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Annabelle Abraham

Lessons on Psychedelic Harm Reduction with PsyCare NL – From the field

September 26, 2024 / Anthropology & Sociology, Humanities & Art / By /

“From the Field: Lessons from Psychedelic Practices in the Netherlands” is a new blog series stemming from my qualitative research at the Rijksuniversiteit Groningen in collaboration with the OPEN Foundation. The study focused on the conception and practice of safe and beneficial use of psychedelics in group settings in the Netherlands—specifically in the counterculture, ayahuasca ceremonies and truffle retreat centers. Based on interviews with experienced practitioners, the series highlights and connects diverse aspects of psychedelic practices, such as cultural influences, ethics, philosophical beliefs, rituals and sensory stimuli. This article is based on my personal experience as part of a new PsyCare NL team, launched last summer (2024) at a festival in the Netherlands.

The Launch of PsyCare NL: Safe Psychedelic Substance Use at Festivals

The PsyCare facility is a calm, safe, cozy and grounding environment for participants in need, playing a crucial role in prevention and harm reduction at festivals where psychedelic substances are commonly used. Visitors are welcomed by experienced psychedelic peer support “sitters” with a deep understanding of mind-altering substances and a relaxed, non-judgmental approach towards difficult and challenging experiences. Ideally, a team is composed of sitters with different professional backgrounds, gender, personality and language skills to ensure the most appropriate support for all visitors.

PsyCare NL was restarted by Cato de Vos following years of volunteer work with international psychedelic support services like Kosmicare at Boom Festival. Developed with her colleague and friend Raoul Koning (who, like Cato, is part of the OPEN team), the pilot was implemented with a team of 11 members. In total, we received 41 guests over three days. Most cases were drug-related and, typical to a festival environment, involved a variety of drug types and doses, with a dominance of LSD. Other cases involved general agitation or overwhelming feelings from the festival. Some guests could not communicate their feelings or which substances they had consumed (if any). Looking back at the stats reveals strong diversity in other parameters as well, such as how guests arrived at PsyCare or for how long they stayed.

So, how can you help someone through a challenging experience with such a wide variety of cases?

Creating a Safe Haven: The Role of Psychedelic Support Services

With the exception of medical issues—which are determined by the First Aid team—we hardly followed any strict protocols. There are handy guidelines, training and even manuals for this complex and challenging work, but much of it is carried out in an intuitive manner. Like humor or the psychedelic experience itself, this sort of knowledge does not lend itself easily to words and numbers. Nevertheless, in this article, I will highlight essential aspects of PsyCare practice as they emerged from our collaboration with First Aid, feedback from guests and visitors and my own experience as a participant-observer and part of the team.

the core of psychedelic Harm Reduction: Being Present

Being present is probably the single most important element of PsyCare, and it begins with the place itself. The festival production supplied us with a Moroccan tent and a yurt, which we made cozy and aesthetic. With mattresses spread around, warm lighting and decoration, PsyCare became both a part of the festival and a peaceful haven away from it. This already had an effect, as by-passers stopped to take a look inside and ask about PsyCare. Some mentioned that they were relieved to know it’s there. 

Festivals with an established PsyCare tend to offer a 24 hour per day service. In this pilot, our official opening hours were from 16:00 to 8:00, with the night hours (1:00-6:00) being the busiest. In practice, we never said ‘no’ to someone in need, and at 10:30 in the morning we welcomed our first guest. We often remind our guests that drug effects are temporary, or as the wise old saying goes: “this too shall pass”. Yet different drugs – and people – require different amounts of time. Guests’ duration of stay throughout the pilot varied from 5 minutes to 14 hours, with an average stay of 3 hours per guest.

Being present in space and time extends to the personal. Often the most meaningful thing you can do for someone who is overwhelmed is just to be there; to stay with them through this difficult moment, fully present with your attention, patience and calm, no matter what comes. Applied within the PsyCare team as well, mutual care and team spirit were vital to the success of the pilot. 

    Community Values: “Psychedelic Peer Support”

    Festivals in this counterculture make room for spontaneity, experimentation, rule-bending and non-conformist behavior. PsyCare emerged from within this community and seems to share with it some core values that came up during my interviews, like non-judgment. In PsyCare, this is applied as refraining from value judgments of people’s experiences, behaviors, thinking processes, or beliefs. Each person’s freedom and autonomy are respected—a principle overridden only in case of imminent risk to oneself or others.

