Music is the medicine

How music can rescue or ruin a psychedelic experience

East Forest, a musician whose album is part of a new psilocybin study

This article is written by Riordan Holly Regan and edited by Jules Evans. To explore Holly’s research on this topic further and read the upcoming second part of this article, check out their Substack.

In December 2023, I fell off my bicycle and broke my pelvis in five places. As it happened in my native United States, where I had no health insurance, I was required to take my healing into my own hands, using a range of alternative medicines, including psilocybin. One particular trip was terrifying: I descended into an underworld cavern where it was clear I would be trapped in eternal mycelial limbo. 

I started to panic. But that’s when a harmonica stretched a synesthetic arm through the blackness and lifted me out. Suddenly my nervous system remembered what was imprinted the last time I heard this music: that I am alive, held, and safe. I saw the tomb-like caverns transform into a wooded glen where my broken body was laid upon a bed of thick green ferns and wrapped in moss, tended by the creatures of the forest. As long as this music doesn’t stop playing, a voice told me, you will make it through this night. 

I was listening to a ceremony concert from East Forest, an artist who makes music within, for, and inspired by psychedelic journeys. It wasn’t the first time his music brought me back from the brink of existential collapse within the medicine space, and it wouldn’t be the last. This experience inspired me to look deeper into the role of music in healing and psychedelic therapy, and I’m beginning a PhD on the intersection of identity, art, and altered states this autumn.

The centrality of music to Indigenous psychedelic ceremonies 

In nearly every culture with ancient roots, sound and altered states go hand-in-hand with healing, where the plants are just conduits for the real medicine: the music. Among the Australian Aboriginal people, who may have been some of the earliest psilocybin users, the droning didgeridoo can induce trance. Halfway across the world in Gabon, members of the Bwiti tribe say the psychoactive shrub, iboga, taught them how to build the instruments played during healing ceremonies, such as harps, drums, and shakers.

In traditional ceremonies, medicine people play multifaceted roles as musicians, healers, and guides who need to respond and adapt to participants in real time. They adjust songs to peoples’ needs, experiences, and emotional states, which is crucial in a setting as dynamic—and often chaotic—as a psychedelic journey. It’s an art, a science, and a spiritual practice that takes years of training, apprenticeship, and direct experience to understand and navigate.

“Music is absolutely obligated,” says Kike Pinto, a musician, composer, and medicine man who plays and teaches traditional Peruvian music. “Without songs, ceremonies simply can’t be performed.” Throughout the South American Amazon and Andes, sacred plants are used in nighttime healing rituals guided by medicine songs. In ceremonies with huachuma, the San Pedro cactus, “the most important traditional music that still exists” are the tarjos, says Laurel Sugden, PhD candidate and co-founder of Peru-based conservation nonprofit Huachuma Collective. The tarjos include chants, spoken prayers, songs, and often a chungana, or metal maraca, played simultaneously to summon the spirits being asked for help: the cactus as well as local mountains, lakes, animals, temples, and certain Catholic saints.

Among some lineages of the Shipibo people, when working with ayahuasca, the purge-inducing psychedelic brew, medicine workers called curanderos/-as or maestros/-as sing the icaros: “a genre of song used for communicating with the spirits of the plants, spiritual world, and animal helpers,” Pinto says. Medicine music, he says, can reveal the sources of, and treatments for, individual, community, planetary, and even cosmic ailments. They’re used to open and close ceremonies, harmonize divisions and negative energies, and direct spirits—human and otherwise—to places that need healing.

Dr Leor Roseman, senior lecturer and researcher at Exeter University, says shamans were the earliest composers, calling them “musicians who do healing.”

Set, setting, and sound 

If some Indigenous societies have established cultural contexts for psychoactive plant consumption—with established genres of music to accompany the ritual—the situation is starkly different in Eurocentric secular culture. We have no culturally entrenched rituals for psychedelic usage and no passed-down playlist. Instead, psychedelics are consumed in a wide variety of contexts with an equally wide variety of musical accompaniment. 

Everyone has their view on the ‘right’ music to accompany a trip: Aldous Huxley recommended Bach but warned against Beethoven, Verdi, or Gregorian chanting. Ken Kesey preferred the Grateful Dead, whose improvised jams were a crucial part of the 1960s Acid Tests. A psychedelic rave might feature Goa trance or techno, a retreat more likely to feature a New Age hodgepodge. Meanwhile, a psychedelic trial or clinic seems to invariably rely on the legendary Johns Hopkins psychedelic playlist.  

