Why Reconscious Medical?
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The current model of psychopharmacology is broken. Clinical studies show that psychiatrists are failing to reach some 50% of the people who need them the most. Mainstream psychiatry hasn’t offered innovation in the treatment of depression -the leading cause of disability worldwide - since the advent of SSRI antidepressants in the late eighties. Meanwhile, the rates of opiate addiction, mental illness, and suicide are still on the rise, with no let-up in sight. Our mission is to pave a safer, more efficient way forward for the field of psychiatry and all the people whose lives are impacted by mental illness and addiction.

 Image of dark mountain during dusk and Ketamine Treatment

Psychedelic Integration

What is Psychedelic Integration?
Psychedelic Integration consists of therapeutic techniques that focus on the use of psychedelic drugs, such as ketamine, psilocybin, LSD, MDMA, DMT, and 2C-B in contrast to the traditional psychiatric medications used by conventional therapists.

These are psychedelic therapy sessions that use psychedelic substances to promote introspection and healing of mental illness and dependence, such as depression, alcohol or nicotine dependence, PTSD, stress in terminal disease patients, and possibly obsessive compulsive disorder, issues related to autism, and many other potential applications.

Psychedelic Integration Centers
Psychedelic Integration patients are typically supervised while under the influence of their medication by their psychedelic therapist, who objectively assists as the patient explores their inner self and experience. Patients of psychedelic psychotherapy typically have multiple psychotherapy sessions before and after their psychedelic drug therapy session to assist in full integration of their experience.

History of Psychedelic Integration Science
Since prehistoric times, humans have consumed numerous psychedelic substances derived from various plants and fungi, such as cacti, roots, mushrooms, bark, and seeds. These natural plants were seen as keys to enter the spirit world by ancient shamans and medicine men, and the knowledge of their use has been passed down through many cultures.

Even Western culture sees medicine men and shamans as spiritual in their intentions and nature; the study of these entheogenic and shamanic rituals has been crucial in the development of modern psychotherapeutic practice.

In 1943, Albert Hoffman discovered the psychoactive properties of LSD and recognized the potential for scientific use. A few years later, Sandoz Laboratories began distributing LSD to researchers across the globe. Over the next couple decades, scientists, therapists, and researchers ran a multitude of experiments into the chemotherapeutic and psychedelic therapy uses of these psychedelic drugs.

By the mid-1960s, the research into psychedelics had become much more widespread and almost mainstream, spawning 6 international conferences, over 1000 peer-reviewed studies, and upwards of 40,000 patients. Many proponents of psychedelic integration research believed these chemicals could be especially useful for patients with conditions such as alcoholism or drug addiction, that are otherwise difficult to treat.

Along this same line of thought, psychedelic researcher Timothy Leary felt that psychedelics could potentially rewire a person’s fundamental personality or system of values in ways that greatly benefit the overall wellbeing of the individual.

In the early 1960s, Leary conducted short, intense psychedelic therapy session experiments with prison inmates with the intention to lower recidivism. In addition to routine group therapy sessions, participants had been administered psilocybin during their psychotherapy sessions.

Eventually, psychedelic therapy was also implemented into other special patient populations, such as children with autism, alcoholism and drug addiction, and the terminally ill.

Despite many promising testimonials and wide reaching research, many countries kept LSD extremely scarce or else banned it entirely. Facing pressure from the government, Sandoz halted the production of LSD in 1965.

Three years later, an informative article was published in the American Journal of Psychiatry which outlined in detail how the legitimate LSD research had been sabotaged by individuals in the pharmaceutical industry and government, discrediting the psychedelic researchers as charlatans.

All research into the medical applications of psychedelic science came to an abrupt stop in the United States after the passing of the Controlled Substances Act in 1970. This Act categorized all chemicals into 4 categories based upon their medicinal value and the likelihood of dependence or abuse when using.
LSD and many of the other promising therapeutic psychedelic drugs were placed into the most restrictive category, “Schedule I” by the US Drug Enforcement Administration, which signifies “significant possibility for abuse and dependence” and having “no known medicinal value.”

