- Psychedelics should never be given without explicit, informed consent from the patient.
- Integration of psychedelic experiences is a key aspect to what makes them theraputic.
- "Nine Perfect Strangers" is fun television, but it's a poor representation of psychedelic therapy.
Spoiler alert: If you haven't seen "Nine Perfect Strangers, go watch it and come back.
The new Hulu TV series “Nine Perfect Strangers” (an adaptation of Liane Moriarty’s book of the same name) shows us what happens when a wellness retreat veers into an abusive cult of personality, fueled by the zeitgeist of psychedelics. Sadly, for the viewer unfamiliar with the extant rigorous and cautious studies of psychedelics as adjuncts to psychotherapy, may come away imagining that the experiences had by the characters in this series are representative of these emerging treatments. Nothing could be further from the truth. In fact, most of the show, while entertaining and engaging, serves as an exemplar of how not to use these very powerful substances.
The retreat (amusingly called “Tranquillum”) centers around a mysterious Russian woman, Masha, played by Nicole Kidman. We watch her weave through the curious collection of nine guests, obtaining their backstories, indulging them in spa treatments and a mélange of new-age practices — yoga, macrobiotic diets, mindfulness meditation, forest bathing, death rehearsals, and overwrought kintsugi metaphors.
While she gathers their stories, we begin to see the efforts to control the characters. Their cell phones are confiscated (benevolently, by Masha’s seemingly vacant-eyed lackeys), their blood is unexpectedly drawn (“for customizing your health protocols”), and she limits what they can eat to the food that is prepared for them. This is standard behavior in cults that seek adherence to a central leader and ideology — from the prohibitions on using the bathroom in the EST seminars of the 70’s to the diabolical actions of Jim Jones sequestering the members of the People’s Temple in the jungles of Guyana before committing mass murder — first you control their body, then you can control their mind.
Without warning, consent, or preparation, she doses their morning health smoothies with psilocybin, leading to a scene of confusion, peril, and uncharacteristic behavior from the bewildered guests. Confronted the next morning, Masha admits to “microdosing” them (that wasn’t a microdose!), contradicting their protestations by reassuring them that “it is perfectly safe!” and then claiming that psychedelics can cure depression, addiction, PTSD, schizophrenia, and dementia. She then turns their accusations of surreptitious behavior on their heads, subtly reminding the guests of the skeletons in their own closets, deepening her control over the group. As she pits them against each other, she suggests that they can leave, but reminds them that they can’t escape their pasts. It’s as if Synanon met The Most Dangerous Game.
Psychedelics should never be administered without clear and uncoerced informed consent on the part of the person ingesting them. To do otherwise is considered assault. In existing studies, much time is spent in non-drug preparation explaining the possible effects of the drug and how side effects can be managed with support from the study therapists. No one should ever be coerced to take a psychedelic. To find oneself in an unexpected, unprepared psychedelic state could be, at best, dangerous, and at worst, deeply traumatizing. “Trust is thus the single most prerequisite of safe and effective psychedelic therapy,” Stan Grof wrote in LSD Psychotherapy, and I can think of few violations of trust greater than drugging someone without their consent.
Despite this significant transgression, Masha continues to dose the group with a variety of compounds, including MDMA, LSD, psilocybin, and 5MeO-DMT. This goes on for the duration of the show. While the subjects have now tacitly consented to her methods, she fails again to provide a basic requirement of any psychedelic therapy — integration. Rather, day after day, she subjects her guests to different drug “protocols,” leading to increasing distress in some of the nine as she pushes them deeper and deeper into their emotional material, without preparation. She pits them against each other to coerce those who were ambivalent to continue to partake in the drugs despite their misgivings.
While media portrayals of psychedelics such as those seen in "Nine Perfect Strangers" may centralize the drug experience, those who work in this modality know that when the drug is leaving the system, the therapeutic work is just beginning. In integration therapy, the subject meets in the days following the drug session with the same therapists to discuss the experiences had under the drug. Feelings and images can be interpreted and meaning can be made of the experience, even if it was frightening or disquieting. Integration can go on for months, even years, following a powerful psychedelic experience. The period following a psychedelic experience (sometimes called the “afterglow”) can be utilized to make meaningful changes in the person’s life and for an enduring shift in perspective to occur. As Cathy Skipper and Florian Birkmayer recently noted in a talk on psychedelic integration, “Healing is slow, soft, often underground. And the idea of a quick fix, this great medicine that is going to solve all your problems, is actually a lie. It’s not going to solve all the problems. Solving the problems is committing to a lifelong journey of self-healing, self-evolution, or individuation.”
Without this integration therapy, frightening experiences on drugs can calcify into a traumatic memory, leaving the subject frightened and apprehensive to even discuss the experience of the drug. Psychedelic experiences that are not integrated often become nothing more than novelties and may not lead to meaningful or stable changes in attitudes, thoughts, or behaviors. Psychedelic learnings reduced to truisms or cliches can represent a kind of quick fix or as a means of avoiding the more painful or difficult questions that can arise during a psychedelic session. Therefore, adequate and thoughtful integration, while not as dramatic or provocative as the drug session itself is, in my opinion, the most important part of the preparation-drug-integration triad, but it probably doesn’t make for the exciting television.
Want to learn what happens next? Look for Part 2 of the "Nine Perfect Strangers" review!