Abstract
Background and Aims
This article examines the therapeutic potential of psilocybin in addressing Post-Traumatic Stress Disorder as the result of sexual abuse. PTSD is a prevalent form of mental distress resistant to most conventional treatment methods.
Methods
Through an in-depth analysis of the narratives of two individuals with longstanding, treatment-resistant mental health conditions, who participated in a weeklong group-based psychedelic retreat involving psilocybin, the study unveils the intricate interplay between psychedelic-assisted therapy, memory, and narrative in the healing process.
Results
The research findings suggest that beyond the commonly acknowledged therapeutic effects of psychedelic drugs, psilocybin can facilitate the retrieval of repressed or forgotten traumatic memories, allowing for conscious awareness, recognition, and reconciliation. A noteworthy aspect of the healing progression observed is the re-narration of one's identity and biographical circumstances following the recovery of unresolved traumatic memories.
Conclusions
This study underscores the importance of memory and self-narrative in the therapeutic landscape of psychedelic-assisted therapy for trauma. The article concludes by advocating for continued exploration in future research regarding the complex dynamics of memory and self-narrative in the healing journey within psychedelic science and trauma studies.
Introduction
This paper explores the effects of psychedelic-assisted therapy (PAT) to treat trauma and, relatedly, Post-Traumatic Stress Disorder (PTSD). The physical, mental, and emotional symptoms that can result from traumatic experiences are resistant to most conventional treatment methods. Whereas PAT has been the subject of numerous clinical trials, studies, and/or experiments in two (or arguably three) iterations in the West since the 1950s, currently a dearth of research exists on the therapeutic efficacy of such drugs in the treatment of PTSD. Beyond the conventional focus on the therapeutic effects of psychedelic drugs, this paper's emphasis is on two factors that have been less specifically analyzed in research on PAT yet are crucial in the healing process, particularly for those suffering PTSD: the interconnection between memory and autobiographical narrative.
This study explores how revealed memories can provide an opportunity for recognition and reconciliation of traumatic biographical events and expresses how such revelations impact survivors' identities and narrative autobiographies. Analyzed here are the narratives of two women who, after living with decades-long, treatment-resistant mental health conditions, used psilocybin at a PAT retreat and recovered repressed memories of sexual assault. The stories told exhibit both psilocybin's ability to bring repressed or forgotten traumatic memories into conscious awareness and the resultant cascade of intrapersonal events that take place during the path toward healing and self-transformation. This research attempts to highlight the significant role of re-narrating one's autobiography as a sequence in the healing process after the recovery of unresolved traumatic memories. The conclusion emphasizes the need for future research in psychedelic therapy, social science, and trauma studies to continue exploring the impact of memory and self-narrative on the healing process.
Post-Traumatic Stress Disorder
To gain a sense of safety and control, the patient creates psychic, emotional and somatic distance between tormenting and introjected versions of self and others; a safe enough distance from intense forms of pain via excessive use of denial, splitting, dissociation and so on. Often, the outcome is a kind of fragmented internal organization, creating an experience of inner and outer chaos that prevents or makes it difficult to achieve a sense of embodied coherence and solidity; a sense of belonging in one's mind, heart and body (Modlin, Stubley, Maggio, & Rucker, 2023, p. 553).
PTSD that is linked to sexual trauma is particularly complex to treat. It is believed that up to 22% of women in the general population have experienced a form of sexual assault, with most assaults taking place in childhood (Elliott, Mok, & Briere, 2004). Sexual assault is significantly associated with serious symptoms of PTSD (Gillespie et al., 2009; Rowland et al., 2022), with survivors showing increased likelihood of sexual dysfunction (O’Driscoll & Flanagan, 2016) and several comorbidities, including poorer perceived health and higher rates of chronic illness, substance abuse, physical disability, risky sexual behavior, and healthcare usage (Lang et al., 2003). Survivors can also suffer a variety of maladaptive psychological dispositions as the result of their experiences. For example, studies have shown that sexual abuse victims are more likely to believe that they have been betrayed and that the world is not safe (Koss & Gidycz, 1985) or engage in self-blame or distrust (Jensen & Gutek, 1982). However, survivors' cognitive schemas (e.g., assumptions, outlook, beliefs, predispositions) have been demonstrated to operate as mediators between traumatic experiences and psychological adaptation. This suggests that cognitive restructuring with regard to survivors' most salient schemas can provide insight into potential therapeutic strategies (Vaile Wright, Collinsworth, & Fitzgerald, 2010).
