Research

The Perpetuation of Child Labor in the Cocoa Industry: A Critical Examination of Neglect and Corporate Accountability

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by Eli Olevsky, May 3, 2024

Consider the chocolate bars you grew up eating. Many of us have fond memories associated with our favorite brands. An exposé by The Washington Post written by Peter Whoriskey and Rachel Siegel revealed that much of the cocoa we buy from major chocolate companies such as Mars, Nestlé, and Hershey begins with child labor. Additionally, the article points out the lack of reduction in child labor, despite pledges from the companies themselves to end child slavery in cocoa plantations such as those in the Ivory Coast in West Africa (Whoriskey and Siegel). This essay will seek to shed light on the inhumane child slavery practices within the cocoa industry, its connections to the chocolate company giants, as well as their subsequent failures to reduce and end those affiliations. Since companies cannot be relied on to change tactics out of the goodness of their hearts, it will ultimately be upon the shoulders of the masses to effect change as they are the primary consumers of these tainted products and can bring about true change by targeting their bottom lines. Once a strategy is no longer profitable, exploitative corporations are forced to change or amend their approaches as proven by numerous successful boycotts and awareness campaigns I will mention in this essay. 

Unfortunately, the presence of child slavery in the cocoa industry is not a recent revelation. It is estimated that 25-50% of children within Ghana and Côte d’Ivoire worked in Cocoa as the results of 2007 and 2008/9 surveys. Despite this, only 5% of children in Côte d’Ivoire and 10% in Ghana worked for pay (Payson Final Report 2011). Comparatively, The Department of Labor reports that currently, “there are 1.56 million children in child labor with 43 percent engaged in hazardous work in Côte d’Ivoire and Ghana”. Additionally, the site lists several dangers of working in these fields, such as chemical exposure, burning fields, sharp tools, and lifting heavy loads (Child Labor in Cocoa). The initial article by The Washington Post described the kind of work children were put to, stating, “There is land to be cleared, typically with machetes; sprayings of pesticide; and more machete work to gather and split open the cocoa pods. Finally, the work involves carrying sacks of cocoa that may weigh 100 pounds or more” (Whorisky and Siegal). A follow-up survey from Tulane University presenting the statistics as of 2013-14 mentioned that these children experienced many types of injuries. The injuries included wounds and cuts, broken bones, burns, snake bites, back pain, muscle pain, and several more (Payson Final Report 2015). Moreover, a 2020 report by NORC found the percentage of children working in cocoa exposed to agrochemicals increased from 15% to 50% in both regions (Sadhu et al.).

In a 2001 congressional record, an article was included in which a reporter details the conditions of working on the Ivory Coast as a child laborer, detailing, “Most of them are 12 to 16 years old. Some are as young as 9. The slaves live on corn paste and bananas. Some are whipped, beaten, and broken like horses to harvest the almond size beans”. The article goes on to a particular account from a consul general in an Ivorian Coast town, reading: 

They called Abdoulaye Macko, who was then the Malian consul general… he found the 19 boys and young men there. Aly, the youngest, was 13. The oldest was 21. “They were tired, slim, they were not smiling.” Macko said. “Except one child was not there. This one, his face showed what was happening. He was sick; he had (excrement) in his pants. He was lying on the ground, covered with cacao leaves because they were sure he was dying. He was almost dead. . . . He had been severely beaten.’ According to medical records, other boys had healed scars as well as open, infected wounds all over their bodies (107th CONGRESS, FIRST SESSION).

The important question to ask after these realizations of child slavery within regions that supply 60% of the world’s cocoa is “What is being done to prevent this?” (Child Labor in Cocoa). In 2001, the Harkin-Engel protocol was established to remove the worst forms of child labor in the growing and processing of cocoa beans. This protocol was signed by several major chocolate companies such as Hershey Food Corporation, Nestlé Chocolate and Confections USA, M&M/Mars Inc., and several more (Harkin Engel Protocol). Despite the protocol, according to The Washington Post Article mentioned before, “The world’s chocolate companies have missed deadlines to uproot child labor from their cocoa supply chains in 2005, 2008 and 2010” (Whoriskey and Siegel).  The 2015 report by Tulane University presenting data between their 2008/09 and 2013/14 surveys noted that children working in cocoa production increased from 1,817,278 to 2,260,407 between the two survey dates (Payson Final Report 2015). The 2020 NORC report also cited, “In Côte d’Ivoire the prevalence rate of hazardous child labor in cocoa production… increased from 23 percent in 2008/09 to 37 percent in 2018/19, while in Ghana….increased from 43 percent in 2008/09 to 51 percent in 2018/19” (Sadhu et al.).

