- The Paradox of Set and Setting in the American Psychedelic Experience - September 23, 2020
- Bridging the Generation Gap in the Psychedelic Community - September 17, 2020
- Ayahuasca Singing, Indigenous Knowledge, and Decolonization - September 10, 2020
Journal of Psychedelic Studies
Guest Editors: Monnica Williams, PhD (University of Connecticut) and Beatriz Labate, PhD (Chacruna/CIIS)
Monnica T. Williams is a board-certified licensed clinical psychologist and Associate Professor at the University of Connecticut in the Department of Psychological Sciences and Department of Psychiatry. She is also Clinical Director of the Behavioral Wellness Clinic, where she provides supervision and training to clinicians for empirically-supported treatments. Prior to her move to Connecticut in 2016, Dr. Williams served as the Director of the Center for Mental Health Disparities at the University of Louisville in the Department of Psychological and Brain Sciences. Dr. Williams’ research focuses on African American mental health, culture, and psychopathology, and she has published over 100 scientific articles on these topics. Current projects include the assessment of race-based trauma, unacceptable thoughts in OCD, improving cultural competence in the delivery of mental health care services, and interventions to reduce racism. This includes her work as a PI in a multisite study of MDMA-assisted psychotherapy for PTSD. She also gives diversity trainings nationally for clinical psychology programs, scientific conferences, and community organizations. Dr. Williams is Associate Director of the Chacruna Institute for Psychedelic Plant Medicines. Dr. Williams is Chair of the Board of Directors of the Chacruna Institute for Psychedelic Plant Medicines.
Dr. Beatriz Caiuby Labate (Bia Labate) is a queer Brazilian anthropologist who immigrated to the U.S. in 2017. She has a Ph.D. in social anthropology from the State University of Campinas (UNICAMP), Brazil. Her main areas of interest are the study of plant medicines, drug policy, shamanism, ritual, and religion. She is Executive Director of the Chacruna Institute for Psychedelic Plant Medicines (https://chacruna.net), an organization that provides public education about psychedelic plant medicines and promotes a bridge between the ceremonial use of sacred plants and psychedelic science. She is Adjunct Faculty at the East-West Psychology Program at the California Institute of Integral Studies (CIIS) in San Francisco, and Visiting Professor at the Center for Research and Post Graduate Studies in Social Anthropology (CIESAS) in Guadalajara. She is also Public Education and Culture Specialist at the Multidisciplinary Association for Psychedelic Studies (MAPS). She is co-founder of the Interdisciplinary Group for Psychoactive Studies (NEIP) in Brazil, and editor of NEIP’s website (http://www.neip.info), as well as editor of the Mexican blog Drugs, Politics, and Culture (http://drogaspoliticacultura.net). She is author, co-author, and co-editor of twenty-one books, one special-edition journal, and several peer-reviewed articles (http://bialabate.net).
While it is exciting to witness the culmination of decades of drug policy advocacy and clinical research, the psychedelic science movement struggles with many of the same social issues that plague healthcare in general. The healing properties of plant medicines and their derivatives were originally brought to Western consciousness by indigenous cultures from around the world. These practices are now being adapted to Western models of healthcare, in part, to achieve governmental approval as medical treatments. The current models of psychedelic psychotherapy being utilized in clinical trials are resource-intensive and therefore likely to remain out of reach for the socioeconomically disadvantaged if approved as medical treatments. Moreover, people of color and women are uncommon in leadership positions in the psychedelic research community, and few people of color are included as research participants in psychedelic studies. This piece introduces a special issue with a focus on issues of diversity, equity, and accessibility in psychedelic medicine.
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Table of contents
Diversity, equity, and access in psychedelic medicine
Monnica Williams & Bia Labate
Although it is exciting to witness the culmination of decades of drug policy advocacy and clinical research, the psychedelic science movement struggles with many of the same social issues that plague healthcare in general. The healing properties of plant medicines and their derivatives were originally brought to Western consciousness by indigenous cultures from all over the world. These practices are now being adapted to Western models of healthcare, in part, to achieve governmental approval as medical treatments. The current models of psychedelic psychotherapy being utilized in clinical trials are resource-intensive and therefore likely to remain out of reach for the socioeconomically disadvantaged if approved as medical treatments. Moreover, people of color and women are uncommon in leadership positions in the psychedelic research community, and few people of color are included as research participants in psychedelic studies. This piece introduces a special issue with a focus on issues of diversity, equity, and accessibility in psychedelic medicine.
