Decriminalization offers an ethical counterbalance to address sexual misconduct in psychedelic therapy

By Lily Kay Ross, PhD|May 20, 2020

Sexual violence is already notoriously under-reported, and barriers— including distrust in police—are amplified when victims are also members of a criminalized subculture and were under the influence of illegal drugs when the violence occurred.

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For the last five years I’ve been on hiatus from the psychedelic community, following my own experience of sexual victimization and the poor community response. I’ve gone on to complete a PhD focused on social responses to sexual violence. I also conduct best practice research on institutional responses, develop curriculums, write and consult on policies and procedures, and teach on sexual violence. All the while, I’ve kept one eye on the psychedelic movement, silently hoping to see the field advance while generally supporting mainstreaming and medicalization. The Kool-Aid I’d imbibed a decade earlier was still in my system, I guess. I thought making psychedelics available medically could make a positive difference in people’s lives.

In the last year my outlook has changed. I have been forced to grapple with the extent to which sexual violence is endemic to psychedelic therapy.

Abuses of power, especially those of a sexual nature, are especially pernicious and harmful in the context of psychedelic therapy for several reasons. First, there is the vulnerability of the population seeking this novel treatment. To be eligible for MDMA clinical trials, for example, one must demonstrate treatment resistant PTSD. This criteria is an important part of obtaining ethics approval for a novel treatment. By definition, these patients have tried multiple treatment options, to little or no avail. They are suffering, and obtaining effective relief may be a matter of life and death. This amplifies the power disparity between patients and clinicians in profound ways: a psychedelic clinician and the drug experience they offer may be a patient’s last hope.

Then there’s the matter of who actually wants to be a psychedelic therapist or play shaman, especially in the underground. It was clear to me, even ten years ago, that psychedelic spaces are home to many people interested in laying claim to spiritual power and authority, and preying on vulnerable people. There are numerous documented cases of people out to satisfy their own desires at the expense of those they claim to serve, and even more allegations and accusations floating around psychedelic communities, communicated in whispers and warnings.

Underground practitioners are an unregulated group of renegades, with minimal oversight and varying degrees of experience, training, and credentials. In some cases, they administer high doses of psychedelics to clients who are trying to heal deep psychological wounds. Sure, there are some good and ethical practitioners, but I have met over two hundred psychedelic therapists to whom I cannot comfortably and confidently refer people seeking treatment. The good ones, often, are the hardest to find.

We must think critically about how to reduce the power of practitioners to do harm and distribute power among people seeking psychedelic experiences, whether therapeutically motivated or not.

Decriminalization of psychedelic drugs would help address the problem of sexual misconduct by distributing access to these substances.

It could mitigate the problem by democratizing access, and allowing for greater choice of when, where, and with whom to take psychedelics. It could limit some aspects of the power held by psychedelic therapists by undermining their position as gatekeepers of psychedelic experiences. It could also reduce medical profiteering by providing alternatives to medicalized use, which may protect against corporate monopolies on access to psychedelic experiences.

Decriminalization could create scope to develop pathways for disclosure and ethical responses—for victims/survivors to tell their stories and seek help from informed others. It opens new avenues for justice. Sexual violence is already notoriously under-reported, and barriers— including distrust in police—are amplified when victims are also members of a criminalized subculture and were under the influence of illegal drugs when the violence occurred. Even in sanctioned settings, such as a clinical trial, stigma may deter filing a report or telling someone. When a victim is not afraid of persecution for their drug use, they may be more willing to tell a friend (friends are usually the first responders), ask for help, post about their experience online, or seek out an ethical oversight board with whom to file a formal complaint.

Frankly, decriminalization and democratization are necessary because too many professionals’ hands are dirty, both under- and aboveground. Of course, while not all practitioners are abusive, rapey, or otherwise exploitative, an alarming number of practitioners have participated in some form of silencing or enabling. Rick Doblin’s unwillingness to warn participants in MDMA clinical trials of the risks of sexual misconduct, or provide pathways for handling cases—especially in light of the history—is one obvious example. Olivia Goldhill reports that:

“‘The loving and trusting feelings that can be induced by MDMA can make patients more vulnerable to sexual pressure,’ wrote the head of MAPS. Yet he warned neither patients nor the FDA”

Allegations against Donna Dryer regarding her knowledge of her husband and co-facilitator Richard Yensen’s sexual transgressions—and her silence—are another example. But the issue is far more widespread. It’s not an issue of bad apples: the orchard is rotten.

For the last several decades, members of the psychedelic community have taken the contemptible stance that acknowledging the scope of the problem of sexual misconduct and abuses of power in the field poses a threat to the future of all psychedelic work. This should tell us something about the pervasiveness of the problem and the extent to which it is an open secret. What’s more, this culture of cover-ups, complacency, and active silencing of victims hurts those who are already suffering. Those who benefit from silencing victims/survivors are psychedelic therapists, researchers, and activists; preservation of the field amounts to preservation of their own jobs, incomes, and reputations.

