Blinded by the White: Addressing Power and Privilege in Psychedelic Medicine

Chacruna.net
Mar 22, 2019 · 20 min read
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An article by Jason Butler, Ph.D., who is a core faculty member in the Holistic Counseling Psychology program at John F. Kennedy University and a licensed Psychologist practicing in Oakland. Jason is passionate about providing opportunities for expanding accessibility to holistic healing modalities and Genesee Herzberg, PsyD, who is a psychologist in Berkeley, co-founder of Sage Integrative Health, and therapist for the MAPS Phase 3 MDMA-assisted therapy for PTSD trials.

The lack of racial diversity is a strong indication that the burgeoning field of psychedelic medicine is recapitulating the same systemic problems around accessibility and diversity that have long plagued the fields of medicine and mental health

As the field of psychedelic medicine gains momentum, the glaring underrepresentation of people of color in the movement is hard to miss. Psychedelic researchers, conference presenters, therapists, doctors, study participants, and patients are all largely White. The lack of racial diversity is a strong indication that the burgeoning field of psychedelic medicine is recapitulating the same systemic problems around accessibility and diversity that have long plagued the fields of medicine and mental health. As White researchers and clinicians, we are intending to speak to other White people about an issue that many don’t think or talk much about. Unlike people of color, White people are not forced to contend with these issues; yet, the topic of racism is one that directly involves all of us, one that we participate in on a day-to-day basis, and have the responsibility to address in a direct and personal way.

We recognize that there is no perfection, and that our contribution to this discussion may illuminate areas where we are blinded by our whiteness. We take full responsibility for any misrepresentations or blind spots and welcome feedback regarding anything that strikes the reader as offensive or misguided.

Although this article focuses on the lack of representation of people of color in psychedelic medicine, we also recognize that, for the field to reach its true liberatory potential and move away from the heavy dominance by straight able-bodied cis White men, we must take up an intersectional perspective, considering issues of accessibility for all minority identities and levels of class privilege. Some of the issues described below, such as the Drug War, are particular to people of color. Other issues, such as the potential obstacle of engaging in psychedelic work with a therapist who doesn’t understand your identity, or the distress that stems from discrimination, are also concerns for LGTBQI, gender creative, and other people from target groups. Furthermore, the lack of representation of women in positions of power, and the failure to recognize their contributions to the field, is a telling marker of the male dominance that still pervades the movement.

In our experience as therapists and researchers in the field, we’ve found that the perception among many of our White colleagues is that the question of racial diversity is important, but incredibly complex and challenging. In spaces that are dominated by whiteness, many of us have a tendency to drop the topic quickly, rather than finding motivation to directly address its complexities. Turning a blind eye is tantamount to supporting the inequitable systems that maintain the profound discrepancy in who receives appropriate and necessary health care. There are a handful of people, mostly people of color, who are talking and writing about these issues and making valuable suggestions about how to address the discrepancy and increase accessibility. Throughout this article, we will highlight some of their vital contributions. We will also shed light on some of the limitations, blind spots, and pitfalls that we perceive within ourselves and among fellow White colleagues in the field.

In this article, we will challenge the narrative that the issue of diversity is too complex to prioritize at this early stage of the movement, and encourage psychedelic practitioners to engage the realities of racism and White supremacy with more rigor and sensitivity. Our use of the term White supremacy is not limited to the hate groups that openly proclaim the superiority of whiteness, but is primarily a reference to the “overarching political, economic, and social system of domination” that benefits White people at the expense of people of color.1 First, we will offer some background that describes how the current disparity came to be, and then we will suggest some ways to address it. We will emphasize the importance of educating ourselves about the systems of White domination that pervade US history and the factors that uphold the insidious racism of today.

The Numbers

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Compare this to the United States demographics, in Which whites make up only 60% of the population, while non-white races and ethnicities make up a full 40%.3 Blacks and Latinx make up a particularly small percentage of participation in the psychedelic field. In the MAPS Phase 2 research, only 1% and 3% of participants were Black and Latinx, respectively, compared to the 13.4% of general population that is Black and 18% that is Latinx.

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How Did We Get Here?

First, race is a constructed notion, developed in the fifteenth century by Portuguese slave traders to justify the enslavement of African people under the guise that those of African descent were inferior to Europeans. Since the dawn of the scientific era, attempts have been made to use science to validate the constructed notion of race and to justify structures of White supremacy. The centuries-old practice of “scientific racism” attempts to use the study of genetics and other forms of scientific research to demonstrate the inferiority of certain racial and ethnic groups and to justify and perpetuate racial and ethnic discrimination. Many prominent historical figures have subscribed to and promoted these ideas, including Thomas Jefferson, who called for science to demonstrate the “obvious inferiority” of African Americans.