The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion
Jamilah R. George, Timothy Michaels, Jae Sevelius, & Monnica T. Williams
In recent years, the study of psychedelic science has resurfaced as scientists and therapists are again exploring its potential to treat an array of psychiatric conditions, such as depression, post-traumatic stress disorder, and addiction. The scientific progress and clinical promise of this movement owes much of its success to the history of indigenous healing practices; yet the work of indigenous people, ethnic and racial minorities, women, and other disenfranchised groups is often not supported or highlighted in the mainstream narrative of psychedelic medicine. This review addresses this issue directly: first, by highlighting the traditional role of psychedelic plants and briefly summarizing the history of psychedelic medicine; second, through exploring the historical and sociocultural factors that have contributed to unequal research participation and treatment, thereby limiting the opportunities for minorities who ought to be acknowledged for their contributions. Finally, this review provides recommendations for broadening the Western medical framework of healing to include a cultural focus and additional considerations for an inclusive approach to treatment development and dissemination for future studies.
The role of Indigenous knowledges in psychedelic science
This paper reflects on potential contributions from anthropology to the field of “psychedelic science.” Although the discipline’s beginnings went hand in hand with colonialism, it has made significant contributions to the understanding of Indigenous knowledge systems. Furthermore, recent calls to decolonize our theoretical frameworks and methodology, notably the “ontological turn,” open up the space for engaging meaningfully with Indigenous worldviews. At this critical juncture of the “psychedelic renaissance,” it is important to reflect on whether the current model is satisfactory and on ways to decolonize psychedelic science. What we need is a shift in paradigm, one that will acknowledge the validity of Indigenous worldviews as equal partners to scientific inquiry. Acknowledging the contributions of Indigenous knowledges to psychedelic science is necessary and needs to go hand in hand with attempts to revise biomedical models to be more inclusive in substantial ways. The paper does not argue for the abandonment of the scientific paradigm, rather for the abandonment of its privileged position. Decolonizing psychedelic science will require allowing multiple perspectives to coexist and contribute equally to our efforts going forward.
Reflections on crafting an Ayahuasca Community Guide for the Awareness of Sexual Abuse
Daniela Peluso, Emily Sinclair, Beatriz Labate & Clancy Cavnar.
This commentary serves to reflect upon the conception and development of a set of guidelines for the awareness of sexual abuse in ayahuasca settings, an assortment of scenarios that take place in local and global settings entailing the use of a psychedelic brew known for producing visionary and purgative effects composed of Amazonian Banisteriopsis caapi (ayahuasca vine) most commonly combined with the leaves of Psychotria viridis (chacruna) or Diplopterys cabrerana (chaliponga). The globalization and diaspora of ayahuasca expertise, usage, and plant materials has broadened the diversity of individual and group interactions and geographical and social contexts in which this hallucinogenic concoction is ingested, and thus given rise to a range of possibilities which also may, despondently, include possibilities for sexual harassment and abuse. Here, the authors raise the key issues and processes that have led to formation, publication, and dissemination of the Chacruna Institute for Psychedelic Plant Medicines’ Ayahuasca Community Guide for the Awareness of Sexual Abuse, focusing specifically on the needs for such guidelines, as well as the challenges faced in collaboratively creating them. The creation of guidelines as a form of education is a task wrought with concerns, as they must first and foremost convey the fact that abuse is never the victim/survivor’s fault, and yet they must also aim to inform individuals of potential common scenarios that can lead to abuse. In this sense, guidelines themselves are held up to scrutiny, and the process of collaboratively crafting the Chacruna Institute for Psychedelic Plant Medicines’ Ayahuasca Community Guide for the Awareness of Sexual Abuse has not been an exception. The authors stress the importance of research and experience in understanding the complexities of the contexts in which potential abuse can occur, particularly around issues of consent and intercultural communication. The overall aim is one of education at all levels; not just in better informing participants but, in doing so, being part of a broader goal of changing the potential scenarios themselves.
Making psychedelics into medicines: The politics and paradoxes of medicalization
Tehseen N. Noorani
This commentary considers efforts to turn psychedelics into medications that can be administered through healthcare systems as examples of “medicalization.” I draw on ethnographic research both inside and outside of university-based clinical trials from 2014 to date, together with analogous examples from psychiatry and drug research and development. Rather than taking a normative stance on medicalization, I situate it in a wider political, economic, and cultural context to better understand its logics and effects. I begin by suggesting the resurgence of psychedelic science has been concerned with medicalization from the outset, recently prompting a crisis in the “psychedelics community” over its self-identity and values. Next, against the confident public messaging surrounding psychedelics, I consider how attempts to scale up and market psychedelic-assisted therapy could end up undermining the safety and efficacy of the therapy itself. I then outline the movements to decriminalize, legalize, and minimize the harms and risks of using psychedelics in their currently illicit therapeutic and recreational modalities. Finally, I explore how working toward psychedelic medicalization over the coming years may influence the movements toward decriminalizing and legalizing psychedelics use, focusing on the underarticulated ways in which medicalization may disregard or even hinder, rather than help, decriminalization and legalization efforts. I call attention to how the cost of gaining approval for therapies incentivizes the development of diluted-yet-profitable forms of psychedelic-assisted treatments, and how frameworks developed for “proper use” demarcate what counts as “abuse” and enable those with newly sanctioned access to psychedelics to condemn afresh their illicit use.