Two decades after the Harkin-Engel Protocol, these chocolate corporations have implemented initiatives to identify child labor within the supply chain and eliminate it. According to Mars’ Cocoa For Generations sustainability plan, they commit to “prevent and mitigate human rights issues…Ensure 100% of our cocoa is responsibly sourced globally and is traceable (from the farmer to the first point of purchase) by 2025” (Cocoa for Generations). Hershey’s Cocoa For Good plan indicates, “we are expanding the coverage of our Child Labor Monitoring and Remediation Systems (CLMRS)…as we aim for 100% coverage of our Cocoa For Good farms by 2025” (Tejada Chavez). Nestlé’s Cocoa Plan echoed a similar tone: “We sourced, in 2022, 68.3% of our cocoa volumes from the Nestlé Cocoa Plan with the aim of reaching 100% by 2025” (Nestle Cocoa Plan). 

To understand the degree to which these companies can be trusted to create any real impact and change, the Washington Post article previously mentioned compiled the relationships between the percent of cocoa that is currently certified by these corporate chocolate giants and the traceable amount. For Mars, “around 50 percent of its cocoa is certified by Fairtrade and Rainforest Alliance”, but only “24 percent is traceable to the farmer level”. Hershey’s claims to have had “80 percent certified at the end of 2018”, while “less than half” is traceable to its source. For Nestlé, however, it has been shown that in the Ivory Coast, 80% of their cocoa that is certified is also traceable to the source (Whoriskey and Siegel). 

Striving for 100% traceable cocoa, while a step in the right direction, does not guarantee any meaningful results as the sourcing of chocolate is done through faulty fair trade certification companies. What good is being able to trace cocoa beans to their source, if the supposedly “certified” source still has instances of child labor harvesting those beans? A 2019 report done by the Corporate Accountability Lab noted, “a BBC investigation found children, including trafficked children, working on Fairtrade certified plantations in Ghana and Cote d’Ivoire. The Kuapo Kokoo cooperative…an Ivorian coop supplying to Nestlé, were both certified Fairtrade” (Empty Promises). A more recent investigation done by the Corporate Accountability Lab in 2021 found that, 

in December 2020, investigators saw a little girl working on a certified farm near Aboisso, carrying cocoa pods on her head. The investigators learned that this farm sold their cocoa beans to the CNEK cooperative, which is certified by both Rainforest Alliance and Fairtrade International…That same December, the investigators spoke with a small boy who was carrying a large bag of cocoa pods to an assembly point on a farm near Abengourou. This farm, they learned, sold its cocoa to the FAHO cooperative that was certified by UTZ through August 2021 and is certified by Fairtrade International (Brudney).

Not only do these certifications fail to adequately reduce the amount of child labor in the cocoa industry, but certified farms in the Ivory Coast were found to be even more likely to have child laborers than other plantations (Whoriskey). The reliance on these certification companies by major global chocolate corporations despite these third-party inspectors only being “required to visit fewer than 10% of cocoa farms”, according to The Washington Post, demonstrates a lack of trustworthiness in these chocolate companies efforts’ to address the still pervasive child slavery in the cocoa industry (Whoriskey and Siegel). It is only symptomatic of the increase in child labor in the cocoa industry over the years.

Despite the prevalence of information highlighting the cruel environments for many children in West Africa, progress has been bafflingly slow to remedy it. Their inability to meet deadlines over the last two decades, coupled with their use of completely unreliable certifications is beyond problematic. Due to this, it seems hard to believe that chocolate companies such as Hershey, Mars, and Nestlé have every intention of demonstrating a major change in their supply chain habits to create 100% ethical chocolate production by 2025. Fueled by the increasing numbers of children put in danger to create the products they sell, they need to be held accountable for their inaction.