The eugenics movement is another set of beliefs and practices broadly enacted by White men throughout the world over centuries; practices which led to atrocious examples of violence and oppression. In short, the eugenics movement attempts to “improve” the quality of the human population by weeding out “undesirable” people and groups. Thousands of women of color and poor, incarcerated, and disabled women have been sterilized through coercion, manipulation, or force. There are reports of Black women going to the doctor for an unrelated procedure being sterilized without consent. In Madrigal v. Quilligan, ten Latina women filed a class action lawsuit against LA County hospital obstetricians, who reportedly coerced them into sterilization while in labor and without informed consent. This problem continues to occur in the US today.

In the well-known 1932 study, commonly referred to as the “TuskegeeExperiment,” but more aptly called “the United States Public Health Service study of untreated syphilis in Black men,”622 poor African-American sharecroppers were enrolled in a study to observe the natural progression of syphilis over 40 years. They were told they were being treated for “bad blood,” and that the study would last for 6 months. Instead, it lasted for four decades. The men were never told of their diagnosis, nor were they offered treatment. This took place in the 1940s, after penicillin had been proven to be effective in curing the disease. Many of the men died of syphilis, and 40 of their wives and 19 of their children contracted the disease.

Over the past century, the nation’s War on Drugs has specifically targeted substances used by immigrants and minority populations as a method of oppression and control.(*) The repercussions of these policies are illustrated in the charts pictured here.

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Rates of Drug Use and Sales, by Race; Rates of Drug Related Criminal Justice Measures, by Race. hamiltonproject.org

African Americans use less drugs than Whites, and sell them at about the same rate, but are 6.5 times as likely to be incarcerated for a drug-related crime.5 Meanwhile, nearly 80% of people in federal prison, and almost 60% of people in state prison for drug offenses, are Black or Latinx.6 A felony remains on one’s record permanently, leading to disenfranchisement, difficulty accessing housing, jobs, and social services, and, ultimately, high rates of recidivism. As Nicholas Powers explains in his talk at the 2017 Horizons conference, the Drug War has made a major impression on attitudes towards drugs in communities of color, leaving many understandably hesitant to associate themselves with these substances.

The 1980s phenomenon of the “crack baby” is a good example of the Drug War’s racial targeting and slandering. The term “crack baby” has since been discredited. It has been shown that in utero exposure to cocaine may have some minor effects on cognitive and circulatory functioning, but nothing like what was being broadcasted by the media at the time, which aggressively promoted a constructed racial narrative of the criminal, degenerate, crack-addicted black woman putting her child at great risk and placing a huge burden on society as a whole. This media campaign served to demonize and condemn Black culture, leading to excessively harsh sentencing for crack-related charges and the mass incarceration of people of color.

Where are We Now?

Institutional Racism

Solid Ground, a Seattle-based non-profit working to end poverty and racism, defines institutional racism as “the systematic distribution of resources, power and opportunity in our society to the benefit of people who are White and the exclusion of people of color.” A 2016 study indicates that the average Black worker earns about 75% percent of the hourly wage of the average White worker.9 This system-wide income disparity places significant limitations on the ability to afford health care. The high cost of psychedelic therapy is generally cost-prohibitive for lower-income individuals, and there are few examples of organizations implementing programs to increase accessibility. Psychedelic therapy training programs also tend to be quite costly, excluding individuals with fewer resources who are, more often, people of color, and ultimately contributing to the ongoing underrepresentation of therapists of color in the field. For example, the two most prominent psychedelic therapy training programs, MAPS and CIIS, charge $9500 and $10,000 for their respective programs. A similar disregard for lower-income needs is evident in many research protocols. Participation in a psychedelic research study is time-intensive and may require taking time off of work; however, there is generally no compensation for participation in the research.

The massive underrepresentation of people of color among participants, researchers, therapists, and, most dramatically, among those who hold leadership positions, is a prime example of institutional racism. As Michaels 10 demonstrate in their research, this discrepancy has been evident over the past 25 years throughout psychedelic research across the globe. In response to this disparity, MAPS has made some recent attempts to recruit more therapists and participants of color. They have also formed an advisory council to address issues of diversity. However, a comprehensive effort to shift the blatant disparity has yet to occur.

Another, more subtle example of institutional racism can be found in the screening tools and diagnostic categories used in psychedelic research, which generally do not acknowledge that trauma and other types of mental illness may show up in different ways for people of different racial and ethnic groups.11

Individual Racism

White practitioners often do not have a good enough understanding of the history and current state of white supremacy, their own whiteness and participation in practices of racism, the lived experience of minority populations, or the traumatic impact of racism and implicit bias on people of color.

