealogical approach, in the sense proposed by Michel Foucault (1971). Foucault's genealogical method challenges traditional views of knowledge development as a linear, continuous progression. Instead, it highlights the breaks, shifts, overlaps, mutations and discontinuities in the history of ideas. Unlike traditional historical methods in search of origins, the genealogical method adopted here focuses on how practices and institutions shape our understanding of truth. The goal of genealogy is not to trace origins but to reveal these power dynamics. In this sense, our approach traces the development of a discourse (on integration) back to the wave of psychedelic research that took place in the 1950s and 1960s and considers the very different conceptual work the term was doing then and now.
Reflecting on our observations of integration practices in a broad range of settings, we make three key observations. The first is that integration services, as they have come to take shape in the last decade, tend to be almost exclusively focused on the individual, at the expense of fully considering how societal and environmental factors may be at play in both a person's dis-ease and their pathways to transformation and wellness. The second observation is that practices of integration are increasingly rendered in standardized formats, such as structured journaling prompts, weekly check-ins, or guided cognitive exercises—formulaic checklists, that may come at the expense of maintaining a more open-ended praxis, running the risk of emptying them of their potential to bring about meaningful, context-dependent change for people in the myriad worlds they may exist in. Our third observation is that integration services are increasingly rendered as formulaic checklists as a result of being marketed as accessible, scalable products, often packaged into online programs or mobile apps.1 In these times of psychedelic hype, countless internet sites now offer integration circles, integration coaching services, or integration training programs. Understanding how we got here and what is at stake requires a genealogical analysis of integration within the field of psychedelics.
A genealogy of integration
At least part of the impetus for integration stems from the way that early psychedelic therapy studies identified this step as integral to reinforcing the therapeutic power of psychedelic substances. Pioneering psychedelic researchers used the term 'integration' alongside other psychoanalytical terms such as ‘unconscious’, ‘transference’ and ‘abreaction’ (Abramson, 1967).2 The concept seems to have initially been tied to that of ego-integration. Ego-integration, the process of consolidating the various aspects of personality into a whole (VandenBos, 2015), was a popular notion among leading psychoanalysts of the period (such as Donald Winnicott or Otto Kernberg). While psychoanalytic terms slowly disappeared from psychedelic literature, the concept of integration remained, and found its way into contemporary psychedelic popular culture. The influence of Carl Gustav Jung brought with it the idea that unconscious elements and transcendent experiences are part of what one needs to incorporate into personality in a process he referred to as “individuation” (Hill, 2019). Other approaches that have contributed to the current concept of psychedelic integration were Gestalt therapy and transpersonal psychology. Both paradigms convey the idea of integrating the different parts of the self into a whole. In Jungian depth psychology there is a strong idea of “integrating” the Shadow (Cohen, 2017). Among those theories, Jungian and Transpersonal psychology were the ones that accepted with more ease the idea that integration was also a process for the assimilation of mystical experiences and spiritual dimensions into the structure of personality. In early uses of the concept, integration principally referred to the manner in which a non-ordinary experience was “integrated” back into the everyday life of the person after a “peak” experience (Papaspyrou, 2015). Commenting on the therapeutic potential of Holotropic Breathwork, a method developed by psychedelic pioneer Stan Grof and his wife Christina Grof, the authors emphasize that “The final outcome of the session does not depend on how much traumatic material was brought into consciousness and processed, but how well the experience was completed and integrated.” (Grof & Grof, 2010, emph.added).
In his extensive review of early psychedelic research, Aixalà (2022) identifies two core ways in which the term “integration” was initially being used: as a descriptor for the way information or different parts of the ‘self’ are brought together anew as a result of the psychedelic experience and to refer to the act of processing or making sense of the contents of the experience with the therapist, usually after the session.