One person’s medicine is another’s poison. Jules once met a person who said their idea of paradise was dropping LSD, putting on headphones and listening to Steely Dan. For others, this would be literal torture. The only thing most people agree on is that music is an essential part of the trip. And yet it is one of the least studied and least discussed aspects of the trip, at least in the last 20 years of the psychedelic “renaissance” in the mainstream Eurocentric world. 

‘I can’t believe more people aren’t talking about [it],’ says East Forest, an artist who makes albums for and inspired by psychedelic journeys. ‘It's the third thing: the medicine; the place and person you're doing it with; and the music.’

An exception to this lack of research is scientist and musician Mendel Kaelen, who has published several articles on the role of music in psychedelic therapy; he calls music ‘the hidden therapist’. 

Kaelen’s team found that resonance with the music was a stronger predictor of positive health outcomes—such as transcendent experiences, personal insight, and reductions in “treatment-resistant” depression one week after the study—than the intensity of the drug (psilocybin) people took. Most found the music brought wonder, awe, comfort, and support, guiding them on a journey that intensified as needed. But others experienced “unwelcome influences,” such as misguidance, dissonance, and a sense of foreboding. In 2021 Kaelen launched WavePaths, a start-up to create music specifically for psychedelic therapy. 

Another musician / scholar exploring the impact of sound and drugs on altered states is researcher Carl H. Smith, associate professor of media in the School of Arts & Creative Industries at the University of East London and director of the Museum of Consciousness (MoC) project, exploring sound and altered states. “Understanding the way music and sound impacts us and other creatures physiologically will shape the way we practice healing, and can shift us to a more holistic worldview,” Smith says. 

There have been few studies comparing the variables of music choice on the psychedelic experience —so far, only this Johns Hopkins study from 2018—but Robin Carhart-Harris is leading a study on the impact of music on nature connectedness under psilocybin, working with East Forest. Carhart-Harris says:

East Forest has created a 6-hour musical album for psilocybin mushroom journeys that we'll use in a forthcoming set and setting study, assessing its role in mediating responses to psychedelics. It's good to hear his sounds have been helpful, most trials could, in a sense, be construed as 'drug-assisted music therapy'. Our forthcoming trial will have one arm where there is no music at all in the session. We're doing this to test our assumptions regarding its role.

Bad vibrations

This sort of research is important because, anecdotally, the Challenging Psychedelic Experience Project hears from people who say music hugely impacted their experience—either positively, as in my case, or negatively, triggering a really bad trip. 

One of the first official complaints to the Oregon Health Authority about the state’s new legal psilocybin programme was actually about the music foisted on the client by the facilitator: 

Some people say they feel the combination of psychedelic and the wrong song actually caused long-term damage to their nervous system. Earlier this year Ecstatic Integration featured the story of Rachel, a veteran who attended an ayahuasca retreat, where her body reacted to the drugs and the sound of a voice singing through an amplifier: 

I was vibrating so badly, I got up to go to the bathroom. I couldn’t even keep my thoughts in my head because it was too painful. I felt like anytime I got close to someone I was vibrating intensely from their energy.

Her body kept on vibrating after the ceremony, for months, causing her intense suffering; the vibrations only stopped when she was prescribed anti-seizure medication. 

And then, back in March, Ecstatic Integration reported on the story of one participant who experienced severe extended difficulties in a Braxia trial of psilocybin for treatment-resistant depression. She had a bad reaction to the drug and the music: in this case, the Johns Hopkins psychedelic playlist. She told EI: 

The music was mostly very disturbing – like, the Lion King, African beating drums, beating in my ear the whole time for close to six hours. I was convulsing and spasming, and the music made it feel 10 times worse

It’s not certain but possibly the track that disturbed was Enya’s ‘Storms in Africa’. This experience led to long-term derangement of her nervous system, and she hasn’t recovered two years on. The story shows the importance of the patient having some choice and control over such an important aspect of the experience.

Sound can be a tool or weapon, and must be wielded carefully—so musicians, researchers, and technologists with experience in this domain are providing resources for the uninitiated. “Music is like a chainsaw,” says Andrea Drury, a composer, music therapist, and musician who performs as ANILAH. “With the proper skill and intention, it can be one of the most transformative tools. In the wrong hands, it’s insanely dangerous.”

Drury has witnessed the damage from “unskilled practitioners using music in dangerous ways” for people who are already vulnerable, giving the example of a group facilitator who chose a death-metal playlist. “It was intended to instigate an emotional response and get people to purge, but a few participants had extreme negative reactions,” she says. “I’m seeing this a lot in facilitators … who aren’t trauma-informed and have little understanding of how the nervous system can be triggered into a heightened sympathetic state. There is no standard of care yet. People need to understand, especially when facilitating at home… that a relaxing sound or frequency for one person could be traumatic for another.” 

