Christopher Tolkien, referring to his father, defined what J.R.R. called his ‘secondary world.’ He said ‘it is a world that cannot be seen, it cannot be found, it exists only in the mind.’[i] He goes on to say for many people when they first realise the existence of this place, this secondary world, they find the experience to be a very delightful thing.
This desire for a secondary world, if not perhaps intrinsic to every individual, is intrinsic to humankind. That is to say this relationship with the secondary world goes back to ornate prehistoric burial sites. It is ghosts and banshees; it is gods and elves. It is found in the art of Blake and the science of dreams. The Hellenic culture, among the most advanced societies of the ancient world, created a secondary world on top of an actual mountain, which they then honoured and worshipped. The volcanoes, the rivers, the sky, the sea, the wine, each aspect of the tangible world endowed with its own God, its own secondary being. Consequently, belief in this secondary world manufactured the temples. This poses the question: what would the world be like if no one ever had conceived of a secondary world? We can say if this were the case there never would have been the burning of a witch, and certainly no heavens and hells beyond. Is our world, our universe even, not sufficient at times for our complicated brains? Newton was an alchemist, and Einstein sourced many of his breakthroughs from his imagination, which suggests a scientist of pure reason can also be subject to fantasy.
Did the secondary world begin with the people who sat around the first fires? Jung thought so, but in reality we can’t know – we would have to ask them, or at least study their behaviour to know for certain. As with all history where there is no evidence at all, there is only the sound of the wind. Where there is scant evidence, we are obliged to speculate and theorise. In this spirit of conjecture, I would suggest the secondary world is a form of reality. It would be useful to make a distinction at this point between what can be solely attributed to the imagination, and neurological shifts that can occur under the influence of drugs and hallucinogens in particular. The world of the imagination, where William Blake should be interpreted, does not in of itself need intoxicants. It is its own entity. This leads to another question: is what is imagined in the mind real, or is it unverifiable? When does the imaginary become reality? If I imagine a story and then write it down, I have worked to bring the imaginary into the world of reality. But what if I just keep it in my mind? Does this mean it wouldn’t be real? What is real in one person’s mind that cannot be detected by others, is of course often interpreted as madness.
To William Blake, the secondary world could be thought of as the real first world, that is the world perceived through the senses, because he perceived the secondary world with his senses. When he was a boy, he witnessed the spirit of his brother Robert rise out of his dead body at their house in Soho and stated categorically the apparition was clapping for joy. He watched angels illuminating the boughs at Peckham Rye. Did Blake have a condition akin to synaesthesia? What modern medical prognosis can we make? Perhaps the most scientific explanation would be that to some people the secondary world is reality itself. We can however say with absolute certainty that Blake would have dismissed any scientific analysis of the imagination. Reason cannot bound the imagination.
Is there a relationship between the unconscious and the imagination in association with the secondary world? According to the basics of psychoanalysis, the unconscious mind is always unconscious, but it can be perceived through dreams. Is there a connection between Freud and Jung through Blake’s oeuvre? Not conspicuously. Blake, or indeed any artist, should not be attempted to be understood through the lens of science. It would be like turning Beethoven’s 5th Piano Concerto into a formula. It strikes me that no one has ever even attempted to turn the source of art into an equation for good reason.
Tolkien’s secondary world lives within our imagination. Perhaps his greatest gift was the extraordinary way he was able to make this secondary world so believable for so many. Remember, there is moon and starlight, as well as cheese and salted pork and tobacco and pipes, in the imaginary world he invented. In this instance the primary world has been superimposed on the secondary world, or the other way around.
In medieval England there was the ‘land of Cockaigne’ an imaginary land of plenty. According to one source ‘Cockaigne was a ‘medieval peasant’s dream, offering relief from backbreaking labour and the daily struggle for meagre food.’[ii] This may provide an insight into the function of the secondary world. Necessary escapism. Or as Tolkien put it, escapism in it’s true meaning, ‘as of a man getting out of prison.’ This also may provide an answer as to why the desire for the secondary world is not universal, simply because there are many among us who do not wish to escape the primary world. They are more than happy where they are, but this is not to say those who seek the secondary world are somehow inherently unhappy. It can be invoked simply for the joy of the thing, like a magic trick. Think of Alice in Wonderland, or A Midsummer Night’s Dream. This brings up the subject of our agency through our imaginations and the effect this has upon the world itself and ourselves. Scrying, palm reading, divination, horoscopes and so on. These are attempts to impose our own agency into the supernatural world that evidentially doesn’t exist. The secondary world is distinct from hocus pocus and bogus truth claims, but its claim to existence does, however, hinge on the power of the imagination.