The first aforementioned facet of the emergent praxis of integration pertains to the way early psychedelic clinicians were understanding these experiences as disturbing and re-arranging the personality structure of the subject undergoing them, leading to “a massive integration of the id-ego-superstructure” in the words of Bergman and Eisner or as enabling the subject to integrate different pieces of information or to fulfill the “integrative function of the psyche” as Abramson would put it (cited in Aixalà, 2022, p. 8). These experiences were therefore understood to require dedicated time in their aftermath. Aixala proposes that the Spring Grove intervention model, developed at the Maryland Psychiatric Research Centre between the mid-1960s and mid-1970s, was the place where the model of intensive preparation, well-held session and systematized sessions of integration was most thoroughly developed and theorized (2022: 13–17). The Spring Grove model fostered what we might call an integrative model of psychedelic care that wove together psychedelic session preparation, supervision and integration. In the words of Walter Pahnke “…what one does with a psychedelic experience may be more important than merely having it. Without integration into the on-going life of the individual, the experience may be only an irrelevant memory, no matter how beautiful.”3
Stanislav Grof, who also worked at the Maryland Research Centre would later (in his book LSD Psychotherapy) come to outline in detail the contours of psychedelic integration. Grof empahsised that what matters is not just that the individual integrates their experience but also that they are able to reintegrate the normal everyday social order in which they exist. This may be particularly challenging for people who have encountered a transcendental or non-ordinary state of consciousness and for whom that experience had particular value. Stanislav and his wife Christina Grof proposed that one of the core challenges is reintegrating a social order that is fundamentally grounded in a materialist, rationalist understanding that actively denies the possibilities that participants of psychedelic experiences regularly report concerning the nature of the psyche and the universe (Grof & Grof, 2010). In this sense, the very notion of integration presumes and is grounded in a social reality in which there is a gap between the worlds propitiated by psychedelic experiences and those of everyday sociality.
as a consequence of capitalism, under which workers are directed toward goals and actions that are not their own, and therefore lose their autonomy to create their lives. The result is alienation from their work, from other people, and from their human nature (and one might add from the natural world, as capitalism resulted in a mass migration to cities and away from the sources of the raw materials of production). From these perspectives, Westerners may particularly need support for integration due to first needing to disintegrate limiting mental structures, then orient and adjust toward new, more authentic, and integrated ways of being that may be unknown to them, within the context of a culture that may define them as abnormal for doing so. (Bathje et al., 2022: 3)
As researchers working in the field of psychedelics with an empirical focus in South America, we have found much of the discussion around integration – as it is unfolding in the Global North – somewhat disconcerting. In the South American settings in which we work, integration was either never mentioned or – when it was – had very different contours. In Latin America, ayahuasca (which biomedicine qualifies as a psychedelic substance) tends to mostly be used outside therapeutic contexts, in Indigenous territories or in spiritual or religious circles. In the rituals of the Brazilian ayahuasca religions such as União do Vegetal, Santo Daime or Barquinha, integration is by no means a rule. There may be, depending on the tradition, informal discussions about what was felt or happened during an ayahuasca experience and there is often a deeply relational, collective network of care that performs some of the functions that the medical literature refers to as “integration” (Diament, Gomes, & Tófoli, 2021; Talin & Sanabria, 2017). Nevertheless, as Talin and Sanabria (2017) argued, these are precisely not rule-bound or formulaic but deeply contextual, situated such that each situation is carefully met with specificity.
Separation, liminality and return
In traditional societies, non-ordinary experiences are often spatially and temporally demarcated from ordinary life and sociality. This led folklorist Arnold van Gennep to propose the notion of “liminality” (from the Latin limen for “threshold”) in the early 20th century as a key concept for understanding rites of passage. The notion was taken up and expanded by anthropologist Victor Turner, who demonstrated that ritual practice is often structured in three stages: 1. separation from ordinary life; 2. the liminal period of the ritual itself, in which participants dwell in a nonordinary spacetime (in some way secluded from the spacetime of everyday life) and undergo a collective experience that builds communitas (a form of social cohesion); and finally, 3. a phase of carefully managed ritual return or re-aggregation into ordinary, mundane sociality (Turner, 1969). This sequence of events was understood to have a deeply transformative potential when all stages of the process are carefully respected. In Holotropic Breathwork, a modality at the core of psychedelic-assisted therapeutic trainings such as MAPS’, emphasis is recurrently put on the fact that the work involves carefully tending to all three of the stages: 1. preparation (including intention setting); 2. a well held session; and 3. integration (Mithoefer, 2017).