In psychedelic medicine and research, individual racism shows up as an inherent power dynamic that takes shape when the practitioner is White and the patient or participant is a person of color. Both the practitioner and patient enter the work with a personal (though perhaps unconscious) relationship to racism, power, and privilege. These dynamics are inevitably expressed in the treatment and, if not addressed explicitly, can be enacted in harmful ways. White practitioners often do not have a good enough understanding of the history and current state of white supremacy, their own whiteness and participation in practices of racism, the lived experience of minority populations, or the traumatic impact of racism and implicit bias on people of color.

The practitioner’s ignorance to the reality of racism, what Robin DiAnglo (2012) has called “racial illiteracy,” compromises safety in the therapeutic relationship, inhibiting the patient’s ability to give voice to racial distress and to talk about the racial dynamics that are present in the therapeutic relationship. For example, while discussing this issue with an African-American colleague, she noted, “with a White therapist I might wonder, ‘does she really get it?’ I’d feel like our worlds were so different … It’s hard to trust that they’re open to talking about it, or that they’re not judging you when you bring it up — like you’re ‘pulling the race card’ or something.”

Where Do We Go from Here?

Culturally-Sensitive Education

Psychedelic practitioners must have a much more broad and integrated awareness of the legacy of White supremacy and racist politics and practices in the field, so as to support their ability to recognize and respond to the understandable hesitation and mistrust that may arise in the treatment.

Furthermore, it is of vital importance to centralize the discourse surrounding racism and its many manifestations in psychedelic medicine. Education around diversity should be an essential part of training in the psychedelic field, woven throughout a training program, rather than relegated to the margins; considered just as important as the education required for assessment and treatment. Psychedelic practitioners must have a much more broad and integrated awareness of the legacy of White supremacy and racist politics and practices in the field, so as to support their ability to recognize and respond to the understandable hesitation and mistrust that may arise in the treatment.

Practitioners must be adept at sensitively broaching issues of difference in the therapeutic relationship. We might remember here our African-American colleague’s poignant question about working with a White therapist, “Does she really get it?” Given the asymmetrical nature of the relationship, the practitioner should not rely on the patient to bring up their feelings or thoughts about racism or to provide education about the experiences and challenges of their demographic group. Monnica Williams13 recommends that practitioners ask directly about patients’ experiences of racism, carefully creating a safe space to discuss these issues, while ensuring that they themselves are informed about the range of potential race-related experiences that a person of color might encounter. White practitioners can educate themselves through reading works and listening to talks authored by people of color, participating in experiential trainings focused on dismantling racism and White supremacy, and engaging in critical discourse with White peers.

Living in a deeply racist culture, even the most well-intentioned and anti-racist White Americans cannot avoid internalizing racist perceptions and participating in practices of racism.

Lastly, and perhaps most importantly, White practitioners must engage in inner work around their participation in maintaining the current structures of oppression. Living in a deeply racist culture, even the most well-intentioned and anti-racist White Americans cannot avoid internalizing racist perceptions and participating in practices of racism. As Camille Barton14 adeptly points out, racism is often unconscious and linked with feelings of shame and guilt. It can be challenging to recognize racism in ourselves, often triggering defensiveness when we are forced to confront our racist behaviors and practices. It is therefore necessary that we conduct a deep and thorough inventory of our whiteness, looking carefully at practices that perpetuate racism, engaging the help of anti-racist educators and activists to bring awareness to our blind spots, and remaining open and receptive to feedback.

Listening and Adaptation

Representation

Representation of one’s identity is an important way to signal to the individual that they belong and that the issues that affect them most intimately will be understood and addressed.

Recent empirical evidence indicates that practices of inequality continue to have a significant impact on the hiring process: “a member of a privileged group is almost always presumed to be the ‘safer bet’”.16 This implicit bias towards those with privilege contributes to the overrepresentation of those who already hold power. Efforts towards increasing representation are also limited by the high cost of psychedelic therapy training programs and inadequate scholarship opportunities for people of color. In research and clinical practice, representation of one’s identity is an important way to signal to the individual that they belong and that the issues that affect them most intimately will be understood and addressed.

Hence, organizations should hold representation of people of color as a primary aim in recruitment and hiring. In addition, conferences and public events should ensure that minority groups are represented among the organizers and presenters. Conference organizers need to ensure that discussions around race are well-facilitated by moderators who can directly address controversial or offensive comments from audience members or panelists. Training programs for psychedelic therapists must provide affordable opportunities for individuals from minority communities. Lastly, those involved in recruitment for psychedelic research should engage in culturally-sensitive outreach practices by building personal relationships with, and showing up as allies for, people of color17 and partnering with organizations and agencies that are serving minority communities.18

Accessibility

Efforts can be made to create protected spaces for people of color to safely experience these medicines without having to censor themselves or deal with the many challenges, vulnerabilities, and power dynamics inherent in working with White therapists, researchers, and facilitators. Nicholas Powers makes this point in his talk at the 2017 Horizons conference, explaining that, while white people have had these kinds of spaces for decades, allowing myriad opportunities for safe exploration, many people of color have not had that opportunity. Ideally, there would be enough practitioners of color that patients and participants could be paired with someone who reflects their identity.

