- 10 Calls to Action: Toward an LGBTQ-Affirmative Psychedelic Therapy - October 17, 2019
Combating Heteronormative Paradigms in Psychedelic Science
To my friends in the psychedelic community: we have rainbow skeletons in our closet. Many people do not realize psychedelic medicines were historically used as “conversion therapies” to treat lesbian, gay, bisexual, transgender, and queer people to become cisgender heterosexuals
To my friends in the psychedelic community: we have rainbow skeletons in our closet. Many people do not realize psychedelic medicines were historically used as “conversion therapies” to treat lesbian, gay, bisexual, transgender, and queer people to become cisgender heterosexuals. [9. Cavnar, C. (2018). Can psychedelics “cure” gay people? Chacruna.net. Retrieved from https://chacruna.net/can-psychedelics-cure-gay-people/] [10. Kingsland, J. (2019). The shameful history of psychedelic gay conversion therapy. Plastic Brain. Retrieved from https://plasticbrainblog.com/2019/05/29/history-psychedelic-gay-conversion-therapy/] Psychedelics were employed as tools of oppression targeting LGBTQ people in anti-therapeutic ways. We have yet to reckon with the historical harms inflicted on sexual minority people, as many of those harms continue to be perpetrated today. It is the aim of this short article to educate about our past failings, describe our current shortcomings, and offer constructive actions for the future.
The history of psychedelic homophobia is replete with harrowing stories of LGBTQ people targeted for treatment of “sexual perversion.” A recent article in The Lancet Psychiatry reports that women in the United Kingdom were treated with LSD to “overcome their sexuality”.[6. Carr, S., & Spandler, H. (2019). Hidden from history? A brief modern history of the psychiatric “treatment” of lesbian and bisexual women in England. The Lancet Psychiatry, 6(4), 289–290.] We also know from published case reports that large doses of LSD were used in conversion therapies to treat patients including: “one transsexualist, one transvestist, five male homosexuals, and one female homosexual”.[3. Ball, J. R., & Armstrong, J. J. (1961). The use of LSD 25 (d-lysergic acid diethylamide) in the treatment of the sexual perversions. Canadian Psychiatric Association Journal, 6(4), 231–235.] The conversion clinicians boasted success in turning gay men straight. For example, after being administered 200 micrograms of LSD, one homosexual male patient refrained from homosexual activity for eight months following treatment. The researchers applauded his progress, reporting that he “felt only once the impulse to indulge in frottage and that only fleetingly. He is much happier, relaxed and contented and claims to be better than he has ever been since his perversion began”.[4. Ball, J. R., & Armstrong, J. J. (1961). The use of LSD 25 (d-lysergic acid diethylamide) in the treatment of the sexual perversions. Canadian Psychiatric Association Journal, 6(4), 231–235.]
The misuse of psychedelic medicines to treat “sexual perversion” occurred on both sides of the Atlantic. A recent study discovered accounts of 12 men with same-sex attraction who were treated with LSD-25 at Hollywood Hospital in British Columbia, then a preeminent international psychedelic center that treated Cary Grant and others. Treatment with LSD often failed to produce a “satisfactory heterosexual adjustment”.[8. Ens, A. (2019). “Wish I would be normal”: LSD and homosexuality at Hollywood Hospital, 1955–1973 (Master’s thesis). University of Saskatchewan, Saskatchewan, Canada.] Masters and Houston, in contrast, claimed that treating more than a dozen gay male volunteers with peyote led to “heterosexualization”.[7. Cavnar, C. (2018). Can psychedelics “cure” gay people? Chacruna.net. Retrieved from https://chacruna.net/can-psychedelics-cure-gay-people/]
These are not marginal cases. Throughout the 1960s, the psychedelic movement was saturated with profoundly homophobic thinking, and respected luminaries publicly touted LSD’s ability to make you straight. Timothy Leary proclaimed, “The fact is that LSD is a specific cure for homosexuality”. [15. Playboy. (1966). Playboy interview: Timothy Leary. Retrieved from https://archive.org/details/playboylearyinte00playrich/page/n1] Ram Dass, then known as Richard Alpert, also used psychedelic medicines to encourage gay men to become heterosexual. Alpert published accounts in which he claimed treatment with LSD helped his “homosexual” patient stay in a long-term relationship with a woman and that “they have been having intercourse every night”.[1. Alpert, R. (1969). LSD and sexuality. The Psychedelic Review, 10, 21–24.] Alpert himself was closeted at the time and later spoke publicly about being attracted to men.