Several campaigns have been previously successful at changing corrupt industries for the better. An example of this includes the campaign against Nike in the 90s to end the use of child labor and sweatshops in its overseas factories which resulted in reforms and improvements in working conditions within the supply chain (Klein). Another notable example is the Accord on Fire and Building Safety established in Bangladesh, which was established after the Rana Plaza collapse in 2013. The tragedy resulted in the death of 1000 garment factory workers as a result of poor working conditions. Due to increased pressure as a result of public outcry and divestment, the regulation led to major brands, trade unions, and NGOs coming together to implement safety inspections, training programs, and remediation efforts in garment factories (The Bangladesh Accord). We as consumers must speak out against this, for these companies rely on our money to make their chocolates. With our voices and without our funding, they will have no choice but to listen. 

Works Cited

Brudney, Allie. “CAL Finds Evidence of Child Labor on Rainforest Alliance Certified Farms.” Corporate Accountability Lab, 25 Oct. 2021, corpaccountabilitylab.org/calblog/2021/10/25/cal-finds-evidence-of-child-labor-on-rainforest-alliance-certified-farms. Accessed 5 Mar. 2024.

Bureau of International Labor Affairs. “Child Labor in the Production of Cocoa.” DOL, 2024, www.dol.gov/agencies/ilab/our-work/child-forced-labor-trafficking/child-labor-cocoa. Accessed 5 Mar. 2024.

“Cocoa for Generations | Mars, Incorporated.” MARS, 2024, www.mars.com/sustainability-plan/cocoa-for-generations. Accessed 5 Mar. 2024.

Corporate Accountability Lab. “Empty Promises: The Failure of Voluntary Corporate Social Responsibility Initiatives to Improve Farmer Incomes in the Ivorian Cocoa Sector.” Square Space, July 2019, static1.squarespace.com/static/5810dda3e3df28ce37b58357/t/5d321076f1125e0001ac51ab/1563562117949/Empty_Promises_2019.pdf. Accessed 5 Mar. 2024.

“Harkin Engel Protocol.” ICI Cocoa Initiative, Sept. 2001, www.cocoainitiative.org/knowledge-hub/resources/harkin-engel-protocol. Accessed 5 Mar. 2024.

Klein, Naomi. No Logo. BUR, 2018. 

“Nestle Cocoa Plan.” Nestlé Cocoa Plan, 2024, www.nestlecocoaplan.com/. Accessed 5 Mar. 2024.

Payson Center for International Development and Technology Transfer. “Final Report – Oversight of Cocoa Industry in Ghana and Ivory Coast.” Issuu, 11 Apr. 2011, issuu.com/stevebutton/docs/tulane_final_report.  Accessed 5 Mar. 2024.

Payson Center for International Development and Technology Transfer. “Final Report: Survey Research on Child Labor in West African Cocoa Growing Areas.” DOL, 30 July 2015, www.dol.gov/agencies/ilab/final-report-survey-research-child-labor-west-african-cocoa-growing-areas. Accessed 5 Mar. 2024.

“PROCEEDINGS AND DEBATES OF THE 107th CONGRESS, FIRST SESSION.” Congress.Gov, 28 June 2001, www.congress.gov/crec/2001/06/28/CREC-2001-06-28.pdf Accessed 5 Mar. 2024.

Sadhu, Santadarshan, et al. “NORC Final Report: Assessing Progress in Reducing Child Labor in Cocoa Production in Cocoa Growing Areas of Côte d’Ivoire and Ghana.” NORC, Oct. 2020, https://www.norc.org/content/dam/norc-org/documents/standard-projects-pdf/NORC%202020%20Cocoa%20Report_English.pdf Accessed 5 Mar. 2024.

Tejada Chavez, Angela. “Visible Progress: Hershey’s Cocoa for Good Strategy.” The Hershey Company, 2024, www.thehersheycompany.com/en_us/home/newsroom/blog/going-beyond-fair-trade-with-hersheys-sustainable-cocoa-strategy.html Accessed 5 Mar. 2024.

“The Bangladesh Accord on Fire and Building Safety.” The Bangladesh Accord, bangladeshaccord.org/. Accessed 29 Apr. 2024.

Whoriskey, Peter, and Rachel Siegel. “Hershey, Nestle and Mars Broke Their Pledges to End Child Labor …” The Washington Post, 5 June 2019, www.washingtonpost.com/graphics/2019/business/hershey-nestle-mars-chocolate-child-labor-west-africa/. Accessed 5 Mar. 2024.