    Embracing Equality and Non-Hierarchy

    The principle of equality, or non-hierarchy, is another unique feature of PsyCare stemming from counterculture. As volunteers in their own community, PsyCare sitters do not operate from a position of superiority or authority in relation to visitors. They are temporarily holding space for temporary “guests”, as their name suggests. This approach carries a multitude of implications. For example, a guest can bump into their sitter from yesterday at the bar or on the dancefloor. Furthermore, yesterday’s sitter can become today’s guest. Accepting such potentialities involved conscious discussions among the team: how do we ensure guests’ privacy? Are we ‘sitters’ outside our shifts? What does this mean in practice?

    On the last evening of the festival, I met a guest with whom I spent three hours in the PsyCare tent. Our guideline in such cases is to let the guest determine what happens. They smiled at me and stretched their arms for a hug. We chatted and danced together for a bit, and then they moved on. For me, this short incidental encounter on the dancefloor supplied closure and reinforced our positions as fellow festival-goers.

    Such liminal cases are exactly where non-judgement and non-hierarchy shine, and have the power to turn an otherwise awkward or embarrassing situation into a meaningful, connecting and supportive event.

    Awareness of Shame and Vulnerability

    Coming to PsyCare requires admitting to being in need, a feeling which can be challenging for many in itself. Guests may realize that they have taken more than they can chew or even completely lost control. Exposing “weakness” is never easy, but in small communities where many people know each other, shame can become a real barrier. Considering these complexities, any authoritative position, even of ‘a professional’ or a ‘responsible adult,’ is unlikely to contribute to PsyCare as a safe haven. This is why, where other emergency services typically wear a uniform, we wore our regular (low-key) festival clothes and a name tag with a little heart on it.

    Early on in the festival, I was called to check on a disoriented person and try to bring them to the PsyCare facility. Despite their highly confused condition, I managed to establish trust and we were quickly holding hands on our way to the PsyCare tent. At the same time, a First Aid worker in uniform approached us and asked if everything was alright. The guest’s state of mind changed instantly. They released their hand from mine, flinched and asked anxiously: “Did I do anything wrong?”

    Following this case, we came to an agreement with the First Aid staff that they remove their jackets before entering PsyCare, notwithstanding their white uniform was chosen for its non-intimidating character. This policy was found useful by both teams.

    Embracing Care: The Heart of PsyCare

    Here is how Ann Shulgin described the ideal MDMA therapist back in 1995:

    “[S/]he has to be able to feel something very close to love for the person [s/]he is guiding. There should be real caring and it cannot be simply an intellectual concern for the client’s welfare; it must be deeper than that, at the gut level.”

    The relatively long experience with mind-altering substances in counterculture is often disregarded or looked down upon by academics, even those studying psychedelics. Some of it is pure stigma, but there is also a genuine conflict of approaches. As PsyCare sitters, we benefit from ‘subjective’ experiences at least as much as from ‘objective’ facts. Both theory and metaphor were used in our training and we followed values and approaches more than rules and protocols. Above all, PsyCare takes place in a vibrant, dynamic and sometimes chaotic setting, which is almost the opposite of a ‘controlled environment.’

    The fear of intellectual uncertainty and making mistakes cannot be entirely avoided, but PsyCare consciously makes room for other ways of knowing. To describe positive attributes of an effective sitter, our training instructor Daan Keiman, who leads OPEN Foundation’s upcoming education programme in psychedelic therapy, shared the following metaphor:

    If a person is immobile, shut, or stiff like a rock, we should be soft and fluid like water. If they are floating and formless like water, we would have to be their rock.

    Furthermore, presence and care ought to be practiced delicately: sitters do not attempt to pull guests out of their experience but offer them a hand to grab on. Curiously, it’s the little things that have the greatest impact: a welcoming smile, a cup of tea, a blanket, holding someone’s hand, offering a hug, listening to their story, laughing with them.

    In one word: Care.

    An attuned caring presence can turn loneliness into a feeling of being held, and a nightmare into a meaningful experience. Like ‘love’, ‘care’ might be difficult to define or even comprehend intellectually; but luckily, this is not necessary in order to give it. Being in a festival setting, I could not help but think of it in terms of the dance floor: there are no steps, but if you listen carefully to the music and let it guide you, there will be a dance.