Culturally informed research design issues in a study for MDMA-assisted psychotherapy for posttraumatic stress disorder
Monnica Williams, Sara Reed, & Rikita Aggrawal
Recent research suggests that psychedelic drugs can be powerful agents of change when utilized in conjunction with psychotherapy. Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy has been studied as a means of helping people overcome posttraumatic stress disorder, believed to work by reducing fear of traumatic memories and increasing feelings of trust and compassion toward others, without inhibiting access to difficult emotions. However, research studies for psychedelic psychotherapies have largely excluded people of color, leaving important questions unaddressed for these populations. At the University of Connecticut, we participated as a study site in a MAPS-sponsored, FDA-reviewed Phase 2 open-label multisite study, with a focus on providing culturally informed care to people of color. We discuss the development of a study site focused on the ethnic minority trauma experience, including assessment of racial trauma, design of informed consent documents to improve understanding and acceptability to people of color, diversification of the treatment team, ongoing training for team members, validation of participant experiences of racial oppression at a cultural and individual level, examination of the setting and music used during sessions for cultural congruence, training for the independent rater pool, community outreach, and institutional resistance. We also discuss next steps in ensuring that access to culturally informed care is prioritized as MDMA and other psychedelics move into late phase trials, including the importance of diverse sites and training focused on therapy providers of color.
Race as a component of set and setting: How experiences of race can influence psychedelic experiences
Set and setting functions both as a concept that guides research and practice with psychedelic drugs, as well as a meme aimed at reducing harm among psychedelic users. Referring to non-pharmacological factors that shape drug experiences, practices of indigenous cultures indicate that people around the world have been mindful of these factors for many years. Yet, the concept of set and setting was not popularized until the mid-twentieth century. Aside from the work of Eisner (1997) and Hartogsohn (2017), little theoretical development has occurred regarding what falls under the umbrella of set and setting since its conception. By bridging set and setting theory with research from the fields of social psychology and sociology of medicine, this review calls attention to how race can contribute the set and setting for a psychedelic experience. I argue that psychosocial factors influencing racial differences in mental health, also constitute meaningful differences in set. Further, I suggest that the character of race relations in the United States provides a distinct cultural setting for non-white psychedelic users, both in therapeutic and naturalistic contexts. In turn, racial identification may contribute to the variation in framing and interpretation of psychedelic experiences. These considerations have important implications for developing protocol for clinical applications of psychedelics, educating future practitioners, and meeting the needs of diverse patient populations. Moreover, investigating race in relation to set and setting serves to enhance our understanding of non-pharmacological variables on drug experiences.
Intersectional insights from an MDMA-assisted psychotherapy training trial: An open letter to racial/ethnic and sexual/gender minorities
The road to the current psychedelic renaissance in research on ±3,4-methylenedioxymethamphetamine (MDMA) – the active ingredient of the drug Ecstasy – for addressing treatment-resistant post-traumatic stress disorder has been fraught with political and academic bias, as well as cultural stigma among underserved populations, all of which serve as barriers to minority inclusion and participation. In this open letter to ethnic/racial and sexual/gender minorities, the author details intersectional insights from his own experience being administered MDMA legally as part of a therapist training trial for MDMA-assisted psychotherapy, in hopes of radically destigmatizing this treatment approach for marginalized populations. Themes covered include: set and setting; cultural pride; LGBTQIA+ pride; acceptance of intersectionality; and patience, perspective, and strength in retrospection. This letter concludes by tasking current investigators of MDMA-assisted psychotherapy to emphasize issues of intersecting identities (e.g., in terms of race, ethnicity, sexual orientation, and gender identity) in their research agenda, attempt to improve minority participation in a culturally attuned manner, as well as increase minority stakeholdership in this field.
Considerations for psychedelic therapists when working with Native American people and communities
Although Native American communities are unique in their beliefs, traditions, and languages, there are some fundamental common belief systems shared by most Native American cultures. Therapists and other practitioners engaging in a healing relationship with Native Peoples should be aware of these fundamental aspects of the Native American culture. This includes trust/respect, confidentiality outside of the context therapeutic setting, culturally based therapy that is inclusive of Native American traditions, and culture, and making efforts to gain an understanding of the culture with which one will be interacting.
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Art by Mariom Luna.
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