Whoriskey, Peter. “Utz Finds Alarming Problems at Four Cocoa-Certifying Firms – The …” The Washington Post, 23 Oct. 2019, www.washingtonpost.com/business/2019/10/23/chocolate-companies-say-their-cocoa-is-certified-some-farms-use-child-labor-thousands-are-protected-forests/. Accessed 5 Mar. 2024.

Facebook and Machine Learning: Powerful or Dangerous?

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by Grace Sargent, April 9, 2024

The intertwined relationship between social media platforms and the technologies they rely on is often overlooked by its users, despite their relevance. Within the past decade, social media usage has increased immensely, and it has become second nature for many people. We have grown accustomed to logging onto our favorite websites and immediately being greeted with content that is tailored to our hobbies and interests, without truly questioning the work that led up to that satisfying experience. Thus, I would like to delve into the evolution behind Facebook and its machine learning—namely, its algorithms. I will then expand on the implications of this relation regarding both Facebook’s users and the development of the platform itself, exploring the question of its greater impact.

Though the two were not always intimately connected, the current, continued success of Facebook is largely due to the advancement of its machine learning; in other words, the two have become inextricably linked. At their inception, many social media platforms were created with pleasurability and collaboration in mind. Indeed, their significance has simply been an extension of the main purpose of where they are typically housed (our phones): to bring us together. When we think of our phones, we think of how we are afforded the opportunity “to stay connected with loved ones and friends no matter where they are” (Liberty). Facebook’s creation was then seen as an innovative way to do exactly that—to stay in touch. After launching in February 2004, the platform allowed users to view their profile page and make posts as they pleased. To check in on your friends, you were required to manually search their profiles. It wasn’t until 2006 when “News Feed” was introduced that users could enjoy a homepage that included the updates and pictures posted by their friends (Wallaroo). Facebook’s true incorporation of machine learning, however, was in November of 2007 when users were able to “like” posts, resulting in a News Feed that was more likely to display content the user would interact with (Wallaroo). Machine learning is defined as “a subset of artificial intelligence (AI) that focuses on the development of computer algorithms that improve automatically through experience and by the use of data” (Crabtree). From there, the power of Facebook’s algorithms took off, and so did how the platform facilitated engagement from its users. 

Machine learning and the algorithms it employs have advanced alongside the social media platforms that use them, allowing their accuracy to improve tenfold. As aforementioned, the preliminary stages of Facebook’s algorithms were solely dependent on the content a user would “like” or “dislike.” Currently, however, its algorithms consider multiple factors to formulate content that is tailored to the interests of each specific user. Not only do the algorithms take note of what users “like,” but also how frequently they will interact with certain types of accounts, and even at what times they do so (Zote). Furthermore, it takes into account large amounts of data that span more than individual incidents; it will take note of your overall behavior, and predict whether you would enjoy seeing content that is similar to what you have already expressed an interest in (Adisa). It is nearly impossible for users to regularly use Facebook without inadvertently creating a space for themselves where they are exposed to a specific genre of content. Thus, as its algorithms (machine learning) widened its capabilities to take in multiple variables (such as what type of content they engage with, which accounts they check frequently, etc.), Facebook’s curation has also become more accurate. This is beneficial to Facebook itself as it increases the likelihood of satisfied users who will return to their platform and further its notoriety, though it is not entirely positive for users in the long run. 

Facebook has evolved past being a website for friendly connections and has established itself as a space for the widespread sharing of important information that can educate the masses. This was seen prominently during the beginning stages of the COVID-19 pandemic when there was an urgent need for medical knowledge. When the world was experiencing unprecedented times, knowing how to take necessary precautions was incredibly important, and many people turned to Facebook as their source. In 2021, Facebook even partnered with the World Health Organization (WHO) to provide vulnerable communities with the means of accessing important health information. Facebook implemented their Discover mobile web, as well as Free Basics, which gave people “health information, job sites, communication tools, education resources, and local government information without data charges” (World Health Organization). This demonstrates how Facebook has managed to merge pleasure with practicality for its users who are navigating challenges while depending on their online platforms. 