William Burroughs, Timothy Leary, Richard Alpert, Terence McKenna and memorably Aldous Huxley experimented with Ayahuasca, all giving vivid accounts of a world that hides behind a veil. This other plain, or higher state of consciousness is not what Tolkien meant by the secondary world. The secondary world is not drug-induced. It is a state that can be accessed by all people. It is the sober world of the imagination, of fantasy, that being the secondary world in our senses, in the reality we have evolved.
It is a mistake to compartmentalise the secondary world solely into the world of fantasy but that the secondary world is a function of fiction is valid. In other words, if it is based on real events, it is biographical. As mentioned, Einstein’s major breakthroughs in science were sourced from his imagination and this is also partly true of Newton. But when Einstein imagined the movements of space time as he looked at the church clock from the window of a tram, had he entered the secondary world, or was he simply using his imagination? Perhaps we can deem the secondary world as a desire for fiction and escapism rather than fact and truth, but fiction is perhaps the best way we have to understand truth. And here lies the riddle.
Arguably, the imagination has an evolutionary function. To imagine a possible attack by wolves or bears out in the forest was likely extremely useful. It may in fact be the reason we dominate the animal kingdom. Our imaginations work in tandem wit reason in the battle for survival. It is the duality and relationship between imagination and reason which must be explored when trying to understand the secondary world, which, once discovered, remains a very delightful thing.
Featured Image: ‘Beatrice’ by William Blake from Illustrations to Dante – The Divine Comedy (1824).
[i] JRR Tolkien – A study of the maker of Middle Earth
I spent twenty years working as an adventure sports guide. In my early twenties, I was a whitewater guide on rivers like the Zambezi and White Nile in Africa. In my thirties I worked as a mountain leader, guiding trekking expeditions to Kilimanjaro, Everest base camp, the Andes and the Himalayas. While it may seem that those working in such fields may be risk-takers, and it may have been true about me in my early twenties, the reality is adventure sports guides are constantly assessing risk, and are in some ways hyper-attuned to risk.
For the past six years, as a psychotherapist and co-founder ofInwardbound psilocybin retreats in the Netherlands, almost a thousand people have come through our retreat processes. This article explores my perspective on risk from these differing viewpoints. While it may seem that these are very different worlds, I believe there are a lot of similarities between managing risk in adventure sports and in psychedelic assisted therapy.
My own personal story is one of outward bound to inward bound- at the age of about thirty due to a series life crises (heartbreak, injuries and tragedies I witnessed in the outdoors) I began to look at more inward self-reflective practises such as meditation, yoga and therapy, which slowly and over time, led me to the work I am doing now, not in a planned way, but through the path of my own lived experience.
As my time working as an outdoor guide was coming to an end, I began to be much more interested in adventure therapy than adventure sports. ‘Being in nature’ rather than ‘doing in nature’. This period coincided with my training as a psychotherapist and moving towards psychedelic assisted therapy.
Since I was a child, there is something in me that was drawn to exploring the boundaries of my known world, and to going first, more by accident than design, whether that was the first descent of a whitewater river in Iran, or setting up Ireland’s first psychedelic therapy organization. Why that is, I am not sure, but it is in my nature, and I enjoy helping others explore their own personal limitations too and to grow beyond the boundaries of their known world. I do this work with psychedelics motivated by a belief, from my own lived experience and from what I have witnessed, that this work has the potential to relieve human suffering and improve people’s lives.
On the Nature of Risk
Life is inherently risky. We make decisions every day to take risks, and few would like to live in a zero risk world. Often, the most significant and rewarding achievements in our lives involve a degree of risk – whether falling in love or starting a business. But today we live in a very risk averse society. In other societies and cultures, through necessity, a higher degree of risk can be seen as acceptable.
Scouting a rapid on the Blue Nile, Ethiopian highlands 2004.
It is also true to say that as adventure sports guides or as psychedelic assisted therapists, we have an ethical duty of care to our clients. And so we also must protect ourselves and our clients, especially people who are vulnerable, from taking on too much risk.
Psychedelic-assisted therapy is inherently risky.
