Preach! On the ethics of psychedelic testimonials

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In 2012, when I was researching a book on ecstatic experiences, I had one such experience in a church in Wales, and abruptly became a Christian. News of my conversion spread through the church I attended in London, and a few weeks later, I was asked if I’d like to talk on stage with the famous vicar of the church. I foolishly imagined this would be a conversation between equals about faith and philosophy. Instead, the vicar said to me, just before I went on stage in front of 500 people, ‘think of it like an advert. Before: dirty shirt. Then Jesus. Now: clean shirt. On you go.’ I felt deeply uncomfortable, instrumentalized, turned into a cog in the miracle machine. My conversion didn’t last long after the high faded and my intellect started to ask questions.

Today, I see strong parallels between Christian evangelism and psychedelic culture, especially with regard to testimonials. Think of the central role that testimonials have played in the psychedelic renaissance, how the salvation stories of participants in the early trials have been retold over and over in articles, books, documentaries, films, and on stage at big psychedelic conferences. These first trial participants must feel like apostles in the early church — tell us again how psychedelics saved your life. Preach!

Testimonials also play a central role in the psychedelic retreat business. If you go onto Retreat Guru and pick any one of the 1300 upcoming psychedelic retreats currently advertised there, most of the retreat centres advertise themselves with video testimonials from customers. They are recorded on the last day of the retreat, with the participant staring into the camera wide-eyed as they testify to their incredible breakthrough.

Christian Angermayer, founder of atai Life Science, says this urge to tell the world about your psychedelic experience is one of the best reasons to invest in psychedelics. In a post this week explaining why he is increasing his stake in atai, he wrote:

I personally know so many people who have already found healing in psychedelics — and virtually all have since become an advocate. Some have simply shared their stories only in their own private circles, while others have done so very publicly. Quite simply, I have never met anybody who benefitted from psychedelics who does not wan to talk about it and extol their potential to others. Based on these personal experiences, I believe that once, approved, the market penetration will outpace conservative estimates, driven by word of mouth, personal testimonies and a passionate ‘patients turned ambassadors’ movement, all of course within the appropriate medical regulation and oversight.

This is, in fact, a conscious marketing strategy pursued by most psychedelic companies, non-profits and clinics — encourage your patients to become advocates and to go out and preach the good news. In the words of one ketamine clinic, which has partnered with the Multidisciplinary Associatio of Psychedelic Science (MAPS) on trials and is organizing a workshop at the MAPS conference in June: ‘In the MAPS model, we make believers out of those who have experienced ketamine-assisted therapy and trusted us.’

Patients turned ambassadors, patients made into believers. This is capitalist medicine meets evangelical religion.

Evangelical wellness

The psychedelics industry is copying the marketing strategy of Christianity, which grew from an obscure Jewish cult to the dominant cultural force of the last 2000 years thanks to the power of testimonies. The conversion stories of St Paul and St Augustine, in particular, wrote the code for what is arguably the most powerful narrative archetype in western civilization: ‘I was lost, but now I’m found.’

Modern culture may often reject Christianity, but it has repackaged many of its tropes, especially the salvation narrative. Many popular wellness movements use the narrative trope. Young Living Essential Oils, a leading homeopathic oils corporation, makes much of its founder Gary Young’s salvation story of recovery from a crippling back injury. Young Living Essential Oils discovered, as many wellness companies have, that if they encourage their customers to tell their salvation story, they can turn them into advocates or sales reps. It’s Christian revivalism turned into multi-level marketing capitalism.

Similar evangelical business models are often found in New Age spirituality. One prominent example is the human potential coaching company, Landmark Forum. Customers go through intense weekend-long personal development workshops which induce altered states and the feeling of being born again, and then they are urged to invite their friends and family to their ‘graduation’, where they get up on stage to share their story, and their guests are signed up for Landmark courses. In effect, Landmark places their clients into a highly suggestible state, then programs them to become marketing spam-bots. It’s an incredibly effective marketing technique. But is it ethical?