Of course, these studies must be understood in the historical context in which homosexuality was considered a disordered pathology. It was not until 1973 that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Today, conversion therapy is considered to be unethical, anti-therapeutic, and profoundly harmful to those who undergo it.
Today, conversion therapy is considered to be unethical, anti-therapeutic, and profoundly harmful to those who undergo it. The American Psychological Association Task Force reported risks involved “confusion, depression, guilt, helplessness, hopelessness, shame, social withdrawal, suicidality, substance abuse, stress, disappointment, self-blame” and other adverse effects.[2. American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (2009). Report of the American Psychological Association task force on appropriate therapeutic responses to sexual orientation. Washington, DC: Author.] Such practices have been widely outlawed or condemned by professional organizations, including the American Medical Association, the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers, and the American College of Physicians. I have frequently treated survivors of conversion therapies in my practice as a psychologist, and it is painful to witness firsthand this type of psychological harm.
Psychedelic researchers and therapists in academic settings continue to proceed without examining their straight and cisgender privileges.
These are the rainbow skeletons in our closet. This is our shameful past. All of this history has been buried, and it is time to unearth it. Yet, there has been almost no meaningful discourse in the psychedelic research community about it. Psychedelic researchers and therapists in academic settings continue to proceed without examining their straight and cisgender privileges.
None of the quantitative psychedelic research in the last 15 years has published on the differential effects of psychedelic treatments as they apply to sexual and gender minority people—cisgender straight norms are assumed throughout.
For example, we continue to require “male/female” therapy dyads in many clinical trials, which revert to traditional gender role stereotypes, essentialize gender, and instantiate a gender binary that disenfranchises trans* people. The male/female dyad presumes that the reproduction of a mother and a father in the form of a heteronormative family is a valuable and valid tradition, as though it offered a comforting sense of safety for all. Additionally, despite recent progress by MAPS, many psychedelic clinical trials still do not assess for sexual orientation, gender identity, preferred name, or pronouns on intake. None of the quantitative psychedelic research in the last 15 years has published on the differential effects of psychedelic treatments as they apply to sexual and gender minority people—cisgender straight norms are assumed throughout.
This must be remedied. We can do better. The only way to dismantle non-affirming practices against LGBTQ people in psychedelic research is for all of us to take proactive steps on every level. We must actively work to not propagate heteronormative paradigms.
Here are ten steps we can take as a community to systemically root out homophobia and transphobia in our policies and practices.
1. Confront structural heterosexism and transphobia at every level.
Address structural factors in psychedelic research: the predominance of white straight cisgender male researchers, funding structures, research priorities, and lack of LGBTQ patient-centric approaches.
2. Retire the male/female dyad and replace with gender neutral dyads.
The male/female therapist dyad is gender essentializing. Move away from gender stereotyped role assumptions. Move toward gender-neutral and client-specific approaches, so that therapist pairings are made on the basis of individual clinical profiles, trauma histories, and gender preferences.
3. Acknowledge that sexual minority stress causes disproportionate harm to LGBTQ people.
Sexual minority individuals have twice or greater the average rates of depressive, anxiety, and panic disorders, as well as problematic alcohol use as compared to heterosexual peers. This is not due to sexual identity, but rather to the extra stress that LGBTQ people face on a regular basis throughout their lives. This must be acknowledged in our therapeutic work.