Much of this framing stems from the influence that van Gennep's work had on comparative religion scholar Joseph Campbell. Campbell, a North American professor of literature, published the highly influential “Hero with a Thousand Faces” in 1949 (Campbell, 2008), in which he proposed a typology of the hero's journey in cross-cultural mythologies. Campbell's work influenced many early psychedelic researchers who were looking for a theoretical model with which to anchor the importation of psychedelic practice into industrialized Western contexts. Christina Grof, who developed Holotropic Breathwork with her husband Stanislav Grof, had studied with Campbell at Sarah Lawrence College4 and Campbell began lecturing at Esalen Institute in Big Sur California in 1965,5 where the Grofs would eventually live and develop their work, following the prohibition of psychedelics and the shutdown of research with these compounds. Campbell's Hero with a Thousand Faces posited that the universal narrative structure of myths, fairytales, and stories was composed of twelve stages that could be broken down into three Acts (which he took from van Gennep's typology): departure, initiation, and return. Liminality (van Gennep's second phase) must necessarily come to an end, as it is a state of such intensity that it cannot be sustained without consequences for the psychic stability of the person. Given the widespread understanding in traditional contexts of the potency of psychedelic-induced states of liminality, ritual prescriptions, from dietary to behavioral ones, are put in place to demarcate the stages of the process and provide structure.
Whether we listen with aloof amusement to the dreamlike mumbo jumbo of some red-eyed witch doctor of the Congo, or read with cultivated rapture thin translations from the sonnets of the mystic Lao-tse; now and again crack the hard nutshell of an argument of Aquinas, or catch suddenly the shining meaning of a bizarre Eskimo fairy tale: it will always be the one, shape-shifting yet marvelously constant story that we find, together with a challengingly persistent suggestion of more remaining to be experienced than will ever be known or told. (Campbell, 2008)
What, we wonder, would theories of psychedelic integration look like if the core theme of Campbell's ‘Monomyth” had been that meaningful transformation is an inherently collective process? In the following section we turn from integration at the level of the bounded individual to the question of the integration of the individual within the social order.
Beyond individual integration
The emphasis on “integration” in the field of psychedelic medicine is intimately tied to enabling individuals that have had peak experiences to derive meaning and insight from this experience in view of improving their quality of life or overcoming mental health distress. In this sense, the focus is very much on the dynamic between the individual and their psyche. While this is important, this framing obscures the way in which mental distress has deep relational and interpersonal aspects. In our work, we encounter many discussions concerning the capacity of psychedelic interventions to deliver “healing” when the societal and environmental conditions in which individuals find themselves remain unchanged.6
Given the complex interplay between inner and outer worlds, so to speak, the “return” stage of the process encapsulated in practices of integration requires tremendous care, spaciousness, and support. Failing this, the intervention runs the risk of leaving people who have undergone deep immersions into the dark nights of their soul with insufficient care and support to bring about the renewal in their life necessary to make the psychedelic-assisted therapeutic intervention meaningful.
This presents a particular challenge given that health professionals delivering interventions such as psychedelic-assisted therapies have little to no leverage over the patient's living conditions. This problem is in no way specific to psychedelics but pertains to a broader set of questions in public health concerning the relative place of curative and salutogenic approaches (Alexander, 2010; Eriksson & Lindström, 2008; Parkin, 2016). There is considerable literature that examines the relationship between “social integration” and mental health from a wide variety of perspectives (Baumgartner & Susser, 2013; Berkman, Glass, Brissette, & Seeman, 2000). Interestingly, the genealogy of the concept of integration in this body of work is markedly different from the one we have just outlined. Much of this work emphasizes social integration as a key outcome for mental health services, where the absence of integration is internment, recognizing that wellbeing depends on existing in supportive social environments (Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). In their review of the origin of the notion of social integration in the health sciences, Berkman et al. (2000) trace one genealogy of the term to Durkheim's sociological work on suicide. Social networks and relationships, as they show, by their range, heterogeneity or density, have some of the most powerful impacts on health, both in terms of promoting wellness and through violence and abuse.