Another way users have utilized Facebook is its ability to provide people with the opportunity for advocacy. Many people consider Facebook to be “pivotal for the innovation of online social networking platforms as the limitless functions of these platforms contribute to the construction of social change” (Kennedy). One of the best ways Facebook allows social activism to thrive is through its “Groups” function. Groups are where people gather with similar interests or ideas, and it allows them to unite, communicate, and collaborate promptly. Those same ideas can then be brought to larger audiences on the site, where they can gain further traction and attention to fulfill their ultimate goals of bringing about change. In other words, this social media site is often viewed—and used—as a legitimate means of mass communication.

Taking these purposes into account, it is interesting to then consider how some of Facebook’s demographics have changed over the years. Years ago, in 2012, Facebook was said to be especially appealing to women who were aged 18-29 (Duggan and Brenner). A reported 57% of its users were female, making 43% of them male (Alexander). Statistics for 2023, however, illustrate a change that has occurred over time. Across all age groups except for 65 and older, there are more male users than female users (Dixon). Additionally, the largest audience group was found to be men ranging from 25-34 years old (Dixon). Therefore, the kinds of users that Facebook attracts have changed along with its general purposes. Facebook is typically not regarded as a go-to social media site for younger audiences looking for pure entertainment—rather, platforms like Instagram and TikTok are most appealing. 

When considering the information that has been gathered and analyzed, I think it’s important to recognize the ongoing trends Facebook has experienced. As I previously explained, Facebook was first and most popular among college-aged adults, and it was used very casually. People enjoyed sharing small parts of their lives such as what they were up to or who they were dating. Since then, however, it has shifted away from serving purely entertainment purposes and instead become a popular place to share news and pressing information. While I have laid out how this has been beneficial to educating large audiences, I think it is also worth noting the potential downsides; namely, the phenomenon of filter bubbles. I established that Facebook’s algorithms are greatly developed to put content on your feed that you are likely to enjoy, however, their ability to prevent you from seeing a diverse range of posts can create these filter bubbles. A filter bubble effectively isolates users from information and perspectives they haven’t yet expressed an interest in, cutting them off from information that could be important (GCF Global). The most dangerous aspect of a filter bubble is that the user will often not realize they are in one, and then not take any action to broaden their perspective since they feel they are being adequately informed in the first place. 

In other words, I am cautious about saying Facebook should be prioritized as a place for information. Rather, I would argue that the site will continue to foster digital spaces that isolate groups of people which could potentially further divide our society. This is largely due to the complex machine learning (algorithms) employed by Facebook—as they become more advanced and consequently adept at curating feeds that are guaranteed to satisfy audiences, users will have a harder time breaking free from the restraints they set. If individuals of the general public each remain in their filter bubble, how will we become properly exposed to a variety of topics and information? Given this, I think a good practice users should keep in mind is to actively seek out opinions that differ from their own to ensure they understand all sides of an issue. It is also important for users to be aware of the limitations of a singular social media site like Facebook; it is always best to get information from multiple sources. 

Works Cited

Adisa, Dorcas. “How to Rise above Social Media Algorithms.” Sprout Social, 30 Oct. 2023, sproutsocial.com/insights/social-media-algorithms/. 

Alexander, Anson. “Facebook User Statistics 2012 [Infographic].” AnsonAlex.Com, 31 Dec. 2020, ansonalex.com/infographics/facebook-user-statistics-2012-infographic/#:~:text=57%25%20of%20Facebook%20user%20are,on%20the%20site%20per%20visit. 

Crabtree, Matt. “What Is Machine Learning? Definition, Types, Tools & More.” DataCamp, DataCamp, 19 July 2023, www.datacamp.com/blog/what-is-machine-learning. 

“Digital Media Literacy: How Filter Bubbles Isolate You.” GCFGlobal.Org, GCFGlobal Learning, edu.gcfglobal.org/en/digital-media-literacy/how-filter-bubbles-isolate-you/1/. Accessed 18 Feb. 2024. 

Dixon, Stacy Jo. “Global Facebook User Age & Gender Distribution 2023.” Statista, 29 Aug. 2023, www.statista.com/statistics/376128/facebook-global-user-age-distribution/. 