The ethics of testimonials

Testimonials play a central role in western medicine, wellness, and capitalism more generally. They’re an extremely powerful way to communicate the benefits of a new product or treatment. Statistics are fine, but nothing moves like a salvation story. The use of patient testimonies is standard practice in medical and pharmaceutical marketing in the United States — there are even companies whose only job is to seek out patients and train them to record video testimonials for medical companies. But these are treatments that are already approved by the FDA, not experimental treatments seeking approval. The testimonials are sought weeks after the treatment, not in the days after taking a mind-altering drug. And these drug treatments typically do not involve a psychotherapeutic relationship.

Sarah McNamee, a licensed psychotherapist, research professional, and former participant in a MAPS trial, who co-authored an excellent recent paper on the risks of abuse in psychedelic therapy, says: ‘There are a ton of complicated power dynamics involved and the potential for that to be exploitative is high, even after treatment/trial participation has ended. And that’s without psychedelics. With psychedelics, those ethical concerns are only increased.’

In psychotherapy, by contrast, the use of patient testimonials is a much more contentious ethical issue. The American Psychological Association Ethics Code does not allow psychologists to solicit testimonials from current therapy clients, nor does the National Association of Social Workers, the American Counsellors Association, or the UK Council for Psychotherapists, because of the risk of ‘undue influence’ from the therapist on the patient, which would exploit the trust and therapeutic bond built up during therapy.

There is significant risk of ‘undue influence’ on patients to give testimonies after psychedelic trials — they are taking a mind-altering drug which increases suggestibility, they may see dramatic short-term results, they’re taking part in trials receiving intense international media attention, and they are encouraged to see themselves as part of a historic spiritual movement whose leaders (Rick Doblin, Paul Stamets, Roland Griffiths and others) think that psychedelics will save humanity from destruction.

One shouldn’t deny participants their autonomy. Many want to share their story and become advocates for a therapy which they credit with saving their life, and which they very much want to be legal. But at the least, there are ethical issues to be considered when people emerge from an experimental treatment for mental illness and rapidly become international apostles for psychedelic religion.

Dr Mark Bolstridge, who worked on Imperial’s early psychedelic trials, says:

These are potentially vulnerable people exposing themselves to all & sundry, and essentially being exploited to market the product. It felt like unfair advertising to me. There are so many ethical factors to consider: a mind-altering suggestible drug in combination with the skewed power dynamic of the therapist willing the drug to make a difference, naturally leading to entry to the ingroup and then the inevitable progression to spokesperson lauding the drug and railing against the unfair drug laws.

Pedram took part in one of MAPS’ early trials of MDMA-assisted psychotherapy for PTSD in Canada. A couple of months later, he was on a stage with his study therapist at a psychedelic conference, sharing his experience to an audience of 450 people. He tells me:

When it comes to giving testimonials, I currently feel an inner conflict. I see the value of sharing stories, and at the time it felt great. I was experiencing the afterglow. The talk was very well received. People were crying. But looking back it felt somewhat wrong. I don’t think I was nuanced enough in my account. The treatment was incredible. But was it perfect? Far from it. There was a lack of aftercare and integration. As time has gone by, I’ve noticed the shortcomings more.

A patient’s story may be simplified, commodified, Disneyfied, and turned into a brief glowing advert for psychedelic therapy. And that may not tell the whole story. One of the co-authors of the article mentioned earlier on the risks of psychedelic abuse is Meghan Buisson, another participant in the MAPS trial of MDMA for PTSD. She told her salvation story at conferences and was hugged by Rick Doblin, while at the same time she was in a toxic and abusive relationship with her MAPS trial therapist, Richard Yensen. That part of the story was left out of the testimonial.

Until 2020, there were only around 200 psychedelic trial participants, and they did a lot of emotional labour for the movement. One trial participant, who has spoken at several conferences, says: ‘Speaking publicly about such personal matters has left me feeling rather exposed at times. It takes emotional and mental resolve to speak publicly about your most difficult experiences and answer the Q&As. It can feel like a very extractive process and leave participants feeling emotionally depleted.’

An ecstatic experience is never simple, and one’s feelings about it can be ambivalent and changeable. But at a conference you have a ten-minute slot and your healers invited you there for a glowing success story, so there is a pressure to hit the right notes.