Writing from Brazil and France, it seems important to us to note that the notion of “integration” is not free of political charge. In France, intégration is a state policy in the context of highly politicized immigration politics, often seeped in racist practices of coercive assimilation to dominant French values that purport to be universal and are also grounded in a Durkheimian legacy (Barou, 2014). This legacy, which pervades understandings of the social in the fields of epidemiology and health sciences, holds that society draws its cohesion from similarity and unity. In this model, integration is the process of producing a coherent social unity. Likewise, the Brazilian nation state was built on the myth of the “integration” of the so-called three races (White, African, Indigenous) which valued miscegenation while grounding it in highly racialized conceptions that many have analyzed as an explicit biopolitics of whitening (Goldman, 2017).
This raises questions about how practices of integration, as they are offered to clients returning from psychedelic experiences, situate themselves in relation to divergent sociopolitical perspectives on the relationship between individuals and their social context. In a context of increasing natural disasters, climate change (Palinkas & Wong, 2020) and enduring racial and colonial violence (Hardeman, Murphy, Karbeah, & Kozhimannil, 2018; Hartmann, Wendt, Burrage, Pomerville, & Gone, 2019; Paradies et al., 2015) we wonder about the ways in which integration as a practice may become normalized and rendered formulaic as psychedelics are mainstreamed. To what extent will this core aspect of psychedelic-assisted interventions be able to address and hold space for questions about the violence of normative social orders, in particular for non-white, gender non-conforming, or otherwise abled persons?
Psychiatry has a complex relationship to normative social orders. For example, in Protest Psychosis (Metzl, 2011), uncovers the institutional racism of American psychiatry. Providing a shocking genealogy of the ways in which psychiatry pathologized African-American struggles for liberation, Metzl reminds us that understandings of illness and wellness are never free of the political context in which they are defined. For example, in one of psychiatry's darker historical chapters, “runaway slave syndrome”, referred to as drapetomania, prescribed whipping and toe amputation. Later, Metzl shows that during the civil rights movement, men holding Black Panther inspired sentiments were pathologized as schizophrenic.
Noorani (2021) has powerfully argued that the medicalization of psychedelics may lead to the exacerbation of mental health crises by ignoring the systemic and societal issues that foster alienation (on drugs and neoliberal governance see also Degrandpre, 2006; Dumit, 2012; Dumit & Sanabria, 2022; Mamo, Clarke, Fosket, Fishman, & Shim, 2010; Petryna, Kleinman, & Lakoff, 2006). He argues that medicalized psychedelics do not challenge neoliberal imperatives of productivity and individually-focused understandings of wellness. In fact, these approaches may be contributing to the very mental health conditions that patients are seeking relief from. Likewise, in their analysis of the “psychedelic industrial complex”, Plesa and Petranker (2022) note ways in which the psychedelic renaissance has a tendency to “effectively individualize systemic issues […] to personal responsibility,” paralleling “the self-help industry's endorsement of neoliberal values as a solution to the rise in mental health crises by transforming psychological conditions into moral responsibilities.”7 They also note the ways in which the psychedelic industry promotes “neoliberal values, such as marketing psychedelics as enhancers of productivity, creativity, and mood while overlooking the sociopolitical reasons people feel overworked, understimulated, and unhappy with their work.”
Schwarz-Plaschg's (2022) analysis of socio-psychedelic imaginaries, proposes the “biomedicalization imaginary” as one of the ways that psychedelics are articulated as a promissory solution for global mental health disease alleviation. This mainstreaming of psychedelics through targeted, individual-centered solutions “almost magically sidelines economic, political, and other oppressive factors that co-create the mental states identified for treatment within an individualizing biomedical framework.” She argues that the vision carried by North American psychedelic corporations “aims to correct individuals one mind at a time to make them functional rather than trying to change unequal socio-economic structures that led to these conditions in the first place.” The (re)nascent therapeutic model perpetuates a neoliberal ideology that holds the individual responsible for their mental state rather than “addressing causes at the systemic level and providing resources for community healing.” (Schwarz-Plaschg, 2022).8 In fact, as we argue below, the imposition of such models can work against the very existence of community-based interventions.
Formulaic integration instructions run the risk of further bolstering what Rose referred to as the “psychology of the individual,” that is a series of techniques that aim to conceptualize, regulate, and improve the self in a never ending “will to health” (Rose, 2006), through which self-making becomes the privileged site of experiments with subjectivity, a process Novas and Rose termed ‘somatic individuality’ (Novas & Rose, 2000). In this sense, we are not suggesting that integration is necessarily individualizing; rather, it may be that the historical context of integration in psychedelic science and transpersonal psychology, combined with the “magic bullet” logic of psychedelic efficacy, has the potential to limit therapeutic modalities' ability to challenge and transform the prevailing individualistic focus within biomedicine.
