- Psychedelic Research and You. Well, Maybe, not You - April 10, 2019
- Psychedelic Research and You. Well, Maybe, not You - April 10, 2019
Introduction
As African Americans in the academy, we have seen how biases skew what is often considered “objective” work, and these presentations can be observed in both explicit and implicit ways
Psychedelic research is noticeably lacking both participants of color and researchers of color, and “objective” thought patterns are the cause. Clinical research is intended to offer an objective window into new knowledge needed to improve the human condition. Then, when we believe we have learned something worth sharing, we generalize these discoveries to all those who were unable to be a part of the studies conducted. Like any facet of research, psychedelic medicine relies on such methods and subsequent generalizations to help understand and predict how people can be helped. At the same time, it is difficult to make an accurate generalization if the research conducted lacks proper context. As African Americans in the academy, we have seen how biases skew what is often considered “objective” work, and these presentations can be observed in both explicit and implicit ways. The common population pools for most psychedelic studies are an example of this. Many psychedelic studies thus far have contained only white populations, and there is much to be desired when attempting to generalize such findings to people of color. The proportion of people of color with mental illnesses is vastly underestimated,1 and their limited inclusion requires deliberate steps to increase their participation to provide us with an understanding of how psychedelic medicine can be helpful for all, and not just some.
Unique Challenges Facing People of Color
People of color are interested in, but are often, and rightfully, wary of research.
Many people of color experience race-based stress continually throughout their lives. This affects how they experience psychiatric disorders and how they are affected by treatment for their disorders. It has been evidenced that attempts to include participants of color in research studies are met with difficulty in retaining them.2 Patients of color underutilize treatment when they require it,3 so it is immensely important that clinicians work to maintain participants of color in both research and treatment. People of color are interested in, but are often, and rightfully, wary of research. To ensure that people of color have increased comfort in psychedelic research settings, it is vastly important for aspiring and current researchers to learn culturally-competent methods that communicate trust and understanding. By implementing such practices, researchers can assure participants that they are safe in such studies, and properly address their absence.
Specific Barriers to Inclusion
One cause for the absence of people of color in psychedelic research is a lack of culturally-competent researchers. Culturally-competent researchers are aware of factors like microaggressions that play a role in the daily lives of people of color. Microaggressions are a form of subtle racism that affects the targeted individual in a multitude of negative ways. Research has shown that people of color are as adept as experts in detecting microaggressions in their interactions with white people,4 and these aggressions can induce negative responses in the form of both anxiety and depression. The more discrimination a person experiences, the higher the likelihood to experience anxiety disorders, mood disorders, and substance abuse disorders.5 Microaggressions then affect how they utilize treatment and what results they see from it. Training researchers in culturally-competent ways prepares them to helpfully understand the experiences of clients of color in American society. Participants of color recognize when researchers lack cultural competence, and prefer when the individual they are working with possesses such traits.6 Training culturally-competent researchers raises the likelihood of participants of color remaining in studies, and ensures findings can be more accurately explored.
Inclusion Thus Far
To examine the inclusion of people of color in psychedelic research, Michaels, Purdon, Collins, and Williams7 reviewed the demographic breakdown of people of color in 18 psychedelic-assisted therapy research studies. The studies they selected were from 1997 to 2017, and they wanted to determine if existing psychedelic research could be generalized to people of color. The NIH standards mandate that studies include a wide variety of participants; yet, 60% of studies did not include racial or ethnic information for their participants. After the researchers for the studies were contacted, it was found that the number of participants of color present were not being tracked. In two instances, the racial and ethnic makeup of the participants was estimated purely based on the research staff’s recollection, rather than carefully tracking. The total participant pool for all of the studies was 282. More than 80% of this pool was white, and less than 5% were of African, Latino, Asian, mixed or indigenous origin. As previously mentioned, the NIH demands that minorities and women be included in representative numbers in all NIH-funded studies. Prior to 1993, when the NIH Revitalization Act was passed, there was no such requirement for research. While not every research study will be NIH funded, the authors8 argue that research as a whole will benefit from adopting NIH-like guidelines to help increase the inclusion of people of color.
The recruitment of people of color from 1995 to 2016 only rose from 36.7%, to 37.2%. (National Institute of Health, 2010; National Institute of Health, 2016). Researchers are not held accountable for failing to include participants of color, and this is a problem
Still, the Revitalization Act9 is not perfect. It appeared to be a great way to hold researchers accountable for conducting research that serves more than just white people, but the numbers disagree. The recruitment of people of color from 1995 to 2016 only rose from 36.7%, to 37.2%. 1011 Researchers are not held accountable for failing to include participants of color, and this is a problem. To further add to the issue, many studies in the US, such as MAPS (Multidisciplinary Association of Psychedelic Studies), are privately funded, and such studies do not have to abide by NIH guidelines. MAPS, which was created in 1986, is a non-profit organization that allows researchers to pursue FDA drug development without reliance on government funding. This supports researchers’ interest in studying a variety of uses for psychedelic medicine with fewer governmental related limitations.
Much like the past, researchers of the present often miss the importance of cultural considerations, including the need for participants of varying races and ethnicities. As psychological disorders impact a multitude of individuals, we would argue that that the NIH mandate is incomplete, but is a good beginning standard for how to fairly conduct studies. Still, discussions such as this must always be closely tied to the time when they were enacted. It must never be forgotten that striving for improvement is good, but continued improvement is what is great. Rising generations of psychedelic researchers and present researchers need to understand the importance of cultural considerations.