Duggan, Maeve. “The Demographics of Social Media Users – 2012.” Pew Research Center: Internet, Science & Tech, Pew Research Center, 14 Feb. 2013, www.pewresearch.org/internet/2013/02/14/the-demographics-of-social-media-users-2012/. 

“Facebook News Feed Algorithm History: 2023 Update.” Wallaroo Media, 9 Mar. 2023, wallaroomedia.com/facebook-newsfeed-algorithm-history/. 

“How Mobile Phones Are Making Our Lives Convenient.” Liberty Title, 6 Mar. 2023, libtitle.com/how-mobile-phones-are-making-our-lives-convenient/#:~:text=One%20of%20the%20biggest%20benefits,to%20anyone%20in%20the%20world. 

Kennedy, Che-Anne. “Facebook as a Construct of Social Change and Collaboration for Activists., Debating Communities and Networks XII.” Debating Communities and Networks XII, 27 Apr. 2021, networkconference.netstudies.org/2021/2021/04/27/facebook-as-a-construct-of-social-change-and-collaboration-for-activists/. 

“Who, Facebook and Praekelt.Org Provide Critical Mobile Access to COVID-19 Information for Vulnerable Communities.” World Health Organization, World Health Organization, 11 Aug. 2021, www.who.int/news/item/11-08-2021-who-facebook-and-praekelt.org-provide-critical-mobile-access-to-covid-19-information-for-vulnerable-communities. 

Zote, Jacqueline. “How the Facebook Algorithm Works and Ways Your Brand Can Outsmart It.” Sprout Social, 10 Jan. 2024, sproutsocial.com/insights/facebook-algorithm/. 

The Possible Anti-depressant Effects of Magic Mushrooms

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By Maisha Pathan, March 9, 2024

Depression is a debilitating condition that affects up to 17.8% of American adults as of
2023 (Witters). Although there are countless treatment options in the form of antidepressants,
and therapy, sometimes, these treatments may still not be enough to provide relief for those
suffering from depression. Shrooms, also known as magic mushrooms may be an emerging
answer to those seeking an alternative. This unorthodox form of treatment called
psilocybin-assisted therapy (PAT) is gaining popularity, and the results are significant enough to
be brought to the public’s attention. In PAT, the patient is given a dose of the psychedelic
psilocybin, also known as magic mushrooms, in a controlled setting while their assigned
therapist stands by to monitor the experience. Despite its low toxicity and even being safer than
nicotine and aspirin, the stigma surrounding psychedelics causes people to hesitate even
considering this as an option, on top of which it’s still a controlled substance by the government
(Lowe et al. 20). However, research obtained from clinical trials shows that in a controlled
environment and administered by a trusted professional psilocybin has a powerful impact on
depressive symptoms, and many participants report improvement in their condition after their
sessions. For the people struggling with treatment-resistant depression, severe depression, or
anyone who finds that medication and therapy aren’t helping them: psilocybin-assisted therapy
could be a viable option for treating depression and should be offered alongside therapy and
medication.


Historically, psilocybin mushrooms have been in use for centuries, prominently in the
Aztec empire around the 15th century. The substance was referred to as “god’s flesh” in Nahuatl
and used in religious and healing rituals (Nichols 679). However, it wasn’t until 1957, when
Albert Hoffman a chemist who (also created LSD) isolated psilocybin from a Mesoamerican
psilocybin mushroom, and published its effects, that magic mushrooms entered modern
American society (Nichols 680) . Although the substance was then used in psychedelic therapy,
it became popularized for its recreational use during the 60’s aided by the hippie movement,
until the USA passed the Comprehensive Drug Abuse Prevention and Control Act of 1970,
which marked it as an illicit drug along with LSD and other psychedelics. Despite these
restrictions, psilocybin continued to be used recreationally by citizens and has been gaining
more traction in media.