Means and Ends

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Raised fist. Photo credit by Desiree Adaway. desireeadaway.com

Note:

This paper was presented at Cultural and Political Perspectives in Psychedelic Science, a symposium promoted by Chacruna and the East-West Psychology Program at the California Institute of Integral Studies (CIIS), San Francisco, August 18 and 19, 2018.

(*)John Ehrlichman, Nixon’s Drug Policy Advisor, admits directly that his Drug War policies were not intended to support public health, but instead, to control minority and counter-culture groups through a targeted, slandering media campaign.

Opening image credit: Black Lives Matter Demonstration. Photo credit by Vincentchapters pbs.org (source).

References

  1. 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. Retrieved from: https://doi.org/10.1186/s12888-018-1824-6
  2. United States Census Bureau. (2017). Population by race and Hispanic origin: 2012 and 2060. Retrieved from https://www.census.gov/mso/www/training/pdf/race-ethnicity-onepager.pdf.
  3. Washington, H. A., (2008). Medical apartheid: The dark history of medical experimentation on black Americans from Colonial times to the present. New York City, NY: Anchor.
  4. The Hamilton Project. (2016, October 21). Rates of drug use and sales, by race; rates of drug related criminal justice measures, by race. Retrieved from http://www.hamiltonproject.org/charts/rates_of_drug_use_and_sales_by_race_rates_of_drug_related_criminal_justice
  5. Race and the Drug War. (2018). Drug Policy Alliance.Retrieved from http://www.drugpolicy.org/issues/race-and-drug-war
  6. Reed, S. (2019). The damage of White Feminism. Chacruna. Retrieved from: https://chacruna.net/the-damage-of-white-feminism-an-anecdote/
  7. Williams, M. (2019). How White Feminists oppress black women: When feminism functions as White Supremacy. Chacruna. Retrieved from: https://chacruna.net/how-white-feminists-oppress-black-women-when-feminism-functions-as-white-supremacy/
  8. Daly, M. C., Hobijn, B., & Pedtke, J. H. (2017, September 5). Disappointing facts about the black-white wage gap. Federal Reserve Bank of San Francisco Economic Letter. San Francisco, CA: Federal Reserve Bank of San Francisco
  9. 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. Retrieved from: https://doi.org/10.1186/s12888-018-1824-6
  10. 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. Retrieved from: https://doi.org/10.1186/s12888-018-1824-6
  11. Harvey, I. (2016). Why the psychedelic community is so white. Retrieved from: https://www.psymposia.com/author/ifetayo-harvey/
  12. Williams, M. (2016). Race-based trauma: The challenge and promise of MDMA-assisted psychotherapy. MAPS Bulletin, 26(1), 32–37.
  13. Barton, C. (2017). The elephant in the room: The need to address race in psychedelic research. MAPS Bulletin, 27, 1–3. Retrieved from https://maps.org/news/bulletin/articles/427-bulletin-winter-2017/6964-the-elephant-in-the-room-the-need-to-address-race-in-psychedelic-research
  14. Springer, D. (2017) Racial-delic. Paper presented at Breaking Convention, June 30 — July 2, University of Greenwich, London, UK.
  15. Perry, I. (2011). More beautiful and more terrible: The embrace and transcendence of racial inequality in the United States. New York City, NY: New York University Press.
  16. 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. Retrieved from: https://doi.org/10.1186/s12888-018-1824-6
  17. Powers, N. (2018). Black masks, rainbow bodies: Race and psychedelics. MAPS Bulletin, 28(1), 47–51. Retrieved from https://maps.org/news/bulletin/articles/429-maps-bulletin-spring-2018-vol-28-no-1/7268-black-masks,-rainbow-bodies-psychedelics-and-race
  18. King, M. L. (2011). The trumpet of conscience. Boston, MA: Beacon Press.

Links

Chacruna Institute for Psychedelic Plant Medicines

We provide public education and cultural understanding…

Chacruna.net

Written by

We educate the public and create cultural understanding and legitimacy regarding psychedelic plant medicines through scientific research. https://chacruna.net

Chacruna Institute for Psychedelic Plant Medicines

We provide public education and cultural understanding about psychedelic plant medicines and promote a bridge between the ceremonial use of sacred plants and psychedelic science.

Chacruna.net

Written by

We educate the public and create cultural understanding and legitimacy regarding psychedelic plant medicines through scientific research. https://chacruna.net

Chacruna Institute for Psychedelic Plant Medicines

We provide public education and cultural understanding about psychedelic plant medicines and promote a bridge between the ceremonial use of sacred plants and psychedelic science.

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