There are certain risks with psychedelic assisted therapy that do not come, or are greatly lessened, in other forms of therapy. These risks include the risk of psychosis or spiritual emergency (kundalini awakening), Hallucination-Persistent Perception Disorder, headaches, nausea, anxiety, dissociation, having a disappointing or underwhelming trip, the increase levels of transference and projection, ontological shock, the altering of metaphysical beliefs or spiritual beliefs, and the risk of being traumatized by a very challenging psychedelic experience. The more serious risks listed here are rare, but they do exist.
Psychedelic-assisted therapy also has the potential to be, perhaps, more rewarding and beneficial than other forms of therapy. Therefore, we need to create a model of access that minimizes risks and maximizes benefits. We also need to take a critical attitude to what Timmy Davis of Psilocybin Access Rights calls “a hypertrophied risk aversion”.
We witness this frequently on our retreats, where sometimes people have emotional breakthroughs and process traumas that have been unprocessed for years or decades, processing the ‘frozen present ’of trauma as Dr Ivor Browne called it. We often see incredible transformations on our retreats. Physical transformations- literally people looking different afterwards, like a heavy weight had been lifted off them. The stories of transformation and rebirth and redemption. The deep, real, authentic gratitude. Giving voice to those whose voice had been lost or forgotten. An inner change from ” a sense of hopelessness to a sense of hope”, as one of our clients put it on a recent integration call.
The question, then, is how best to balance the risk/ reward ratio? If psychedelic assisted has potentially life-changing therapeutic benefits, what level of risk is ethically tolerable?
We need, as a field, to accept the reality of these risks, not deny them or hide them, and to learn how best to mitigate them.
There is sometimes a tendency in the ‘psychedelic renaissance’ for proponents of psychedelic assisted therapy to be messianical. It would be more prudent for us to acknowledge and accept the reality of these risks and take steps to mitigate them. We need, as a field, to be more open about talking about adverse experiences. Our job as those working in the field is to define, acknowledge, communicate and mitigate risks as best we can.
The difference between risk and consequences
Researchers such as Professor David Nutt have demonstrated that psilocybin, for example, has a very low harm score compared to other drugs. While the risks involved in working therapeutically with psychedelics may be low, the consequences may, on rare occasions, be high. It is important to distinguish between the likelihood or probability of a risk occurring, and the consequence or severity of that risk, which may be minor or major.
Blue Nile, 2004
In adventure sports environments, risk assessments fall within several broad categories, known as the risk likelihood/ severity matrix. This framework may be helpful for the field of psychedelic assisted therapy when thinking about risk. It is also important to consider potential benefits when talking about risk, and to consider the difference between perceived risk, and actual risk. There is also a clear distinction in risk assessment when making personal decisions, and when leading a group in the outdoors.
Risk Likelihood/Severity Matrix
a) The first category is low risk likelihood and low consequences. We could say micro-dosing falls into this category. Teaching novices in an adventure sports environment should fall into this category. In terms of the difference between perceived risk and actual risk, sometimes beginners learning a sport may perceive a high level of risk in a situation where the actual risk is extremely low, learning to climb on an indoor climbing wall, for example. Likewise in psychedelic assisted therapy, sometimes participants can present with increased levels of perceived risk, fear of the unknown. Managing people’s fears, anxieties and expectations is a vital part of guiding in the outdoors, as it is in psychedelic assisted therapy.
b) The second category is low risk and medium or high consequence. I would put most psychedelic assisted therapy, when done in a carefully controlled set and setting, in this category. Guiding a group on Kilimanjaro would fit into this category. Statistically, Kilimanjaro is a very safe mountain for an almost 6000m peak, but, on rare occasions, the consequences can be high (heart attack or high altitude pulmonary or cerebral edema, which can be fatal).
Kilimanjaro, 2018.
c) The third category is high risk likelihood and low consequence. For example, climbing a challenging bouldering problem where the likelihood of falling is very high, but the consequences, falling a few meters on a protective bouldering mat, very low, at most causing a sprained ankle.
c) And the fourth category is high risk likelihood, high consequence. This last category is usually reserved for people at the peak of their ability taking personal responsibility for their decisions who want to challenge their limits. This last category is unsuitable when guiding a group in an adventure sports environment, unless guiding at a very high end, such as guiding an expedition to K2, and would be unsuitable for psychedelic assisted therapy.