    Continuing the Conversation on Psychedelic Support in Recreational Settings

    A broader look at PsyCare will be discussed in an upcoming OPEN event (3.10.24) moderated by PsyCare NL founder Cato de Vos and featuring international Psychedelic Support Services experts Amanda Guzinska (PsyCare UK) and Valerie Beltrán (Zendo Project). Click below to register.

    BEYOND SUBSTANCES: WHEN CULTURE GOES INTO THE LAB

    May 28, 2024 / Uncategorized / By
    mystic-experiences-or-self-knowledge
    Photo by By Andre Vas

    BEYOND psychedelic SUBSTANCES: WHEN CULTURE enters THE LAB

    Brendan Borrell’s recently published New York Times article The Psychedelic Evangelist, about Johns Hopkins University’s late pioneering researcher Roland Griffiths, joins a series of blog posts, news articles and academic papers discussing problematic aspects of psychedelic science. Some of these concern personal misconduct, but others are rooted much deeper. Psychedelics bring together human psychology and chemical compounds, science, metaphysics and cultures. They are explored by pharmacologists and philosophers, anthropologists and psychiatrists, all trying to study what’s in a psychedelic, each with their own vocabulary and worldview. Some of the problems which arise from psychedelic research represent old schisms between the sciences and the humanities, and questions about knowledge as a whole. Here too, psychedelics seem to have a revealing effect, exposing our own thinking mechanisms.

    Mystical science

    The concept of “mystical experiences” has been one of these subjects of ongoing discussion. According to the Cartesian view, the spiritual and the experiential are in principle beyond the bounds of science, as they can neither be confirmed nor refuted. Thus uncomfortable feelings around their appearance in scientific articles can be easily understood. In The Language of Metaphysical Experience, Alan Watts relates to a similar problem encountered by physics in relation to unknown fundamental entities. While these cannot be explained and remain mysterious, they can be related to in quantitative terms for prediction purposes. For example, we can say that “dark matter makes up 30.1 percent of the matter-energy composition of the universe“ without knowing what ‘dark matter’ is. In the same way, we can put ‘mystical experiences’ on a scale, and measure how many subjects experienced them, their level of intensity and so forth. Even if such information enables prediction, ontologically such statements remain meaningless, or as Alan Watts puts it: “By admitting a few numbers, even ‘Jabberwocky’ may become scientific”.

    ‘Mystical’ is surely an eye-catcher, but psychedelic literature is abundant with what Bateson called “heuristic concepts”: concepts which bring to the table more fog than clarity. Consider for example ‘connectedness’, ‘awe’, ‘oneness’, ‘ego-death’, ‘oceanic boundlessness’, or even basic terms like ‘mind’ and ‘consciousness’. Do we really know what they mean? Humanities scholars thoroughly discuss and contextualize such terms, like the mystical in religion studies or awe in art and philosophy. As they travel to the hard sciences and find themselves in quantitative questionnaires, they can become inaccurate and biased.

    These are differences within disciplines in our own culture; stepping outside reveals a deeper abyss, but it could also help in bridging gaps. In the same essay, Watts elaborates on differences between Western and Asian conceptualizations of metaphysics and their purposes. In the West we see metaphysical statements as conveying positive information about Reality. In Asia they are treated as remedies to frustrating human psychological ‘unreal’ problems, while Reality itself is ineffable. There is indeed something paradoxical about using objective terms and methods like observation to understand a subjective phenomenon like the psychedelic experience. There is a constant need to find less subjective terms: from ‘bad trip’ to ‘negative’, ‘adverse’, ‘challenging’ experience. The latter may sound more scientific than hippy, but aren’t they all personal value judgements of subjective experiences? Do they tell us anything objective at all? Another example is the quest to compile THE playlist for psychedelic interventions. Can there be one or even multiple recommended playlists? Is music not a matter of personal taste, memories and associations, of cultural references and education?