History of Psychedelic Medicine and People of Color
Originally, psychedelic medicine began with the practices of indigenous people all over the globe. When the Western world “discovered” psychedelics in the 1950s, Western research into psychedelic medicine began. Sadly, so did the purposeful exclusion of its indigenous originators and other groups of color. Through Presidents Nixon and Reagan’s War on Drugs, people of color were further excluded due to stigma. This presentation of drugs as a by-product of deviance among people of color did immense harm. It further normalized studies mainly containing white people, and made many people of color living with mental disorders reluctant to seek drug-related aid.
Training culturally-competent researchers is a start, but training and supporting researchers of color is also a part of the discussion
In the same breaths that we discuss the inclusion of participants of color, we also must mention the need for more researchers of color. Analysis of the American Community Survey showed that white people made up 84% of the psychological workforce in 2016, and each person of color group made up 5% or less of it respectively.12 This reality can be daunting. People of color frequently lack the comfort of having a provider that is matched with them racially or ethnically, and this is another component germane to why they are absent from studies in psychedelic medicine. More specifically, it shows why such studies are unable to maintain people of color as participants when they do sometimes initially elect to participate in studies of psychedelic medicine. Training culturally-competent researchers is a start, but training and supporting researchers of color is also a part of the discussion.
Conclusion
In order to increase representation in psychedelic medicine, it is paramount that researchers take the time to reassess the barriers people of color face surrounding inclusion and how they may even contribute to them. As the field continues to remain one that largely benefits white people, it supports the feeling many people of color have that they do not belong in it. To properly generalize findings, acknowledge their biases, and improve the field, researchers must put more effort into including people of color in higher numbers. To guarantee this is done, it is necessary for researchers to be trained in and use culturally competent practices. These practices will not only help maintain participants of color, but encourage researchers to reassess which interventions are suited for helping people of color. Inclusion is a holistic process. In order to ensure it is done properly, it must be done at all levels of research. If the field does not question its own history and its present, the same problems will continue.
Table 1. Number of Active Psychologists by Race/Ethnicity, 2007-2016
Art by Karina Alvarez.
Note. Reprinted from Lin, L., Stamm, K., & Christilds, P. (2018). Demographics of the U.S. psychology workforce: Findings from the 2007 – 16 American Community Survey. Washington, DC: American Psychological Association. Retrieved from https://www.apa.org/workforce/publications/16-demographics/table-7.pdf
Source: 2007-2016ACS PUMS files,U.S.Census Bureau
References
- Williams, M. T., Printz, D. M. B., & DeLapp, R. C. T. (2018). Assessing racial trauma with the trauma symptoms of discrimination scale. Psychology of Violence, 8(6), 735–747. ↩
- Warner, E. T., Glasglow, R. E., Emmnons, K. E., Bennett, G. G., Askew, S., Rosner, B., & Colditz, G. A. (2013). Recruitment and retention of participants in a pragmatic, randomized intervention trial at three community health clinics: Results and lessons learned. BMC Public Health, 13, 192–203. ↩
- Warner, E. T., Glasglow, R. E., Emmnons, K. E., Bennett, G. G., Askew, S., Rosner, B., & Colditz, G. A. (2013). Recruitment and retention of participants in a pragmatic, randomized intervention trial at three community health clinics: Results and lessons learned. BMC Public Health, 13, 192–203. ↩
- Michaels, T., Gallagher, N., Crawford, M., Kanter, J. W., & Williams, M. T. (2018). Racial differences in the appraisal of microaggressions through cultural consensus modeling. The Behavior Therapist, 314–321. ↩
- Chou, T., Asnaani, A., & Hofmann, S. G. (2011). Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups. Cultural diversity & ethnic minority psychology, 18(1), 74–81. ↩
- Owen, J. J., Tao, K., Leach, M. M., & Rodolfa, E. (2011). Clients perceptions of their psychotherapists’ multicultural orientation. Psychotherapy, 48(3), 274–282 ↩
- Michaels, T., Purdon, J., Collins, A., & Williams, M. (2018). Inclusion of people of color in psychedelic-assisted psychotherapy: A review of the literature. BMC Psychiatry, 18(245), 1–9. ↩
- Michaels, T., Gallagher, N., Crawford, M., Kanter, J. W., & Williams, M. T. (2018). Racial differences in the appraisal of microaggressions through cultural consensus modeling. The Behavior Therapist, 314–321. ↩
- National Institutes of Health. (1994). NIH guidelines on the inclusion of women and minorities as subjects in clinical research. Federal Register, 59, 1408–1413. ↩
- National Institute of Health. (2010). Report of the advisory committee on research on women’s health fiscal years 2009-2010 (NIH Publication No. 11–7749). Bethesda, MD: U.S. Office of Research on Women’s Health. ↩
- National Institute of Health. (2016). Report of the advisory committee on research on women’s health fiscal years 2015-2016 (NIH Publication No. 17 OD 7995). Bethesda, MD: U.S. Office of Research on Women’s Health. ↩
- Lin, L., Stamm, K., & Christilds, P. (2018). Demographics of the U.S. psychology workforce:Findings from the 2007 – 16 American Community Survey. Washington, DC: American Psychological Association. ↩
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