Introduction

It is a queer thing that the queerness of psychedelics, remains mostly unexamined as psychedelics re-emerge into popular culture and mainstream discourse. Psychedelics are arguably queer in every imaginable sense of the word. They are queer in the way that Lewis Carroll's Victorian readers would have understood Alice's use of the term; odd, peculiar, non-ordinary, fantastical, whimsical, and weird. They are also queer in the way that the term was understood when the imagery from Alice's Adventures in Wonderland was given a psychedelic reading and adopted into psychedelic culture; as countercultural, transgressive, and deviant. They are queer in their history; like queerness and queer bodies, they were seen as a threat to the hegemony of white supremacy, and capitalist patriarchy. “Queers used to be illegal, just like the drugs we like” (Williams, 2021, p. 111). That threat has been treated the same way by those with regulatory and bureaucratic power; pressed into the closet through legislation, violence, and propaganda. Now, after being unable to eradicate these threats, governments seek to colonize and neutralize them using legislation, bureaucracy, corporatization, and medicalization. Make no mistake, psychedelics are queer. During this psychedelic renaissance, queer voices cannot be omitted from discourse regarding these queer substances. It is imperative that the perspectives of 2SLGBTQ+ patients and practitioners are included in the development of Queer-Affirming Psychedelic-Assisted Psychotherapies (QA-PAP).

Methods

Examination of the extant psychedelic literature reveals simultaneously a growing abundance of population level research, and a dearth of sub-group analysis. The Chacruna Institute has started some of these conversations through conferences and recent anthologies, but peer reviewed academic literature on queer experiences of psychedelia is minimal.

Results

This knowledge report is structured as a brief discussion on the conceptualization of queerness alongside psychedelics in historical and contemporary literature and legislation.

Discussion

The ontological multiplicity that is posed by psychedelic experiences is foundational to the spirituality, ceremony, and worldviews of Indigenous cultures, who for centuries have been caretakers of the plants and fungi that psychedelics are derived from (Williams, Romero, Braunstein, & Brant, 2022). As Western philosophers, academics, and community members discovered and appropriated medicinal plants, they created new, queer ways of understanding and describing psychedelics. Psychedelics were birthed into the English lexicon through the literary intercourse of British Canadian Psychologist Humphry Osmond, and British author, philosopher and mystic, Aldous Huxley. It was Osmond's candidate, blending the Greek roots for “mind” and “manifesting”, and presented in a rhyming couplet that came to represent this powerful group of substances in Western collective consciousness, and the states of consciousness that the engender individually. He wrote “To fall in Hell or soar Angelic, You'll need a pinch of psychedelic.” (Dyck, 2008, p. 2). From the moment this concept entered discourse it was subversive, it was queer. These experiences are so far outside normative consciousness, that they defy linguistic description without spiritual allegory. The couplet above captures the queer, binary defying ontology of these experiences. They can hold simultaneously that which is conceived as both contradictory and mutually exclusive: heaven and hell, dark and light, terror and ecstasy, science and spirituality-how queer‽ Illusions that can reveal truths, meaningful hallucinations, are queer. They are surreal, somatically outside of consensus reality, and simultaneously hyperreal, subjectively more real than reality. They are grounded in the mundane, in deterministic biology and chemistry, but these analogues of endogenous neurotransmitters when incorporated temporarily physiologically into our bodies can produce a subjective mental experience of the sacred-the profoundest spiritual awe, and the darkest night of the soul (Yaden et al., 2017).

Although psychedelics have remained prohibited for decades, those working across a wide array of disciplines are currently experiencing renewed interest in their study and uses. This is being referred to as the ‘psychedelic renaissance,’ both in the academic literature (George, Hanson, Wilkinson, & Garcia-Romeu, 2022), and frequently in popular culture. Michael Pollan's bestselling book How to Change Your Mind (2018), and the eponymous Netflix documentary series (Walker & Elwood, 2022) are an example among many, of how psychedelics have become a ‘new’ topic in discourse around mental health. This artificial perception of newness obfuscates the proliferation of psychedelic experience across time and place, and threatens to repeat the colonial violence that was inflicted on Indigenous peoples during the European Renaissance (Williams et al., 2022). Likewise, diverse sexual and gender identities have long histories of Indigenous ceremonial significance (Smithers, 2022), that are distorted by the perception that queer and trans bodies are a ‘new’ threat. Despite this, media reporting on psychedelics and research data give many reasons to be optimistic.