Despite objections from the greater scientific community, this effectively rendered these and other naturally derived chemicals illegal in the United States, and ultimately paved the way for the worldwide discontinuation of authorized research into psychedelic chemicals and their therapeutic applications in the 1980s.
As with all prohibition, unauthorized and unofficial studies and research into psychedelic integration continued through the following decades. To skirt the rules, some therapists would use substances in particular windows before the scheduling of those substances. Other therapists attempted to find alternative methods of achieving altered states of consciousness using techniques not focused on using chemicals or medication, such as Holotropic Breathwork.

Unofficial psychedelic integration has largely become underground, with many practitioners from the fully accredited therapists to those self-taught in the community. Due to the taboo nature of the prohibited psychedelic research, very little information is available of the research conducted during this time period.

Some well known authors and researchers of this time include Alexander and Ann Shulgin, George Greer, Athanasios Kafkalides, and Myron Stolaroff (who wrote on the underground therapies of Leo Zeff.)

Resurgence of Psychedelic Integration in the 21st Century
Psychedelic Science Research - Psilocybin Studies at Johns Hopkins
In the early 2000s, what can only be described as a psychedelic renaissance overtook the United States, renewing interest in the clinical and psychiatric benefits of psychedelic integration. Vast improvements in technology, such as PET and MRI scanning to view areas of activity in the brain, allowed for more extensive testing and data.

To circumvent the bureaucratic barriers of research on the effects of some of these Schedule I substances on the brain, illicit drug users volunteered as research subjects, allowing for the gathering of much needed data to potentially reverse previous scheduling.

The new century also brought with it a new political climate that seemed to be more open to the use of psychedelic medicine. The US Food and Drug Administration specifically seemed to have a change of attitude, after many legal challenges and much introspection into the use and intention of this category of drugs.

The FDA has granted unique permissions and breakthrough therapy designations for psilocybin and MDMA research. Other reports have investigated the use of ayahuasca and LSD. One study in the late 2000s found an overall remission rate of 2/3rds for those with chronic PTSD. There have been only rare complications involved in the administration of LSD.

Psychedelic Integration Research Reemergence
Johns Hopkins University and New York University conducted two of the first large scale, controlled psychedelic research studies into the effects of psychedelic integration on stress and depression in cancer patients. There were zero reported adverse reactions to the psychedelic drugs, and based on both clinician ratings and patient ratings, the psychedelic integration research treatment resulted in significantly decreased levels of depression and stress, for a minimum of two months following the treatment.

Interestingly, each scientific report attributed the effectiveness of the treatment to patients having a “mystical” experience while using the psychedelic drugs. These mystical experiences can be described as moments of deep, personal introspection, feelings of unity, or transcendence of time and space. More research is necessary in order to understand the biological components of these mystical experiences.

Patients often refer to seeing the bigger picture, sensing profound insight about themselves or humanity, feeling physically and/or emotionally re-balanced, clear-headed, releasing pent up stress or pain. This is a stark contrast to the described effects of SSRIs, which include feeling muted emotionally or mentally.

Applications of Psychedelic Integration
The main three psychedelic substances that are considered for psychedelic therapeutic uses are LSD, psilocybin (the active compound in psychedelic mushrooms), and mescaline (the active compound in the peyote cactus.) Scientists have recently been able to pick back up on the previous research of the 1970s into the medicinal value of these chemicals.

Over the decades, research has expanded into other chemicals such as MDMA, Ketamine, DMT, 2C-B, 2C-I, AMT, 5-MeO-DMT, DOM, and Ibogaine. Research into these psychedelics has shown that these substances can help people with post-traumatic stress disorder, depression, cluster headaches, alcoholism, and even obsessive-compulsive disorder.

With such limited research, the mechanism and therapeutic uses of these chemicals generally remain poorly understood. Set and setting play a large role in the final outcome of the psychedelic integration.

Psychedelic Integration Near Me for Alcoholism
Humphrey Osmond and Betty Eisner, along with others, researched the potentials of psychedelic integration in treatment of alcoholism (and other addictions, although much less commonly). A few studies over the years have found LSD to be generally effective at reducing an individual’s propensity of alcohol misuse after even just one single high-dose session.

Bill Wilson, the creator of Alcoholics Anonymous, took part in a medically supervised study in the 1950s on LSD psychotherapy for alcoholism. Wilson understood the benefits of ego reduction under the influence of LSD and believed that routine administration of LSD in controlled, structured settings would benefit most recovering alcoholics.