Major depressive disorder is a serious depressive disorder that can have a lasting impact
on the brain. This damage essentially rewires the brain which can keep the person in their
depressive state for a prolonged amount of time. The compounds that makeup psilocybin can
sometimes reverse, or rewire, the damage depression does to the brain. According to an article
published by Healthline, a medical information website, depression can shrink regions of the
brain governing memory (hippocampus), emotion (amygdala), and cognitive functions
(prefrontal cortices). As a result of shrinking, function in these brain regions such as emotional
regulation and interest, memory, and concentration are also diminished (“5 Ways Depression
Can Physically Affect the Brain”). Psilocybin, specifically psilocin comes into play here due to
its role as a subtype of serotonin receptor. It activates a serotonin receptor called the 5-HT2A
which increases serotonin levels similar to SSRIs (2-Minute Neuroscience: Psilocybin, 0:16). In
a study conducted by researchers at Weill Cornell Medicine, an fMRI was used to show how the
activation of the 5-HT2A serotonin receptor by psilocin affected the brain landscape. The results showed that on psilocin, the brain lowered energy barriers between different regional
connections in the brain which allowed regions of the brain that were typically not stimulated to
be activated. Due to the flattening of the brain’s energy landscape, new connections could be
made between different brain regions, enabling neuroplasticity and promoting neurogenesis,
which is generation of new neurons. This opens up space that allows the brain to rewire itself,
and if the psilocybin is taken in a clinical setting such as in a PAT session, old patterns of
thinking can be replaced with new, expansive thought patterns which can reverse the effects of
depression on the brain by fostering new connections (Kuceyeski).


The structure of PAT is what makes it so successful and extremely safe in treating
depression. It’s is controlled by doctors and therapists in a clinical setting and is spread
throughout three stages: a preparatory stage, an administration stage, and an integration stage
(Schuitmaker 2). Each stage of PAT plays a significant role in how effective the treatment will
be for the patient while maintaining the environment in a controlled setting.


In the preparatory stage, participants attend several psychotherapy sessions to set their
goals and intentions for their experience. This creates the set and setting. Although individuals’
experiences on psilocybin vary from person to person an important factor to the experience is set
and setting. An article analyzing PAT in medicine by Cureus, a peer-reviewed medical journal,
explains that set refers to a patient’s goals and intentions for their psilocybin experience and is
discussed with their therapist so that it could be used to guide the individual and keep them on
track. The setting refers to the patient’s mental, physical, and emotional state prior to and during
the treatment. Attending these preparatory therapy sessions helps the therapist assess when and
where treatment should take place (Ziff et al. 7).


Once the patient is prepared, the next stage is “administration” which the Yale Manual for
Psilocybin-Assisted Therapy of Depression details. Typically, on the day of administration, the
patient is taken to a homey, welcoming room, where they lie down on the couch, put on
headphones, run a musical playlist, and wear a blindfold. The dose of psilocybin provided can
vary but typically is less than 1 gram and based on what the participant can handle. The music,
lying down, and blindfold work together to create a relaxing environment where the patient can
feel safe. They know that if they need any support they have their therapist right there next to
them. These measures create a controlled environment for the patient, minimizing possible
adverse reactions like anxiety or paranoia which can lead to nausea or vomiting. Once the patient
is settled and has consumed their psilocybin dose, the drug slowly takes effect, guiding them on a
journey into the depths of their mind. The therapist only guides the patient when needed based on
the goals and intentions set in the preparatory sessions, and otherwise does not interfere with the
psilocybin trip (Guss et al. 45-50).


The day after administration takes us to the third stage, “integration.” Integration
consists of several sessions through the following weeks during which the therapist asks the
patient about their experience, what they saw, felt, learned, what they’d like to take away from
their experience, and how to integrate that into their lives (Guss et al. 51-60). Although all three
stages of psilocybin-assisted therapy are equally as important, integration ensures that the
positive experiences are incorporated into the patient’s life and have a lasting effect while the
negative experiences if any are worked through. This structuring makes the therapeutic
administration of psilocybin safe and maximizes the benefits the substance can provide a
patient.