    Experiencing objectivity

    Some of the challenges are anchored in psychedelics’ legal status as schedule I drugs and the wish to develop them into treatments for medical conditions. Here too, our web of ontological assumptions and scientific methods keeps getting entangled, sometimes creating dangerous traps. Trying to stay as objective as possible, we wish to minimize the “human element” in order to properly assess the efficacy of substances. We use blinding and placebo-controlled trials, but this very practice sometimes leads to a nocebo effect (worsening of symptoms due to not getting the treatment) and even death, as described in the New York Times’s article. In many cases, practices applied to enhance objectivity are reinterpreted by participants as cold or unempathetic, and thus end up influencing results. For example, in order to minimize bias, the FDA recommends that a trial’s in-session monitor would not be involved in post-session psychotherapy. The assumption is that a therapist may be biased, in the sense that they know what happened during the psychedelic session and may use this information later. For participants, this means there is no continuity between the psychedelic session and the integration part (if there is one). This, in turn, creates trust issues and makes it difficult for participants to let go and to share their experiences. Since the therapy element is so determinate and hard to measure, psychotherapy and psychological support are often minimized in trials (also due to financial reasons), raising ethical concerns and undermining potential benefits. So some of the measures taken to accurately determine the safety and efficacy of psychedelics are in themselves a detriment to the safety and effectiveness of trials.

    Medicalization as a goal has received much critique. Different approaches, as manifested by indigenous cultures or even by counterculture are often regarded as less or not at all valid. But even within mainstream culture, and within medicine and psychiatry, psychedelics raise some thoughts about the very definitions of mental illness, health and well-being. Here are a few: how come psychedelics seem to work for so many different mental disorders? Could it be that the terms “placebo” and “inner healing” refer to the same thing? If placebo works so well, why do we focus on external solutions which would prove better, instead of trying to enhance placebo? Some say that psychedelic research is leading to a full-blown paradigm shift in psychiatry, integrating social and cultural factors into conceptualizations of mental disorders and to transformation as the new basis for psychiatry.

    Wired by culture

    Known since the beginning of the 1960’s, ‘Set and Setting’ is the main mechanism through which subjectivity and culture enter the psychedelic experience. Indeed, many academic papers include an apologetic paragraph acknowledging the importance of these two illusive and immeasurable components, before embarking on a futile battle to neutralize them. 

    Originally referring to a person’s mind-set and environment during a trip, set and setting bring into the psychedelic experience a complex web of one’s personal history, tendencies, mood, culture, environment and education. And all of these together influence participants’ interpretations, the meanings they give to their own experiences. In 1997, Betty Eisner added the Matrix component, one’s broader cultural frame. Then, in American Trip, Ido Hartogsohn expanded it to a Collective Set and Setting of a nation with its particular history and sociocultural context. Our Collective Set and Setting influences not only participants, but researchers and therapists as well. It can include, for example, the infamous hype of the psychedelic renaissance, articles we’ve read, films and documentaries we watched, stories and images from the 1960’s counterculture and echoes from the “War on drugs”. Back in 1959, Anthony F.C. Wallace already attributed the discrepancy seen between reactions to mescaline of Westerners and indigenous people to their cultural beliefs. While white subjects reported ‘going mad’ (e.g. mood swings, losing touch with reality, forsaking social inhibitors, etc.), such phenomena were not felt by the indigenous group, who remained generally stable and positive. Wallace concluded that the differences stemmed from the cultural conceptualization of hallucinations. In Western psychiatry, hallucinations are perceived as signs of mental illness, while in the indigenous culture, they are considered normal and even desirable.

    Several elements in the setting of Griffiths’ lab were deemed problematic by Dr. Richards. It is easy to see how participants’ interpretations and experiences may be affected by a Buddha sculpture. But in fact, a ‘neutral’ setting does not exist. A hospital building carries its own associations, the outside and inside appearance of clinics also matters. According to Art literature, even white walls are not neutral. Music, smells… There is no way out; everything matters, from the size of the room and type of furniture through the number and gender of people present, to perceptions and beliefs of researchers, therapists and participants about psychedelics, people and the world. Moreover, not only do they affect trial results, but also their design, our research questions and our approach to the process. For example, a study aimed at minimizing nausea during consumption of Ayahuasca treats it as an undesired side effect, while another can regard it as an act of cleansing conducive to positive changes in well-being. Simply put, Set and Setting cannot be kept away from the lab.

    Psychedelic research is full of contradictions, paradoxes and absurdities. We strive for total control and meticulous procedures to study substances which make one lose control and reflect on your own processes. We wish to eliminate anything weird or mysterious, but also dream of discovering a “magic pill”. As meanings, chemicals, cultures and personal tendencies collide, interdisciplinary research can supply the necessary means – perhaps not to overcome all contradictions – but at least to understand them better and to live with them as best as we can.

    By Annabelle Abraham

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