Commodifying integration
The field of psychedelic medicine is at a critical juncture, with forecasts predicting a market value of $5.7 billion by 2027.9 As we approach this massive scale-up, concerns are growing regarding the quality of care that will inevitably be compromised as markedly less trained and experienced practitioners take on the task of accompanying patients and helping them integrate their experiences through increasingly commodified and standardised interactions. Investors and CEOs of psychedelic pharmaceutical companies are focusing on broadening “access” to these therapies, somewhat cynically framing human hours of care as the main impediment. Consequently, digital health alternatives, such as mobile phone apps, are being actively promoted as viable alternatives for patients to access therapy, including integration services. “Remote monitoring, digital integration, and counseling will make psychedelic treatments available” Introspect CEO David Keene announces on psychedelic start up atai's webpage. “By integrating a digital strategy from the very beginning of chemical development Introspect is creating tightly integrated Digital Therapeutics on a shared architecture across all of atai's platforms.”10 Dubbed precision psychiatry or digital aftercare, these apps are set to radically transform psychedelic-assisted therapies in ways that bring algorithmic logics to bear on the window of neuroplasticity that psychedelics open.
One estimate held that psychedelic-assisted treatment protocols cost a total of $7,543 per patient, of which 91.2% amounted to specialized therapists' compensation (Marseille, Kahn, Yazar-Klosinski, & Doblin, 2020). Increasingly, we have been hearing investors and CEOs of psychedelic pharmaceutical companies pick up the bastion of broadening “access” in a context where human hours of care are construed as the main impediment to the rollout of these therapies. In these circumstances, digital health alternatives are pitched as cost-reduction strategies, delegating therapeutic support (including but not limited to integration services) to mobile phone applications.11 Calling attention to the way the infrastructures of “digital psychedelia” rely on algorithms – which are profit oriented – Noorani (2021) raises an important series of concerns about the potential future costs (in terms of civil liberties) of buying into these totalizing surveillance devices, which are often disproportionately hyperbolic in their promissory emphasis (Sanabria, 2021). Hagerty and Garofalo (2021) argue that there is an urgent need to examine the assumptions about minds, behaviors, and social relationships that work to shape subjectivities, material realities, and imaginable futures encoded in digital technology systems as they begin to pervade mental health: “these Eurocentric theories of the human are largely drawn from experimental psychology and freely mixed with Silicon Valley notions of human optimization and venture capital logics.”
There are parallels to draw between the institutionalization in the UK's National Health System (NHS) of the Improving Access to Psychological Therapies (IAPT) program, which purported to broaden access to therapy, and the massification of integration coaching services. The IAPT program was heralded as diminishing reliance on psychotropic drugs in addressing mental health suffering. However, evaluations of the program have been mixed (Jackson & Rizq, 2019). This one-size-fits-all model of mental health care delivery has been critiqued for being organizationally and clinically top-down, leading to the shutting down of local services, or their conversion into short-term efficiency-driven regimes of accounting. There are many lessons to learn from this. The prime lesson is perhaps this program's excessive emphasis on the individual's responsibility for mental health, at the expense of addressing the socio-economic context underlying mental health issues.
The gringo approach that is dominating now is standardize everything: do a weekend training in this or that and then sell your services, set up an Instagram account and boom, you’re giving medicine out. We’re talking people with very little experience giving medicines out, with minimal prep and at best one follow up integration session, on the phone or Zoom. Because time is money. And the magic of this work is deep availability at all times of day or night to support the person after their journey. Integration is not a checklist. You need to walk your talk. It’s not just conceptually derived recommendations. It requires you as a facilitator to have waded through the darkness in your soul and found a path back to yourself. Otherwise, how will you be credible to the person you are guiding? How could they ever trust your capacity to guide?
In the face of a commodified and formulaic approach to integration, there is a need to reclaim the potential of psychedelic therapies to promote collective healing and challenge the oppressive structures that contribute to mental health issues. This requires a reevaluation of the values and goals driving the field and a commitment to prioritizing equity, justice, and community well-being over profit maximization.
