During the final panel with all the speakers at the Queering Psychedelics conference held in June of this year, a participant asked why we use the term medicine to refer to the substances (i.e. plant medicine) and not to the practices associated with their use.

I think it’s an excellent question and one worth exploring because it says a lot about the differences between the approach being taken in the current “psychedelic renaissance” and traditional plant medicine work.

Medicine has two very different meanings when it comes to psychedelics. One meaning is based in the traditional western model of allopathic medical practice. In this biomedical definition of medicine, psychedelics are no more than pharmaceutical agents. They are molecular compounds that when ingested have specific pharmokinetic effects that lead to changes in neurochemistry that lead to medicinal benefits such as enhanced mood, reduced anxiety, increased sense of wellbeing. The understanding here is based in neurobiology and neurochemistry. The manner in which it is administered matters only for the purposes of safety.

From this point of view, psychedelics are no different than SSRIs or any other class of medications that operate on serotonin receptors other than that they have these pesky “side-effects” such as visual hallucinations, cognitive distortions and other terms that medical research uses to describe the subjective effects of psychedelics.

Plant Medicine alludes to something very very different. The term plant medicine when applied to substances such as psilocybin mushrooms, ayahuasca, and peyote is derived from the indigenous traditions and healing practices from which their modern use originates.

Medicine here refers to the healing and beneficial effects of the material substance itself but also the beneficial spirits of the plants and the power they hold, as well as the practices for working with both the substances and the spirits in a healing or beneficial way.

Each of the indigenous traditions that use plant medicines have a history of using them for healing purposes. They have their own indigenous words to describe this but due to the impact of Spanish colonization of the Americas these many different indigenous cultures learned the Spanish word “medicina” to describe both the material itself and the practices. From some indigenous points of view, these plants are medicines and they are part of a rich medicinal tradition of indigenous healers/doctors.

Psychedelic-Assisted psychotherapies occupy a space somewhere between these two understandings. On one hand, in the FDA-approved therapy models being researched, the psychedelic substance used is treated as as a bio-molecular compound completely disconnected from its traditional uses and traditional practices. Here the plant has been discarded completely and the synthetic version of what is considered in the biomedical model to be the “active ingredient” is administered (eg psilocybin).

However, the therapeutic framework used in these trials draws from historical research on psychedelics which have certainly been influenced by indigenous practices and some may argue are fundamentally based in them. One cannot even say this is purely a biomedical model. After all, there is a therapeutic container, there is music being played and there are facilitators available to guide the client, all elements that can be found in traditional “medicine” practices.

Additionally, we also have a very diverse array of underground psychedelic therapy models some of which draw directly from indigenous lineages to greater or lesser degrees. There may even be overtly spiritual themes as part of the facilitation of the experience and some resemble what would traditionally be called a ceremony.

My personal understanding comes from the traditional ayahuasca practices I learned during my apprenticeship as an ayahuasquero in the Peruvian Amazon. I learned from a mestizo medicine man from the Ucayali river region in the northern Peruvian Amazon. His tradition, taught to him by his grandparents, sees ayahuasca as a medicine and the practice of working with ayahuasca for healing as a medicine path. Both the medicine and the path are inseparable from Spirit, a word you will not hear used in the biomedical model.

Ayahuasca is seen as a spirit (or spirits more accurately) and the practices of working with ayahuasca are fundamentally about connecting with healing spirits and medicine spirits for the purpose of addressing the complaint of the client. All the practices, from the way the cook is prepared, to how dosing is determined, to how the ceremony is guided, to how the individual healings are conducted are based in spirit medicine. From this perspective, plant medicine is fundamentally plant spirit medicine. My understanding of Mazatec practiced with psilocybin mushrooms and the Wixáritari practices with Peyote are also fundamentally spirit-based.

So the fundamental different between “medicine” from the pharmaceutical medical model and traditional indigenous models is that of spirit. One has spirit. One does not.