Finding a successful treatment for diverse categories of PTSD has been complicated and many studies have shown that the use of pharmacotherapy to treat symptoms is often inefficacious (Yehuda et al., 2015). Psychotherapies attempt to enable patients to confront and process the content of traumatic experiences to replace self-defeating cognitive schema with those that are healthier and rational (Yehuda et al., 2015). Evidence-based psychotherapeutic treatments like prolonged exposure or cognitive processing therapy are rarely curative and are defined as “successful” when partial reduction of symptoms is achieved (Dahlgren, Martinez, Méte, & Dutton, 2020; Larsen, Fleming, & Resick, 2019). This is especially the case with PTSD associated with sexual abuse (O’Driscoll & Flanagan, 2016). As well, due to the intense nature of recalling traumatic experiences, high dropout rates exist throughout PTSD treatment (Watkins, Sprang, & Rothbaum, 2018).
Notably, trauma scholars indicate that memory of traumatic experiences can be disrupted or forgotten altogether. According to the DSM-IV, the inability to remember traumatic events or their details is typically due to dissociative amnesia. Nevertheless, the complicated nature of PTSD is that while some triggers (e.g., smells, sounds, sights, sensations) can be consciously indexed and therefore rationalized, others exist outside cognitive or somatic awareness. Because of this, sufferers of PTSD who have trouble integrating the memory of trauma into their lives, and who therefore may be unable to account for and/or fully comprehend its (often multiple) outcomes, can unconsciously relive the past or misjudge innocent stimuli (Van der Kolk, 1994, 2014).
The role of memory and narrative in psychedelic therapy
The “classic” psychedelics (or serotonergic or hallucinogenic psychedelics) are psychoactive substances that primarily interact with the serotonin receptor system in the brain and induce altered states of consciousness that distort perception, mood, and cognition. A growing body of research suggests that these drugs, used as an adjunct to psychotherapy (c.f., Goodwin, Malievskaia, Fonzo, & Nemeroff, 2023), can help ameliorate the symptoms of numerous forms of mental distress. Psilocybin is the focus of this paper. Recent clinical trials have shown the ability of psilocybin-assisted therapy to successfully treat substance abuse disorders like alcohol (Bogenschutz et al., 2018) and tobacco (Garcia-Romeu, R. Griffiths, & W. Johnson, 2014; Johnson, Garcia-Romeu, Cosimano, & Griffiths, 2014, 2017), obsessive-compulsive disorder (Moreno, Wiegand, Keolani, & Delgado, 2006), cancer-related anxiety and depression (Griffiths et al., 2016; Ross et al., 2016), and treatment-resistant depression (Carhart-Harris et al., 2016; Roseman, Nutt, & Carhart-Harris, 2018; Watts, Day, Krzanowski, Nutt, & Carhart-Harris, 2017). Calls have also been made to study the potential of psychedelics to treat PTSD (Averill & Abdallah, 2022; Modlin et al., 2023).
The therapeutic mechanisms behind psychedelics are not fully understood. Most studies in the field of PAT take place in clinical settings and are thus significantly influenced by the biomedical sciences (Andrews & Wright, 2022; Giffort, 2020; Langlitz, 2013; Schwarz-Plaschg, 2022), analyzing therapeutic efficacy using methods that reduce the scientific purview to neurological and cognitive dynamics (Letheby, 2021). Other explanations are phenomenological in nature and suggest that the transformative potential of such substances may come from “mystical/peak” experiences or “ego dissolution” (Lebedev et al., 2015; Millière, 2017; Nour, Evans, Nutt, & Carhart-Harris, 2016), increased insightfulness (Davis et al., 2021) or emotionality (Bogenschutz et al., 2018; Roseman et al., 2019), or from the ability of psychedelics to act as “meaning-enhancers” (Hartogsohn, 2018). However, there are myriad other factors that are valuable to therapeutic and transformative outcomes. Two such factors in PAT that have received an undersized (or inexplicit) interest—especially for the treatment of PTSD—are memory and autobiographical narrative and their interconnectedness.