There are in fact instances of psychedelic guides intentionally using music to disturb and derange clients. The controversial Mexican psychiatrist Salvador Roquet used loud, jarring music (sometimes accompanied by porn movies) to shock the psychedelic patient and break open their defences. 

We’ve heard of another ‘shaman’ who was fond of pushing both the drug dosage and the sound environment to the limit of what the client could bear. They used to work at a Mexican iboga clinic and one of their colleagues once found them banging their shamanic drum repeatedly and very loudly right next to the client’s head while they were on ibogaine. 

Music, like psychedelics, can be an instrument of torture, used for the intentional destruction of someone’s personality.  

Should people be able to pick their own psychedelic therapy playlists? 

Tony Moss, an artist and producer who makes music for and inspired by plant-medicine work with his band, Bird Tribe, says:  “You’re asking people to quite literally open up their psyche, and if they don’t trust your music choices, they’re not going to do it.”

Given that one person’s musical paradise is another’s sonic hell, should psychedelic therapy clients get to pick their own playlists?  The question provoked an interesting discussion on psychedelic Twitter this week, initiated by investment group Psychedelic Vantage: 

K’ant, a psychedelic therapist, disagreed: 

Curating your pharmaco-musical journey 

In Kaelen’s studies, the more people resonated with the music, the better their health outcomes. But in settings where everyone comes from a different cultural, geographical, and personal background, resonance is highly personal, and it doesn’t necessarily correspond with being comfortable. 

Purpose-built music can bring the ceremony to the person who can’t access, or doesn’t want to, seek a guided journey. “The music I think is best to guide a psychedelic journey is recorded inside a ceremony,” Forest says. “I'm improvising, and it makes me open to the arc of the experience in real time. … The magic happens when you don't have a plan.” His Music for Mushrooms is a five-hour album designed for psilocybin journeys. In: A Soundtrack for the Psychedelic Practitioner, Vol. II is two hours long, created for ketamine but adaptable for any journey.  

Other artists have created music for ketamine, one of the few legal U.S. pathways, but say the music is broadly applicable. Electronic producer Jon Hopkins released the popular Music for Psychedelic Therapy” in 2021. Justin Boreta, formerly of electronic band the Glitch Mob, creates journey music through solo and collaborative projects such as Superposition, Boreta, and Formless; he also offers a Spotify playlist curated and tested within the psychedelic space. 

Artists often collaborate with each other and incorporate talks and meditations from spiritual teachers like Ram Dass and Alan Watts into their songs. They also say we underestimate our own capabilities for musical self-healing. Singing on a psychedelic journey can be healing, Forest says, activating the vagus nerve and vibrating the body: a concert of one. “We gave away our power to make music ourselves [with recorded music]. We said, ‘we'll pay somebody else to do it who's better at it,’” Forest adds. “We need that reconnection as human[s] to what a core element it is to make music, not just experience it.” (Check out this story about Chloe, who used shamanic singing to guide her way through an extended psycho-spiritual crisis triggered by a high dose of psilocybin). 

Because music is so personal, Boreta encourages people to build their own playlists once they’re familiar with a given medicine. He tried the Johns Hopkins playlist on a journey, but found it so unpleasant that he switched to Aphex Twin.  The “mystical formula” for playlists, he says, is “music, medicine, and mindfulness.” 

When assembling a playlist, he says, the arc should include nature sounds or a guided meditation, followed by calm or ambient music; ramping up the tension to reach a peak “with some dissonance to process emotion”; a ramping-down period with less intensity; and ending with familiar, soothing songs that he calls “comfort food.” This corresponds to the typical framework mapped by psychedelic researchers in the '60s and '70s.

In any case, preparation, intention, and integration are vital. That includes creating a supportive set and setting, the environment in which you’re taking the trip—which involves not just sound but lighting, decor, other living things, and physical support. Even just building a relationship with music outside of psychedelics can help, Drury says, “having songs you can put on and immediately remember that feeling of safety.”  

That’s precisely what helped me in my darkest trip. 

• East Forest is the subject of a forthcoming documentary, Music for Mushrooms. Watch the trailer here. 

• Here’s a little podcast Jules made on ecstatic techniques in rock and roll.

• Here’s an interview Jules did with Brian Eno about ecstasy and surrender

• And here’s an interview Jules did with Sister Bliss of Faithless on the same topic