Modern psychedelic research has confirmed what earlier psychedelic science had theorized about LSD helping in treatment and recovery of substance use disorders. One study in 2015 found that psilocybin psychedelic integration resulted in less drinking, less cravings for alcohol, and longer periods of alcohol abstinence.

Psychedelic Integration Near Me for Terminal Disease
The study of psychedelics on the debilitating anxiety and depression associated with terminal illness began back in the early 1950s and 1960s, sponsored by the National Institute of Mental Health. The more recent published studies also confirm these early studies findings that LSD and psilocybin are extremely effective psychotherapies in treating the terminally ill suffering from stress and anxiety.

Many psychologists have found that terminally ill patients undergo intense emotional turmoil as they face their own mortality, which makes it even more difficult for these patients to enjoy and find meaning in their final weeks, months, or years or life. Though every experience is completely unique, common themes noted were heightened clarity, confidence in personal values and self, and a renewed understanding or recognition of the meaning of living.

Psychedelic Integration Near Me for Post-Traumatic Stress Disorder
The Multidisciplinary Association for Psychedelic Studies (MAPS) has conducted multiple studies into the efficacy of MDMA in treatment of post-traumatic stress disorder. A late 2010s study that consisted of 107 members with chronic, treatment-resistant PTSD that had lasted an average of 18 years found that 61% of those patients were no longer diagnosable as PTSD after only 3 sessions of MDMA psychedelic integration sessions.

Through research, MDMA psychedelic therapy has also been found to treat PTSD in patients with PTSD that have not responded to traditional treatment. One study found that over half of the study’s participants no longer met the diagnosis qualification for PTSD after they completed the MDMA psychedelic therapy.

Psychedelic Integration Near Me for Depression (TRD) and Anxiety Disorders
One study found that psychedelics are especially effective at treating stress and mood disorders. It found that psilocybin significantly reduced levels of depression and stress in cancer treatment patients.

Psilocybin psychedelic therapy has also been reported to cause increased levels of optimism, higher quality of life, and lower levels of stress. Even six months following the psychedelic integration treatment, 4 out of 5 people continued to report improvements.

Another study researched the attendees of music festivals. An overwhelming number of participants referred to a strengthened feeling of unity and connection with their friends, fellow humans, and the world and universe as a whole, which carries over and lasts long after the trip.

Based on research, there are signs that psilocybin along with emotional support can be effective at lessening the effects of treatment-resistant depression. A 2019 analysis found that microdosing psilocybin resulted in similar effects to antidepressants, with a large reduction in fear-based thought without any negative effects to memory or social interaction; this is an indicator micro-dosing could help treat mood and anxiety disorders.

The FDA has authorized “breakthrough therapy” designation for psilocybin in studying the effects of psychedelic integration for Main Depressive Disorder and Major Depressive Disorder.

Methods of Psychedelic Integration
There are many unique psychedelic substances with a variety of possible therapeutic applications. As each drug is unique, and the general effects of psychedelic drugs on the mind are complex, distinct, and difficult to characterize, individual psychedelic therapist practitioners have developed their own modalities of practice. Some of these are discussed below:

Psycholytic Therapy
Psycholytic therapy refers to a form of psychedelic assisted therapy that focuses on consistent (every couple weeks) lower to medium doses of psychedelic drugs while under supervision of the therapist. The psychedelic therapist is present during the experiences to help the patient mentally and emotionally process any experiences that arise during the psychedelic integration session.

This form of psychedelic psychotherapy is typically used to treat patients diagnosed with psychosomatic or neurotic disorders. The term psycholytic literally means “soul dissolving,” and was implemented with the idea that psychedelic integration can dissolve conflicts in the mind.
Psycholytic therapy has played a large role in psychedelic therapy in Europe. Some psychedelic therapists in the United States also practice this form of psychedelic assisted therapy.

Psychedelic Integration Near Me
Just as the visible light spectrum is only a tiny sliver of the entire electromagnetic spectrum, the conscious realm of our minds is only a small sliver of our overall self. Psychedelic drugs allow one to explore their subconscious. With the assistance of a trained psychedelic therapist, the patient is able to remain intellectually alert throughout the session and recall their experience afterwards.

Psychedelic Integration sessions allow the patient to enter a highly introspective state that facilitates seeing with different perspectives, recognizing various ego defenses like denial, displacement, and projection, and analyzing how they react to their surroundings and the choices they make.
This opening of new mental pathways, through the guidance of trained psychedelic integration therapists, enables the patient to work through and develop personal philosophies and their life framework.