Psychedelics are a class of psychoactive substances that share certain subjective properties, producing altered states of consciousness and perception; however, the subjective effects of these substances exist on a spectrum and are caused by several substances which are chemically distinct (Nichols, 2016). Classic psychedelics like lysergic acid diethylamide (LSD)-25, mescaline, and psilocybin are serotonergic hallucinogens that operate primarily on the 5-hydroxytryptamine 2A receptors (5-HT_2A), in the brain (Nichols, 2016). Substances like the dissociative ketamine, entactogens such as MDMA, and polydrug admixtures such as Ayahuasca, are also considered psychedelics depending on context.

The Multidisciplinary Association for Psychedelic Studies (MAPS) is completing phase 3 clinical trials for treatment of PTSD using MDMA (MAPS, 2021). Psilocybin is in phase 2 clinical trials for the treatment of depression (NYU Langone Health, 2022). Patients are legally accessing ketamine-assisted therapy in private clinics across Canada, and an esketamine nasal spray- SPROVATO^TM, has been approved by Health Canada for treatment of depression (Government of Canada, 2020). There is an abundance of recent and ongoing research that suggests these substances may be safe and effective for a variety of mental health conditions (Wheeler & Dyer, 2020), and even for prophylactic and wellness purposes (Wexler & Sisti, 2022). The province of Alberta where my research is located became the first Canadian jurisdiction to implement legislation regulating Psychedelic-Assisted Therapies (Government of Alberta, 2022). The state of Oregon recently started providing licences for psychedelic therapy clinics, having legalized psilocybin for adult therapeutic use via ballot initiative in 2020 (Herrington, 2023). Meanwhile Australia's federal regulators have created a framework for Psychiatrists to begin prescribing MDMA and psilocybin (Haridy, 2023).

Although psychedelic medicines are not yet federally approved in Canada or the United States, Social Workers have been included in Alberta's recent decision to create a regulatory environment for access to PAP. The profession of Social Work has well-developed codes of professional ethics, which are committed to social justice, and human dignity (Alberta College of Social Workers, 2019; Canadian Association of Social Workers, 2005). The Canadian Association of Social Workers (CASW), and the Alberta College of Social Workers (ACSW) ensure a high standard of professional practice and hold members accountable through established avenues of recourse. Social Work theory and practice have much to contribute toward research on psychedelic medicines, the development of safe and affirming modalities, and the protection of patients needs in these contexts.

Psychedelic-Assisted Psychotherapies (PAP) are an emerging area of practice which deserves consideration by social workers in the development of unique standards of care, and towards thoughtful consideration of the application of professional ethics. Some aspects of this issue require immediate attention, and others are dependent on forthcoming legislation. The former represents issues of liability, risk to patients, and duty of care that intersect with current practice. The latter involves forthcoming legislative changes and changing mental health paradigms, about which the profession should be proactive.

While Alberta's legislation pre-empts both the rescheduling of psychedelic substances by Health Canada, and federal regulations permitting PAP, the provincial government under the United Conservative Party, has come out vocally in favour of expediating access (Government of Alberta, 2022). Demonstrably, the issue of access to PAP has broad support across the political spectrum. Increasing public awareness of these therapies, and media reporting on psychedelics is likely to lead to great numbers of people seeking access to these interventions. Folks are currently accessing these experiences in a variety of ways. Legally in clinical trials, religious ceremonies, private ketamine clinics, and through psychedelic tourism. Extralegally, through ‘underground’ therapists, at raves and music festivals, or alone. Strictly from a harm reduction perspective clinical social workers should be prepared to support their clients should they choose to access these medicines, and not only when the access becomes mainstream and widespread (Hutchison & Bressi, 2020). It is increasingly likely that psychedelics are going significantly impact the mental health landscape.

What is far less certain are the ways in which policy and regulation will ultimately shape how PAP are practiced-who may administer psychedelics, how therapists will be trained and supervised, who will be able to access services, and how patients will be safeguarded. Patients experiencing altered states of consciousness during PAP have increased suggestibility, and reduced capacity to consent (Anderson, Danforth, & Grob, 2020). Afterwards, patients may have difficulty recalling the exact details of their experiences due to state-based memory. These factors increase the risk to patients for abuses of power, boundary violations, and sexual assault (Villiger & Trachsel, 2023). Issues of sexual exploitation by psychedelic therapists and prominent figures in the psychedelic field are well documented, not only in unregulated underground settings, but in highly regulated clinical trials (Tillet Wright & Ross, 2021).