The effectiveness of psilocybin-assisted therapy as a treatment is evident in a number of studies.
In an article published by Johns Hopkins Medicine, the efficiency of using psilocybin to treat
major depression is explored through two studies conducted under their Psychiatry and
Behavioral Sciences department. The results found from both studies showed that using
psychedelic therapy by giving each participant a dose of psilocybin followed by psychotherapy
significantly reduced the symptoms of depression in both studies. Half of the participants in the
first study entered remission from depression at the end of the four-week follow-up. In the
second study, participants with a long history of depression on antidepressants were provided two
doses of psilocybin in a few weeks. They took a GRID-Hamilton Depression Rating Scale before
and after. The results showed that 67% of the participants showed a reduction in their symptoms
after a week, and four weeks after treatment, 54% of participants in the study were in remission
(“Psychedelic Treatment with Psilocybin Relieves Major Depression, Study Shows”). In another
study conducted by the Psychiatric University Hospital of Zurich, 52 participants suffering from
major depressive disorder were treated with psilocybin-assisted therapy. Half of them were given
psilocybin while the other half, 26 individuals were given a placebo. The results showed that
psilocybin significantly decreased depressive symptoms in those who had it, more than those
who received a placebo along with their therapy sessions. By the end of the study 14 out of 26,
met the criteria for remission from depression on the Montgomery–Åsberg Depression Rating
scale. In comparison to the placebo group in which the treatment was technically seven required
therapy sessions, 4 out of 26 met the criteria for remission demonstrating that psilocybin was the
driving force for the symptom reductions (Rotz 7-10).


In one clinical PAT trial conducted by NYU School of Medicine, the participants were four
cancer patients struggling with depression and anxiety. At the end of their participation which
spanned 26 weeks, each patient demonstrated a significant reduction in their depressive
symptoms which resulted from the experiences they had during their trips.
Many people suffering from depression who participated in psilocybin-assisted therapy
clinical studies report having positive experiences that aided in reducing their depressive
symptoms. Chrissy, a 50-year-old female with stage 4 breast cancer stated “[The psilocybin
experience] brought my beliefs to life, made them real, something tangible and true – it made my
beliefs more than something to think about, really something to lean on and look forward to,”
(Malone et a. 4). Although Chrissy knew that she was still going to pass, she was able to accept
and even look forward to the time she had left. In a separate trial by the Faculty of Medicine at
Al-Hikma University, ten participants struggling with depression were treated their with
psilocybin-assisted therapy. During an integration session with their therapist, a young adult
known as Participant 1 stated, “My whole thought pattern changed. I was so relieved. My head
had never been clearer. I was so happy the day after cried to my trip buddy about how I could see
again…. I was on three different anti-depressants, valium, and sleeping pills. This stopped within
2 weeks of my first dose,” (Hisham et al. 3). Many other participants from the same study
reported the experience was mind-expanding, and gave them a more positive outlook in life. The
experiences of the participants in this particular study are consistent with the neuroplasticity
effect psilocybin can have on the brain which allows it to create new connections and eradicate
old, negative thought patterns.


Psilocybin-assisted therapy has proven to be a worthwhile treatment venture for many of the
patients who participated in treatment for their depressive disorders. It’s important to note that psilocybin in this case is being used for treatment, not for recreation or self-exploration and
because it is being used for treatment by entrusted clinics it poses a relatively low risk, if at all to
those who receive it. However, that is not to say that this should be an option for everyone.
Studies have shown that people who are genetically predisposed to psychotic disorders such as
Schizophrenia can be triggered if exposed to any psychedelic substances such as psilocybin, in
the case where if they hadn’t been exposed to the substance they would not have developed any
form of psychosis (Ziff et al. 8). This is however, managed under psilocybin-assisted therapy as
before being able to receive it, all patients must undergo medical health screening to ensure it
will be an appropriate option for them. Many of the clinical studies on PAT usually begin with a
large pool of participants, which is slowly trickled down to a very small number via medical
health screening. The doses of psilocybin provided by these clinics are also quite moderate, and
typically less than even 1 gram which is the starting dose for recreational users. Years of research
and studies have gone on to show that psilocybin-assisted therapy can bring profound
improvement to depressive symptoms, especially for those who have exhausted all other options
such as medications and therapy. Age, health, and environment are all factors to consider when it
comes to PAT and it should be offered based on a mutual decision between the patient and their
mental healthcare provider. Although psilocybin-assisted therapy is not currently offered as an
official treatment and can only be accessed by participating in clinical trials, this may change
soon. In 2018, the FDA granted psilocybin-assisted therapy “break-through therapy” status
which means they will prioritize reviewing it soon for approval meaning it could soon be widely
offered for treatment (Coleman). For those struggling with depression who haven’t found relief
from any of the current treatment options, or are interested in trying psilocybin-assisted therapy,
this may be good news. Still, as in all cases, it’s important to do your own research to determine
whether this is the right option for you.

Bibliography

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