4. Research the question of differential responses between LGBTQ individuals and a heteronormative population.
Assess sexual orientation and gender identity in all psychedelic studies. Run subgroup analyses to evaluate treatment response for sexual minority people. Run meta-analyses across studies to aggregate data for LGBTQ populations.
5. Create new affirmative therapies by, with, and for LGBTQ people.
Develop and test LGBTQ-affirming psychedelic-assisted psychotherapies (QA-PAP). The new approach would be guided by evidence-based principles of affirmative psychotherapy. [11. Proujansky, R. A., & Pachankis, J. E. (2014). Toward formulating evidence-based principles of LGB-affirmative psychotherapy. Pragmatic Case Studies in Psychotherapy, 10(2), 117.] [12. Pachankis, J. E. (2014). Uncovering clinical principles and techniques to address minority stress, mental health, and related health risks among gay and bisexual men. Clinical Psychology: Science and Practice, 21(4), 313–330.] A model pathway is provided by Dr. John Pachankis.[13. Pachankis, J. E. (2014). Uncovering clinical principles and techniques to address minority stress, mental health, and related health risks among gay and bisexual men. Clinical Psychology: Science and Practice, 21(4), 313–330.] Development of an LGBTQ-affirmative psychedelic treatment would consist of three stages:
(a) qualitative research,
interviewing LGBTQ patients and expert mental health providers
(b) treatment development and pilot trial
(c) randomized-controlled trial of QA-PAP vs. a generic psychedelic-assisted psychotherapy. Identify unique LGBTQ stressors and mechanisms.
6. Do psychedelics lead to any change in sexual orientation? Do they make straight people less homophobic? Does psychedelic experience increase self-acceptance?
Despite the history of conversion therapy, many people have shared that psychedelics were helpful in exploring their gender and sexuality, and the psychedelic movement is intertwined with the sexual freedom and gay liberation movements. We should assess sexual and gender identity, attraction, sexual behavior, and internalized homophobia in all participants, pre- and post-treatment in all psychedelic studies. How do people change in regard to acceptance of repressed identities? Do reported sexual or gender identities change? Do gay individuals become less transphobic?
7. Pursue sex and sexuality research.
Incorporate the body, sensuality, sex, and sexuality in our research and praxis. Our current paradigms seem very sex-phobic.
8. Ally and get intersectional.
Address how our multiple identities (e.g., sexual identity, gender identity, race, ethnicity, class, indigenous status, immigration status, disability) affect each other (intersectionality). Ally with other target groups to dismantle pre- and post-colonialist patriarchal, homophobic, and transphobic structures in ayahuasca circles, underground work, and clinical research.
9. Access queer wisdom.
The psychedelic community can learn from queer people because our wisdom is intersectional; we come from every family, every walk of life, every religion, and every path. Our lineage is pluralism; we are by nature a convergence.
10. Queer the “Mystical Experience.”
Queer spirituality, like psychedelic spirituality, can be embodied, relational, political, and visionary.[5. Belser, A. B., Agin-Liebes, G., Swift, T. C., Terrana, S., Devenot, N., Friedman, H. L., … & Ross, S. (2017). Patient experiences of psilocybin-assisted psychotherapy: An interpretative phenomenological analysis. Journal of Humanistic Psychology, 57(4), 354–388.] Reform psychedelic spirituality research from its narrow lineage.
The psychedelic practices of the past may have been homophobic and transphobic, but our future need not be. It’s time for a reckoning with the heteronormative history of psychedelic research. Let’s join together to address and dismantle the subtler forms of cisgender heterosexual male privilege in our policies and practices today. I believe we are up to the task.
Alex is part of Chacruna’s Women, Gender Diversity, and Sexual Minorities Working Group. He presented this talk at our conference, Queering Psychedelics. Check it out here.
Art by Karina Alvarez.
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