Intersectional factors must be duly considered when assessing the power differential between practitioner and patient, and it is reasonable to assume that marginalized groups may experience greater risk in clinical settings that is compounded by the vulnerability of the psychedelic state (Harrison, 2023). This poses danger to 2SLGBTQ+ patients because of the unique needs that sexual and gender diverse persons bring to the clinical setting (Belser & Keating, 2022). Similarly, the dangers faced by persons who seek clinical support are racialized, and these dangers are multiplied for those at the intersection of race and queerness (Ching, 2019).

Sexual and gender diverse persons suffer persecution, violence, and oppression around the world. Even in so called “developed” nations, 2SLGBTQ rights are far from comprehensive. These are recently won, often through the efforts of poor queer and trans folk whose access to these same protections are restricted by systemic racism (Greey, 2018). Existing rights are tenuous and under threat of repeal. The United Kingdom is currently attempting to restrict puberty blocking medications for minors, something many in the trans community consider to be life saving medication (Lawrie, 2021). The state of Texas recently declared that providing gender affirming care to a minor is to be legally considered “child abuse” (Chappell, 2022), and the Supreme Court of the United States (SCOTUS), recently overturned Roe v. Wade, allowing states to criminalize abortion, and paving the way for a rollback of civil rights including the criminalization of queer identities (Thomas E. Dobbs, State Health Officer of the Mississippi Department of Health, et al., Petitioners v. Jackson Women's Health Organization, et al., 2022). In response to this ruling, Texas Attorney General Ken Paxton stated he would defend the state's anti-sodomy law, if SCOTUS were to revisit Lawrence (Bella, 2022). As I write this the American Civil Liberties Union is tracking nearly 500 anti-LGBTQ bills currently moving through various stages of the legislative process (ACLU, 2023).

This is the ethos that pervades the everyday lives of 2SLGBTQ folks, and it is significant not only for the impacts that this sort of political climate has on the physical and mental health of sexual and gender diverse people, but also because this is occurring contemporaneously with a massive paradigm shift just beginning to unfold within mental health research and practice (Frecska et al., 2018). Historical pathologization, and contemporary marginalization contribute significant barriers for sexual and gender diverse patients to access health care services (Vegosen, 2022). These issues of risk and barriers to access are compounded for those who experience minority stress due race, ethnicity, color, age, and ability, in addition to gender identity and sexual orientation (Quinn, 2022; Skinta, 2022). Shaia and colleagues describe this as systemic trauma, a confluence of “…white supremacist racism, neoliberal economic policies, and cisgender-hetero-patriarchy,” which act to disproportionately generate trauma within specific communities (Shaia, Avruch, Green, & Godsey, 2019, p. 240).

Conclusions

The potential of PAP to improve outcomes, even in mental health conditions which have been treatment resistant, may be of particular interest for patient groups which are subject to socially engineered traumas and systemic oppression (Hutchison & Bressi, 2020). As psychedelic medicines ‘come out of the closet’ it is imperative that 2SLGBTQ+ patients are not left behind. There is a need to develop intersectional queer-affirming models of Psychedelic Assisted Psychotherapies (QA-PAP) (Belser, 2021). In order to do so, large gaps in the literature must be addressed, and many questions need to be answered. Foundationally, how queer persons experience psychedelic states of consciousness will need to be considered as interventions are developed in collaboration with queer patients and practitioners.

For these reasons there is a great need to delve into the queer phenomenology of psychedelic mediated states of consciousness, in order to build an understand of how 2SGBTQ+ persons subjectively experience and make meaning out of these experiences in relation to their own narratives of gender identity and sexuality. This is essential in order to center queer patients needs in psychedelic healing, and in discourse on the development of Queer Affirming models of Psychedelic Assisted Psychotherapy (QA-PAP).

Funding and conflict of interest

This research is funded by the Alberta Patient Oriented Research Unit (AbSPORU) Graduateship. I have no known conflicts of interest to disclose.