Psychedelic Integration
This form of psychedelic therapy involves higher doses of entheogenic drugs. The ultimate goal of the session is a peak transcendental, mystical, spiritual experience. These sessions usually begin with a talking session between the therapist and the patient to discuss the psychedelic integration session.

Following the introductory talking session, the patient will then spend most of their psychedelic experience lying comfortably, with their eyes closed, and listening to instrumental music while exploring their inner self and mind. After the psychedelic drugs wear off, the patient will have another talking session with the therapists to assist in the psychedelic integration of their experience.

This is a more common modality of psychedelic therapy in the modern era, and psychedelic integration is primarily practiced in North America.

High Intensity Psychedelic Integration
High intensity psychedelic integration usually involves partaking high doses of ayahuasca, a combination of plants from the Amazon rainforest containing N, N-dimethyltryptamine and a monoamine oxidase, or psilocybin, also known as magic mushrooms. These sessions are much more intense, but have been used in cases to treat chronic alcohol abuse or make other behavioral changes.

This sort of psychedelic integration can also cause internal personality and behavioral shifts that would not have been possible without the psychedelic integration.

Other Versions of Psychedelic Integration
A Czechoslovakian psychedelic researcher found a form of psychedelic therapy that marries the main forms, microdosing and macrodosing, into a single practice. Moderate doses of LSD along with Jungian and or Freudian psychoanalytic thought was found to trigger this same mystical, spiritual experiences described in high-intensity therapy without some of the more uncomfortable effects of higher doses.

Other psychedelic therapists have researched the use of other chemicals, such as MDMA, MDA, ibogaine, or ketamine for psychedelic psychotherapy.

Hypnodelic Psychotherapy
This form of psychedelic assisted therapy uses hypnotism along with typical psychedelic experiences. First, the patient must be trained in order to respond to the hypnotist. After this, the patient is administered LSD, and during the onset of the trip, the patient would be placed into a state of hypnosis for the psychedelic therapy session.

Shamanic Psychedelic Integration and Non-Clinical Psychedelic Integration
There is a rich history, over thousands of years, of psychedelic science and psychedelic integration. Shamans throughout Mexico, Brazil, and Peru have communed with nature through use of ayahuasca and other naturally occurring entheogen plants. The Shipibo tribe in Peru create music and art with the help of their shamans and psychedelic science.

The shaman is the communicator between the spirit realm, through the plants’ souls, to the physical realm in which we live, with the intention of healing and balancing, in both the physical and energetic states. These are the origins of psychedelic integration and psychedelic science.

Those who are involved in shamanic psychedelic practice are usually very spiritual and or religious. In the United States, there is one church that is legally documented as using psilocybin for healing and as the sacrament, Holy Heart Medicine Sanctuary.

Renewed Public Interest in Psychedelic Integration
Over the past decade or so, mainstream media has even picked up on the interest in psychedelic science and psychedelic integration. The Wall Street Journal and New York Times have published articles about psychedelics that not only refer to older studies of the 50s and 60s, but also new research as they discover new findings in psychedelic therapy.

Psychedelic Tourism and Psychedelic Integration
While some still choose to travel to South America or Central Africa for mostly self-lead psychedelic integration, the western version of this psychedelic science is on the rise. Psychedelic retreats are a newer trend, with some in the Netherlands ranging from $1000-$1500 for a group psilocybin experience.

Also in the west, there is an underground network of psychedelic “guides,” helping those on their journeys navigate their trips, somewhat similarly to shamans who lead and guide others through psychedelic healing experiences.

Psychedelic Integration Centers Near Me
Reconscious Medical is excited to be your choice psychedelic integration center. We have much to offer both patients and practitioners of psychedelic integration. Our approach is catered to the individual; we look forward to working with you on your psychedelic integration goals.

Psychedelics have been practiced for thousands of years. In psychedelic integration, hallucinogenic substances are used to help patients in their therapy sessions.

There was a short window between the discovery of LSD and when the government declared it was illegal. During this time in the 50s and 60s, research into psychedelics and their therapeutic uses thrived. Even today, with psilocybin and LSD still federally illegal, these substances are believed to positively treat the effects or even heal a variety of mental illnesses, such as depression, addiction, and anxiety through psychedelic integration.