Some psychedelic conferences have finally begun to feature negative or critical testimonials. At the NEST Harm Reduction conference in Palm Springs in November, the conference began with testimonies of psychedelic abuse, and also featured a man who’d tried to kill himself on DMT. Erica Siegal, the founder of NEST, says:

A healthy community must be able to listen to, honor, and respect dissenting opinions, narratives of harm, believe survivors, and help to improve the systems that perpetuate abuse. The majority of the psychedelic community has some pretty intense rose-colored glasses on right now. Instead of supporting individuals who have adverse reactions or are harmed by practitioners, many survivors of psychedelic harm are ignored, blamed, or in some extreme cases, threatened by psychedelic advocates in the hopes of silencing them to skew public opinion and media coverage to reflect their own personal or professional agendas.

Indeed, the psychedelic industry treats positive testimonials as moving and powerful evidence, while negative testimonials are sometimes dismissed as ‘anecdotes and misinformation’.

The ethics of retreat testimonials

There are similar ethical issues with retreat testimonials, but more so, because they’re invariably recorded on the final day of the retreat, the morning after a person has taken psychedelic drugs, when they’re still in the afterglow state, emotionally vulnerable, barriers down, wide open, sharing the most intimate details of their life, and arguably not capable of giving informed consent to being recorded talking about drugs and then used as marketing material on the internet.

Above, a testimonial from a guest at Rythmia, one of the biggest psychedelic retreat companies in the world, and most aggressive in its online marketing. Read Britta Lokting’s excellent article on them.

Psychedelic retreat centres almost all use testimonial videos shot on the final day of a retreat. Indeed, Retreat Guru, the online shopping site for wellness retreats, encourages centres to feature such videos on their pages. So there can be a pressure to get glowing testimonials to compete with the other companies in this crowded market.

Eric Osbourne, who co-founded MycoMeditations in Jamaica and now runs the Psanctuary Church, says: ‘Ultimately it’s about expanding the community and access to support so it is ultimately a good thing, but I have certainly seen facilitators and particularly retreat owners compelling guests to leave reviews, even going so far as to offer free retreats to a raffle winner made up of guests who contribute reviews. That is plain gross.’

I asked members of the biggest ayahuasca Facebook group if they thought it was OK for psychedelic retreats to seek testimonials on the final day of the retreat. Opinion was mixed. Johan Fremin, who worked at a leading ayahuasca retreat centre in the Amazon 20 years ago, says: ‘We used to record testimonials on the last day of retreats and put them up on our website. I always thought it was a bad thing. People might be glowing, but they might crash a day later.’

This, in fact, is exactly what happened to me. I was recorded giving a positive testimonial for the Temple of the Way of Light (an ayahuasca centre in the Peruvian Amazon) on the final day of a 10-day ayahuasca retreat, only to fall into a highly dissociated state for the next two weeks, which the Temple was not able to support me through — an experience I wrote about in Holiday From the Self.

Finally, there is the wider ethical and scientific issue of seeking or encouraging positive testimonials by trial participants before a trial has finished, thereby arguably compromising the integrity of the trial. As a new paper by Noorani, Bedi and Muthukumaraswamy explores, the publicity given to salvation stories increases the public hype, which then breaks trial binding and feeds into participants’ experiences. The authors call this ‘chemosociality’ — the public enthusiasm for psychedelics is hard to separate from the drug treatment’s ‘actual effects’.

For the last 20 years of the psychedelic renaissance, we have largely been fed salvation stories in the media. Netflix’ coverage of psychedelics has been entirely positive, from Fantastic Fungi to Have A Good Trip to Michael Pollan’s smash-hit series How To Change Your Mind — the latter is so glowing it’s used for fund-raising by MAPS. Several of the most popular podcasts in the world — Joe Rogan, Andrew Huberman, Tim Ferriss, Sam Harris — are also overwhelmingly positive and hortatory in their coverage of psychedelics. This public hype feeds into trial participants’ expectations in complicated ways. If the short-term efficacy of a treatment depends partly on public faith in its miraculous powers, then we should expect efficacy to go down once public enthusiasm diminishes — just as we’ve seen with other forms of psychotherapy.