After my experience of rape and violence, I was attacked for wanting to speak out. I was told that I was selfish, self-interested, and fame-seeking. I was warned that my speaking out would effectively end the psychedelic research movement and re-instigate the war on drugs. That same sentiment is on the record in Olivia Goldhill’s reporting on the problem of sexual abuse in psychedelic therapy:

“In the course of reporting this story, one psychedelics researcher Quartz reached out to said they didn’t want to be interviewed and warned that this article could have negative consequences for the field. ‘I’m a bit worried that mainly some very vocal people will be interviewed that will blame MAPS or the mainstreaming of psychedelic therapy for this incident, while these things are always much more nuanced and definitely not exclusive to psychedelic therapy,’ the researcher wrote in reply to Quartz’s email. ‘I think it is important to have a constructive dialogue around these issues and challenges, but it can easily become polarizing and potentially damaging to the current developments as well. I hope that you are aware of that and are approaching this carefully.’”

It’s important to note that the researcher who made the comment lacked the basic courage to put their name on the record and stand behind their own statements. They advance the toxic notion that telling the truth is the source of harm.

Harm is not done by those who seek to tell the truth: it’s done by those who are adamant that sexual violence and abuse must remain hidden.

Silencing tactics contribute to the long-term, devastating impacts of sexual violence on victims and survivors. Secondary victimization comprises its own area of research, focused on poor institutional responses across multiple sectors. Jennifer Freyd, a psychology professor at the University of Oregon, coined the term “institutional betrayal” and found worse outcomes for victims/survivors who were subjected to poor institutional responses. Such responses are often motivated by an institution’s reputational interest, which highlights the critical need for external oversight bodies and accurate measurements of the problem. Within the psychedelic community, one would hope that a group of people supposedly motivated by the alleviation of traumatic suffering would be a bit more savvy in how they respond to traumas happening in their own domain. At least, that’s what I once hoped. It turns out that my hope was gravely misplaced.

Goldhill’s article raises questions about the fundamental tenability of psychedelic-assisted therapy in a professional setting. We cannot divorce current practices from violent histories, and the history of these therapies is one of limited oversight, insufficient or absent training to prevent sexual misconduct, dead-end reporting pathways and protocols, and, troubling, zero indication that these gaps will be meaningfully addressed.

In spring 2019, MAPS published a Code of Conduct which outlines Sexual Boundaries. MAPS’ training involves discussion of erotic transference and sexual boundaries, which are necessary but not sufficient. Addressing sexual misconduct requires comprehensive, evidence-based prevention education strategies and clear avenues for holding therapists to account. In terms of external oversight, Goldhill’s Quartz article suggests that the FDA and IRB boards have been useless in intervening and providing necessary oversight to MAPS.

“All US clinical trials are overseen by an independent review board (IRB) and, in the trial consent documents, MAPS told trial participants to contact the IRB with any concerns or complaints. Buisson did so in January 2018, but says the IRB told her it could not investigate as the trial was over. The IRB did not respond to requests for comment.“

I used to believe in the potential of psychedelic therapy. After my rapist chose to assault and abuse me, I wanted to sound the alarm in a way that I hoped would preserve and nurture all that I found healing and good about psychedelic therapy, while rooting out sexual misconduct and hostility towards victims. But these patterns of violence are endemic to the psychedelic therapy movement. When people told me I risked destroying an entire movement that I loved, I believed them—I disappeared, went quiet, and left the community.

Now, I have come to the sad conclusion that any movement predicated on the belief that women and our safety are an acceptable sacrifice to a larger cause—especially causes with blatant histories of advancing at the expense of women—is a movement that I am unwilling to support. The ethical viability of the psychedelic therapy movement is in question—and not because victims are speaking out and finally being heard in our #MeToo world. No, it’s not the fault of victims. Responsibility lies on the shoulders of abusers and the people who have been enabling abusers and covering up for them for decades. MAPS, and their affiliates both under- and above-ground, have demonstrated that neither patients nor the public can trust them.

The greatest hope for introducing an ethical psychedelic therapy model is in conjunction with the decriminalization of all drugs.

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Lily Kay Ross, PhD

@ LilyKayRoss

Lily Kay Ross, PhD has been taking a feminist approach to theorizing ethics in psychedelic spaces since 2009, especially with regard to sexual misconduct, abuses of power, charlatans, and the dominance of traditional gender norms in psychedelic spaces. Her PhD research looks at how neoliberal discourses burden victim/survivors of sexual violence with the directive to individually overcome social problems, and the trouble with posttraumatic growth. Her other projects advance best practice and evidence based policies and responses to sexual harm. She is a feminist writer, educator, and violence prevention facilitator. After a five year hiatus from psychedelics, she’s happy to be home.