Researchers have been able to acquire special use permission to study these psychedelic substances and their potential therapeutic benefits over the past 20 years. Many of these studies do boast positive effects over patients experiencing the psychedelic integration.

These chemicals have been proven to be used safely, under the supervision of a psychedelic therapist, and have shown they have positive outcomes for patients of psychedelic integration as well.

While psychedelics have been explored by humans for thousands of years, the true science of psychedelics was not truly understood nor even considered until the discovery of LSD-25 and its hallucinogenic properties.

Shortly following its discovery in the 1940s, it quickly became apparent that LSD and other similar psychedelic drugs could be used in what would later be called psychedelic therapy. Researchers studied tens of thousands of patients and published many findings on the uses of these chemicals for psychedelic psychotherapy, particularly in treating alcoholism.

However, all of this research came to a screeching stop when the United States government classified LSD and other psychedelic chemicals as “schedule I” substances via the Controlled Substances Act of 1970. This severely limited the clinical and medicinal use of these psychedelic chemicals and halted all research into psychedelic integration.

After years of underground and unofficial research into psychedelic integration, in 2006 a group of scientists were granted permission to administer psilocybin to patients. The results were overwhelmingly positive. Not only was the psychedelic substance safe, but the patients reported significant favorable experiences and results.

Effects of Psychedelic Substances
Despite all of the positive results surrounding supervised psychedelic integration sessions, it is very important to remember that there can also be negative reactions while under the influence of these chemicals.

Some effects of psychedelic drugs can be:
Hallucination - seeing, hearing, or feeling things that are not truly there
Relaxation & Peacefulness
Distortion of reality or perceptions
Mystical, Spiritual, or Religious experiences
Altered perception of time
Intense or amplified emotions or perceptions

After having a psychedelic experience, most people report feeling a sense of calm or peace, unity, and increased empathy.

Some physical effects of psychedelics can include:
Increased heart rate
Increased blood pressure
Nausea or other effects, depending on the specific chemical ingested

Effects of psychedelics can vary wildly from one individual to another, and also depend on the type of chemical ingested and the amount ingested.

Common Psychedelic Substances and Therapeutic Benefits
Below are some of the more common psychedelic substances used in psychedelic integration.

LSDType: 5-HT2A (serotonin) agonist of pyramidal neurons
Effects: Hallucinations, dizziness, weakness, tremors, paresthesia, enhanced mood, distortion of space and time
Potential Psychedelic Integration Use: alcohol addiction, stress from terminal illness
This is a naturally derived chemical that causes distortions in perception of time, space, and consciousness. LSD has shown promise in treatment of anxiety and addiction, especially alcoholism with psychedelic integration.

PsilocybinType: 5-HT2A (serotonin) agonist of pyramidal neurons
Effects: Hallucinations, nausea, dizziness, weakness, tremors, paresthesia, enhanced mood, distortion of space and time
Potential Psychedelic Integration Use: alcohol and tobacco addiction, cocaine addiction, anxiety from terminal illness
Psilocybin is a naturally occurring chemical in certain mushrooms. It also causes distortions in perception of time, space, and consciousness. Psilocybin has been used in treating depression, stress, and addiction with psychedelic integration.

AyahuascaType: 5-HT2A (serotonin) agonist of pyramidal neurons
Effects: Hallucinations, dizziness, tremors, paresthesia, fatigue, enhanced mood, distortion of space and time
Potential Psychedelic Integration Use: alcohol and tobacco addiction, depression, anxiety
This is brewed liquid made from South American plants that is reported to aid in treatment of depression, anxiety, and addiction with psychedelic integration.

MDMAType: Serotonin, dopamine, and noradrenaline agonist
Effects: Euphoria, altered perceptions, arousal, increased empathy, increased sociability
Potential Psychedelic Integration Use: PTSD
MDMA is a different class of chemical than the previous three. MDMA is a chemical that is synthesized from natural substances. It causes intense feelings of euphoria, increased sensitivity, stimulation, and sociability. This has shown promise in relationship or couples therapy and also in treatment of post-traumatic stress disorder (PTSD) at psychedelic integration centers.