Potential solutions or compromises

Is it appropriate to seek testimonials from patients or customers, and if so, when and how? There are signs some of the leading research facilities have shifted their policies in recent years. In 2019, Imperial College let the BBC shoot a TV documentary about its psilocybin trial for depression, following patients through the trial. Now, Robin Carhart-Harris, who led Imperial’s psychedelic trials, says: ‘in current trials, we advise and ask against premature engagement with media. I suspect the same is true of other sites.’

One should presumably wait until a trial is over before accepting or soliciting testimonies from participants. One could also suggest a recorded video testimony as a way of saving people the emotional labour of live appearances. And one could check in with the participant to get their consent for every future use of that video, to see if they still feel the same. One could also make the effort not to commodify or instrumentalize their experience — does the clinic give space for the ambiguities and difficult or critical aspects of a person’s experience, or are they basically saying: ‘Before, dirty shirt, then psychedelics, now, clean shirt’?

Could conferences try and provide spaces and panels for people who didn’t have good experiences? Yes — NEST Harm Reduction did this, as did the recent ECNP conference (thanks to Tadeusz Hawrot of PAREA, who invited me to speak on my own and others’ adverse experiences). But it’s harder to persuade someone to give a testimonial about a negative, or extremely negative, experience than a positive one, so any field which overly relies on testimonials is going to have a strong positivity bias.

As for retreats, some retreat organizers have decided it’s not appropriate to ask for video testimonials on the last day of the retreat, and they should wait a few weeks or even longer. Gv Freeman, retreat facilitator and founder of Psychedelic Masterminds, says: ‘I never receive or publish a testimonial earlier than 90 days and often wait upwards of a year. Additionally, their personal details are left out.’

But not everyone agrees. In a lively Facebook discussion, one retreat organizer, who comes from a marketing background and set up a retreat company this year, strongly disagreed with the suggestion it is unethical to seek testimonials from people the day after they’ve taken psychedelic drugs. They suggested that, firstly, testimonials are an essential part of the retreat business, which should be regarded as a tourism business; secondly, clients are not high on the final day of a retreat and are fully capable of giving informed consent; thirdly, it is ridiculous to suggest one could seek testimonials weeks or months after a retreat — clients wouldn’t bother to reply. And finally, to suggest otherwise is ‘inflammatory journalism’ by ‘keyboard warriors’ who ‘have no idea how marketing actually works’ and show ‘an utter lack of understanding of key industry drivers’. This retreat organizer did suggest, however, that retreats could check in with clients a month after the retreat to see if they are still OK with their testimony.

If a psychedelic retreat is really as life-changing as people say, why wouldn’t clients still agree to giving a testimonial months later? And wouldn’t such a testimonial actually be much more persuasive to potential customers? One can review a hotel or restaurant the day after leaving, but for something closer to surgery, you don’t want a next-day review, you want to know how the person is doing months later.

Conclusion: sometimes it’s OK not to share your story

Journalists, activists and ‘keyboard warriors’ often get things wrong, but it’s our job to warn about risks, especially when a culture has veered too far in one particular direction. And yet journalists also face ethical issues around testimonies. People tell you the story of their most raw, personal experiences, and the journalist commodifies it and turn it into a story for clicks. It is often the journalist and their outlet who simplifies the complexity of a person’s experience into either a totally positive story, or a totally negative one. Journalists constantly use other people’s stories in extractive and sometimes harmful ways. So those of us reporting on the movement need to take care as well, not just to report on the full range of experiences, but to get full informed consent from our interviewees. I’ve hurt people in the past by not properly checking my interviewees’ wishes. Even the choice of headline can be sensitive — when I first spoke about having social anxiety back in 2007, the Guardian went with the headline ‘The Man Who Was Terrified Of Human Contact’, making me feel like a B-movie monster.

I began this article with the story of myself on stage at a church, feeling commodified for the evangelical mission. But the exploitation went both ways — I wrote about that experience in my book, The Art of Losing Control. The church used me for evangelism, I used them for a story. When the book was released in 2017, it was not a comfortable publicity tour. I spoke repeatedly about my own ecstatic experiences, sometimes to incredulous or unsympathetic audiences, and I sometimes felt I had cheapened my experiences by sharing them so indiscriminately.

We live in the peak of a confessional culture, in which we are told ‘we must share our stories’, particularly of mental illness and healing. But must we? Always? Perhaps some things are best kept between ourselves and the Mystery.

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