A version of the risk likelihood/severity matrix.
On the importance of screening
Careful screening can lessen the likelihood of certain risks occurring. Screening and preparation was also very important in adventure sports, especially when guiding treks to remote high altitude locations, making sure people had the required level of fitness and no major health contraindications. On our psilocybin retreats we have recently been turning away approximately 60% of applicants. While this is necessary and makes sense from a risk management perspective, it is challenging from a business perspective, and also leaves a significant group of people in need of help without a therapeutic pathway. But we do this to reduce the possibility for ourselves, and our clients, from taking on things that we or they cannot handle.
We work with what we call the ‘walking wounded’, the average human being with their hopes and fears and traumas, not with people in deep psychological distress or who are very unwell. Such individuals may be better off served in a medical model with more specialized care. It is also important for us to be aware of our limitations.
However, careful screening is not foolproof, as sometimes clients do not disclose, or perhaps are unaware of, or are in denial about, relevant psychological or medical issues. People sometimes can lie, even to themselves, especially if they are in deep need of help.
Sometimes participants present on a retreat in a very different psychological mindset they presented with during screening and preparation. We have found other factors than the usual contraindications to be relevant, such as presenting with an overwhelmed nervous system or in the midst of a major life crisis.
One of the challenges of working with psychedelics is dealing with the unknowns of the unconscious. By definition, we do not know the contents of our unconscious mind. Despite careful preparation, sometimes people have experiences that they did not expect or were unprepared for.
It may be that certain substances such as 5 meo DMT or iboga have higher risk profiles than, say, psilocybin. It may also be that certain substances have greater potential benefits for high risk cohorts of people, such as iboga/ibogaine for severe addiction, and ketamine for suicidality, which means the risk-benefit equation is different for those substances.
I believe that the risk of being traumatized by a challenging psychedelic experience can be mitigated by skillful and dedicated integration. I have found that helping people find meaning in their suffering can change what was previously seen as a very negative experience into a positive therapeutic one. One senior therapist in the US told me that he believed almost anything could be held therapeutically, depending on the capacity of the therapeutic team and the strength of the therapeutic container. While this may be true, it does not take into account just how challenging it can be to hold very difficult therapeutic processes for the therapists and participants involved.
Informed consent
One part of managing risk is making sure clients are aware of, and give their consent to taking on, the risks involved. One challenge is that it is difficult to fully communicate the changes that may occur as a result of a psychedelic experience to those who have never had a psychedelic experience. Perhaps some form of standardized consent procedure could be worth developing.
We also need to acknowledge that sometimes there will be consequences as a result of those risks, and come up with ways of dealing with those consequences.
As a field, we need to accept that despite careful screening and preparation, on occasion things may go wrong. The parallels with adventure sport are prescient. In the outdoors, despite careful management of risks, occasionally things go wrong. Over a 20 year period of working as an outdoor guide, especially in the dynamic environment of whitewater rivers, I saw a lot of things go wrong directly and indirectly. This naturally leads to increased risk aversion over time.
Azores, 2011
This can perhaps be best illustrated by the following story. I am not a very experienced offshore sailor, but on one occasion, I crewed a catamaran sailing from the Azores to the UK. Halfway across the passage, 1000 km offshore, we hit some heavy weather. I noticed that the skipper, an incredibly experienced sailor who had circumnavigated the globe several times, including the Cape of Good Hope, was nervous, more nervous than I was as a novice sailor. When I asked him about it he told me that on his first transatlantic crossing, as a relatively novice skipper, he had felt no such fear. I understood why. From his vast experience, he had become more aware of what could go wrong than I was as a relative novice.
Overtime, you become more aware from lived experience of what can go wrong and the possible consequences. Things do not always go as planned. Often accidents in the outdoors occur, not in high risk situations when people are pushing their limits and very focused, but often in situations where the likelihood of a risk occurring was not particularly high. When you witness and have to deal with the consequences of serious accidents in the outdoors, it changes something in you.
Northern Norway, 2006.
Consequences I have witnessed in low risk situations
On two occasions I have witnessed people having experiences that could be described as spiritual emergencies which can look very similar to psychosis. Neither case involved a high dose psychedelic experience. One case occurred after a vipassana meditation retreat on Maui. No psychedelics were involved, but other powerful practices, such as kundalini yoga, were. The second case involved a low dose of psilocybin, not at one of our retreats, but at an indigenous style ceremony.