MescalineType: 5-HT2A (serotonin) agonist of pyramidal neurons
Effects: Hallucinations, dizziness, tremors, paresthesia, enhanced mood, distortion of space and time
Potential Psychedelic Integration Use: alcohol addiction

Ketamine is more of an anesthetic, but it is important to note that it has gained popularity recently for treatment of severe depression in psychedelic integration sessions.

What Can Psychedelic Integration Treat?
Scientists and researchers over the decades have discovered that psychedelics are useful in treating a variety of conditions, such as anxiety and depression, stress, addiction, and PTSD at psychedelic integration centers.

How Psychedelic Integration Works
Due to the relatively new nature of psychedelic science, there are no standards to practicing or administering psychedelic integration. There are a few common themes:

Administering a low to moderate dose of a psychedelic substance

Supervision by a professional therapist during the psychedelic experience

Repeating the supervised psychedelic experience every one to two weeks

Set and setting are crucial to the psychedelic experience. The setting typically refers to the environment one is in at the psychedelic integration center. Set refers to the expectations and the mental space of the patient going into the psychedelic integration session.

Following the psychedelic experience, the therapist will assist the patient in what is called psychedelic integration. This is the part of the psychedelic integration session where the patient ascribes and finds meaning in their experience.

Microdosing with Psychedelic Integration
Microdosing refers to taking very minute doses of a psychedelic substance, just to barely feel any of the effects of the chemical. Supporters claim that microdosing increases productivity, enhances performance, lowers depression, and increases energy.

Microdosing is ingesting sub-hallucinogenic or sub-perceptual doses of a psychedelic substance, usually LSD, psilocybin, or cannabis. While microdosing has been used at psychedelic integration centers, most often people microdose outside of clinical settings.

Microdosing became popular after several articles touting Silicon Valley tech workers affinity for the practice were published within the past decade.
MIcrodosing is reported to increase overall productivity, increase creativity, and improve disposition without any of the more distracting side effects of higher psychedelic doses.

Some researchers found that microdosing lessened anxiety and enhanced the mood of rodents involved in a laboratory study on effects of microdosing.

Personality Improvements Following Psychedelic Integration
Some patients have claimed their psychedelic integration sessions have produced positive, long term changes to their overall personality. Some participants in a psilocybin psychedelic integration session reported they felt more open and more extraverted during and following their psychedelic integration sessions.

Risks of Self-Treatment with Psychedelics
With so many positive results, it can be tempting to want to self-treat with psychedelics. However, in a clinical setting, patients are given a precisely measured and pure dose of the psychedelic substance, which can never be guaranteed when purchased from the street. Patients of true psychedelic integration also have a professional to help them integrate their experience.

The Future of Psychedelic Integration
Johns Hopkins University founded the Center for Psychedelic and Consciousness Research in 2019 with the goal of continuing the pursuit of knowledge in regard to psychedelic science. Researchers are currently studying how psilocybin can treat addiction and even conditions such as Alzheimer’s Disease.
The FDA in the United States named psilocybin a “breakthrough therapy” which removed some red tape from its use in clinical trials and research. This has allowed for psilocybin and LSD in some cases to be used in clinical trials studying various aspects of psychedelic integration in treatment of depression, stress, and alcohol addiction.

Scientists are optimistic on the future of psychedelic integration. Research has shown that psychedelics have much promise in treating a wide variety of mental health conditions through psychedelic integration centers.

Are Psychedelics Safe for Use with Psychedelic Integration?
Over the course of over half of a century, tens of thousands of patients have participated in official clinical psychedelic integration sessions. All sessions are controlled from start to finish, and there have been no complaints of safety in reference to any psychedelic integration sessions.

Psychedelic Integration Near Me
Reconscious Medical is the premier psychedelic telemedicine company. We work with each of our patients to ensure you are getting the psychedelic integration treatment you need.

We follow the latest psychedelic integration research and ensure your psychedelic therapist is a great match for you and your situation. Reconscious Medical uses the latest technologies to ensure you are receiving treatment from the best of the best of the psychedelic integration companies.

Clinical trials have found that ingesting psychedelics under professional supervision is a generally safe practice that results in positive and profound, long term changes in thought, personality, and behavior.

Questions about Psychedelic Integration?
Contact us today to see if Reconscious Medical is a good fit for your psychedelic telemedicine or therapy needs, whether you are a patient or a practitioner.


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