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This is How to Scale Access to Psychedelic Medicine

A butterfly flapping its wings in India causes a hurricane in America.

This is the classic trope that describes non-linear dynamics. Who knows if that is true or can even be tested.

But we can say with confidence that a Burmese businessman’s chronic headaches in 1955 lead to the Mindfulness revolution in the West that continues to grow 50 years later.

The organization he built serves as a case study for building the psychedelic ecosystem that can scale access to everyone who seeks it.

In 1955 S.N. Goenka had a pretty good deal going for himself.

He ran a textile and agriculture conglomerate that made him one of the country’s wealthiest men, was happily married with six boys and lived a posh life in Yangon, Burma, an exotic yet sophisticated outpost of the British Empire.

All was well except for debilitating headaches that neither the most advanced medical treatment nor traditional herbs and tinctures could resolve.

Reluctantly, Goenka turned to meditation under the guidance of a Burmese government official, Sayagyi U Ba Khin, who had taken up the practice and taught other government officials and businessmen like Goenka.

You may have heard of the specific form of meditation Goenka learned; Vipassana.

Also known as ‘insight’ or mindfulness.

Goenka went on to resolve his headaches and spent 14 years practicing and studying with his teacher.

They Came in Throngs

In 1969 he left his business and moved to India in order to teach this specific, non-sectarian form of meditation.

Goenka’s Westward move from Burma to India coincided with the Eastward pilgrimage of thousands of American and European seekers.

Joseph Goldstein, Jack Kornfield, Sharon Salzberg and others who are largely considered the first and most prominent meditation teachers in America got their start, or at least spent significant time with Goenka studying Vipassana.

Since then hundreds of thousands have sat a 10-day Vipassana retreat with Goenka or his students.

Recently, Jack Dorsey, founder, and CEO of Twitter and Square, was both chided and celebrated for taking a break from running his companies to spend 10 days in silent Vipassana meditation.

Historian and best selling author of Sapiens and Homo Deus, Yuval Noah Harari, credits his capacity to focus and success as a writer to his Vipassana meditation which he learned from Goenka.

While the rise of Vipassana can be credited to the simple non-sectarian format that made it accessible to Western minds and culture, there is another lesser-known vehicle that I believe is responsible.

Goenka’s Business Model

In 2019, 50 years after Goenka left Burma for India to begin teaching, there are 203 retreat centers that operate as free-standing trusts and an additional 139 locations where Goenka’s Vipassana curriculum is taught to thousands of students around the world.

Meditation changes lives.

It makes people better parents, partners, humans, more empathetic, less reactive, less tribal.

It offers another way to be in the face of challenges that life inevitably dishes out.

It changes the mind.

The value of such a change is priceless.

For many the experience of 10 days away from the stress of life, from technology, from obligation, routine, without direct human interaction while paying very close attention to experience is transcendent.

It can be so transcendent that attendees often return for a 10-day retreat annually, some even go as far as sitting 30 and 60-day silent retreats.

Attendees of a Vipassana retreat through Goenka’s organization are not obligated to pay anything.

On the last day before attendees leave they are asked to make a donation.

From the website:

How much does the course cost? Each student who attends a Vipassana course is given this gift by a previous student. There is no charge for either the teaching, or for room and board. All Vipassana courses worldwide are run on a strictly voluntary donation basis. At the end of your course, if you have benefited from the experience, you are welcome to donate for the coming course, according to your volition and your means

This strategy reliably procures donations that far exceed the average.

People pay what they can, what they feel according to their means and the value the experience gave them.

And some vipassana devotees value the experience in the millions.

Asymmetric Donations

Subhash Chandra is an Indian Television News entrepreneur who credits his vipassana practice with building his fortune.

“When Chandra returned to work after a ten-day retreat, his colleagues commented that his mind had become “sharp like a knife.” When asked to ­describe the experience, he demurs, adding, “It can’t be truly explained. Suffice to say, the return on the time I invested in doing the course was enormous. Immeasurable.””

Chandra is the primary donor in the $20 million retreat center and pagoda in Gorai, India.

Jack Dorsey and Rivers Cuomo, the lead singer of Weezer, are two other notable retreat attendees.

The value of such a practice for people with wealth incites generosity and sometimes extreme generosity.

This pay-it-forward model could not work in conventional medicine where the cost of care has ballooned so far from anything closely resembling market prices.

Insight 2.0

But it could work for psychedelic medicine.

Like meditation, psychedelics promote insights and potentiate traits that fundamentally change people’s lives.

Psychedelic experiences are regularly reported as some of the most significant and important in people’s lives and the desire for others to have such a powerful and meaningful experience is strong.

In order to provide access for the poor and marginalized, as I’ve written before, I don’t think we can rely on third-party payers to take up the responsibility of access to psychedelic medicine, let alone for societies most vulnerable, so we must get creative.

I believe Goenka’s model can offer…insight.

Coupling Those in Need, with Those of Means

I believe that the highest point of leverage for improving many of society’s ills lies in restoring wholeness to the poor and marginalized.

The cycle of poverty perpetuates itself largely because of early childhood exposure to stress, trauma, and violence.

These early childhood experiences set the stage for conditions of dysregulation that rob people of fulfilling their potential as parents, as partners and as contributing members of society through conditions like PTSD, addiction, depression, and others.

The promise of psychedelic medicine is that we will finally have a treatment method that works in the face of these conditions of the mind, heart, and soul.

A bold claim, for sure, but the transformational power that has been criminalized for the last few decades could unleash a trophic cascade that nourishes and nurtures society's most vulnerable for generations to come, extinguishing the torch of intergenerational trauma that so many have carried without consent.

If we can get it to them.

Wealth is not a vaccine against sadness, depression, anxiety, shame, trauma, addiction, and self-loathing.

These conditions do not discriminate, they afflict rich and poor, black, white, brown, men, women, nonbinary, those who have succeeded and those who have failed, mothers, fathers, sons, daughters, sisters, brothers.

Creating a model that leverages the generosity of patients with means in order to offer treatment to the less fortunate will be necessary for psychedelic medicine to fulfill its potential.

I believe Goenka’s model is an example that the early builders of psychedelic medicine should be aware of.

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