In both cases, although the behavior involved was quite bizarre at times (such as talking to trees and persistent shaking and twitching over several days) these people could be held in a supportive and loving environment in nature for several days which was enough to ground them and bring them back to consensus reality. Sometimes people need more time to come back from ‘between the worlds’ after powerful psychedelic experiences.
My own experience
In my own lived experience, I recall having persistent hallucinations, double vision, dizziness and vertigo for a week after a Bwiti iboga initiation. The experience was one of the most transformative therapeutic experiences of my life, processing layers of shame I never thought possible. Even at the time, I understood the difficulties were a part of the process. Sometimes the most rewarding things in life are not easy. That said, I was very glad when my eyesight and balance returned to normal!
It is also important to recognize that these risks are ones we all face, whether in a clinical trial, a legal retreat setting or an indigenous ceremonial setting. The fact of the matter is that any of us working in this field face these same risks. Some of the most difficult and dangerous adverse reactions I have heard about occurred at ayahuasca retreat centers in Peru.
My point is that extended difficulties after a psychedelic experience could equally easily occur on a clinical trial at Johns Hopkins, Imperial College London, at a legal psychedelic retreat setting, an underground ceremony, or an indigenous ceremonial setting in the Amazon. The sooner we collectively acknowledge these risks and potential consequences, and are able to talk about them openly without shame or fear of judgment, the better. Otherwise, a culture of secrecy, shame, blame and judgment could emerge. What is not in the light, will be in the shadows, as it were. We need to create a culture of self reflection, acknowledging that we can all make mistakes. We need, as a field, to be more open about talking about adverse experiences.
On the power of belief and focus
When running a large whitewater rapid, we would spend as much time as necessary looking at the line and the risks involved, all of the consequences and potential worst case scenarios. Then a careful assessment would be made, based on all relevant factors including river water level, skill level, the team and the safety set up involved, on whether to run the rapid, or not.
Scouting a rapid, Northern Norway, 2006.
But, and this is the important part, once a decision has been made to run a whitewater rapid, that decision was taken in full commitment, focussing fully in confidence on the desired outcome, with no focus on the worst case scenario. In other words, completely focusing on where you want to go, not where you do not want to go. Focusing on what can go wrong when running a whitewater rapid is an almost certain way to ensure a negative outcome.
Below Victoria Falls, Zambezi, 2018.
Perhaps this mindset has some parallels with psychedelic assisted therapy. In the early stages of screening and preparation it is important to address, communicate and acknowledge the risks involved, assessing if it is the right course of action for an individual to embark on.
Once a decision has been made, in consultation with the participant, that the therapeutic process is suitable for the individual involved, then it is important to move forward with as little doubt as possible, creating the right mindset for a positive outcome. At a recent conference in the Netherlands, “Unveiling the mind: Convergence of Hypnotic and Psychedelic realities”, many speakers emphasized the power of suggestion and belief.
For this reason, it is important to prime the participants mindset carefully, creating an atmosphere conducive to a positive therapeutic outcome. This can include preparing them in advance for difficult feelings to arise, and emphasizing the normality and purpose of these feelings. Acknowledging that while the process may be challenging, there is a reason for undertaking it. In my experience, once a meaning can be found in suffering, it can allow even the most challenging psychedelic experience to be seen from a positive therapeutic perspective. I often tell my clients that I don’t do this work because I enjoy watching people suffer, but because a light can be found at the end of the tunnel. Sometimes the most challenging psychedelic experience can be the most therapeutic ones.
It is also important to be mindful that the pressure of making the right decisions can be a heavy responsibility for those working in the field, so creating multidisciplinary spaces for open discussion and supervision is essential. I am sure I am not the only person in the field who feels this, very deeply at times.This is not something I hear talked about too often, just how challenging this work can be for the therapists involved.
To conclude, as a field we need to acknowledge the risks and consequences of psychedelic assisted therapy, to agree on how best to communicate, address and mitigate them, to consider what levels of risk are ethically acceptable, to address how to manage consequences, and to consider the possibility of standardized screening and informed consent procedures. In this, we can learn lessons from other fields such as adventure sports.
Feature Image: An Ethiopian woman crossing a class 6 rapid on the Blue Nile with a new-born baby wrapped in her shawl. A fall here would have meant certain death for both of them.