To ensure that the transformative potential of psychedelic therapies is not lost in the process of commodification the field of psychedelic medicine should prioritize research and interventions that acknowledge the interconnectedness of individuals and their social contexts, recognize the importance of community-based approaches, and address the systemic issues that underlie mental health disparities.
Conclusion
As psychedelic research and therapies expand across the globe, incorporating relational frameworks from the Global South brings a much-needed corrective to practices that are at times excessively rooted in individual-centered approaches. In many non-Western traditions, psychedelics are deeply tied to community-based ritual practices, challenging individualistic narratives influenced by models such as Campbell's “Hero's journey,” which focuses on individual self-mastery. We have suggested ways in which Campbell's model has influenced Western approaches to psychedelics, overshadowing the communal dimensions of healing central to many Global South traditions, where the psychedelic experience unfolds as a shared journey within collective support networks.
We examined the increasingly individualized and commodified approaches to psychedelic integration prevalent in the Global North, which risk disconnecting integration from its socially embedded transformative potential. Integration, understood more broadly, is not a set of techniques but a collective, context-sensitive process that emphasizes the social and relational aspects of healing. By moving beyond a narrow focus on personal agency and self-reflection, we propose a model that includes diverse knowledge systems, cultural traditions, and interdisciplinary insights, addressing the interconnectedness of individuals and their social worlds.
In fostering community-oriented approaches that honor cultural specificity and support systemic change, psychedelic-assisted therapies can evolve toward a more inclusive vision of integration. This vision means not only aiding individuals but also addressing the societal, economic, and environmental conditions underlying mental health struggles. Cross-cultural dialogue and collaboration can support the development of frameworks that respects the multiplicity of psychedelic practices.
Funding sources
This research was in part made possible by generous support from the ERC Grant n°757589 “Healing Encounters: reinventing an indigenous medicine in the clinic and beyond” based at CERMES3 (CNRS, EHESS & Université de Paris Cité) for which Emilia Sanabria was Principal Investigator.
Conflict of interest
Tófoli and Sanabria are both employed in public research institutions and declare an explicit interest in public health as a common good.
Acknowledgement
We are grateful to Pietro Benedito, Isabel de Rose, Silvia Mesturini and Piera Talin as well as to the participants of the Brazilian Psychedelic Association Network of Therapists for Integration (Terapeutas em Rede pela Integração Psicodélica da Associação Psicodélica do Brasil - TRIP-APB) for incredibly helpful feedback on previous versions of this article.
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The best examples of formulaic integration services are the myriad ‘tripping’ apps that are now available, such as Field Trip or ‘Mind Leap Psychedelic Wellness’.
For example, in Winnicott's work, the notion of integration is core to the developmental process of establishing the line between “me and the not-me”. Integration is “an ineluctable movement toward something that does not exist; it is a feeling of independence alongside a capacity for cross-identification that enables the simultaneous acknowledgement of interdependency” (McIvor, 2017, p. 216).
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https://www.esalen.org/memorial/christina-grof (accessed 18/02/2025).
https://www.esalen.org/memorial/joseph-campbell (accessed 18/02/2025).
For example, while psychedelic therapies have been shown to have some promise in supporting people struggling with substance dependency, these interventions are less likely to be successful if the person remains in a social environment conducive to problem substance use. Likewise, treating persons for disorders which have their origin in toxic environments without providing these people with solutions to exit said toxic environment is widely recognized to be insufficient.
Online first version, no page numbers.
Online first version, no page numbers.
https://atai.life/programs/introspect/ (accessed 18/02/2025).
For example, Ronan Levy, Field Trip's Executive Chairman, recently explained: “So we decided to take the custom developed [sic.] protocols that we were building for our Field Trip Health centers and make them available to a much broader audience. While Trip is not intended to be a substitute for properly supervised medical and psychological care, it leverages our best-in-class tools, and makes them available to anyone who may be working with consciousness-expanding practices.” https://www.prnewswire.com/news-releases/field-trip-psychedelics-inc-introduces-trip-a-mobile-app-designed-to-expand-your-mind-301122785.html (accessed 18/02/2025)