As described above, memory has received significant attention in trauma research, and one reason the classic psychedelics may be useful in the treatment of PTSD is their unique capacity to bring forgotten or repressed memories back into cognitive awareness. As Healy (2021) argues, such medicines “increase the vividness of autobiographical memories and frequently stimulate the recall and/or re-experiencing of… memories that are affectively intense (positively or negatively valenced) and that had been avoided and/or forgotten prior to the [psychedelic] experience” (p. 639). In other words, used with therapeutic intention, psychedelics can be categorized as facilitating a type of psychological exposure therapy (Abramowitz et al., 2019) where patients can be assisted in revealing and exploring repressed memories and psychological patterns and can therefore integrate the derived lessons and insights into everyday life. As Richards (2015) argues, “the benefits of a well-planned psychedelic experience come not from the substance itself, but rather from the integration of the enduring memories of the particular states of consciousness that were experienced during the period of drug action” (p. 19; italics added). The therapeutic potential of this treatment method thus emerges when sufferers, in recovering hidden or repressed traumatic memories, develop novel frameworks for understanding their traumas and hence build healthier relationships with it (Nutt, Erritzoe, & Carhart-Harris, 2020; Watts et al., 2017).
Notably, it is important to recognize the complicated nature and veracity of memories—i.e., of the revealing and piecing together of repressed memories “like sensory puzzle pieces” (Watts et al., 2017, p. 539), or of defining which memories are real or objective. While revisiting or recovering memories during psychotherapeutic or psychiatric treatment might be experienced as personally meaningful by patients, such memories should not necessarily be taken as literal or factual, as empirical studies have shown that it is possible to both recover memories and produce false memories (i.e., remembering events that did not happen), as shown in the extensive debates over “false memory syndrome” (Pope, 1996). A critical orientation toward the topic of memories is especially important for both therapists and patients of PAT due to the increased “suggestibility” of individuals under psychedelic states (Dupuis, 2021). In this study, the researcher considers participants' memory narratives as meaningful experiences, deserving of thoughtful examination and recognition (Watts et al., 2017).
Scholars of psychedelics and PAT have recently begun to analyze narrative and narrative reframing as fundamental elements of self-transformation and healing (Amada, Lea, Letheby, & Shane, 2020; Dupuis, 2022a, 2022b; Hipólito & Tzima, 2023; Lutkajtis, 2021; Lutkajtis & Evans, 2023). Because of the ability of psychedelics to produce significant alterations to one's sense of self—such as the experience of “ego dissolution” (Gearin & Devenot, 2021; Millière, 2017)—psychedelic phenomenology is often described as offering users a fresh perspective on their lives. Such altered states and the idiosyncratic insights they provide can be incorporated into daily life for beneficial and/or healing purposes—such as changing maladaptive behaviors (for example, addiction—see Noorani, Garcia-Romeu, Swift, Griffiths, & Johnson, 2018) or self-referential thought patterns—or toward the development of cognitive and narrative frameworks that are more compassionate and accepting (Malone et al., 2018). In other words, a “disruption in the usual patterns of self-perception and interpretation” enables a “more fluid and dynamic interaction with the environment and one's own inner world” that “opens the door to potential shifts in personal narratives and perspectives” (Hipólito & Tzima, 2023, p. 15). Research suggests that even “challenging” experiences or “bad trips” can be transformed through autobiographical narrative reconstruction into valued events that hold important existential or personal insight (Gashi, Sandberg, & Pedersen, 2021). In this vein, Dupuis (2022a, 2002b) calls psychedelic experiences techniques of the self (not used in the vein of the work of Michel Foucault) in that they can produce in users a renewed sense of identity and narrative autobiography steeped in the cultural context in which the psychedelic experience took place. However, more research is needed to understand how narrative and self-concept are transformed in the context of medicinal psychedelic use.
Resolution of the traumatic or disrupted memory processes would be manifested as a more coherent, less fragmented memory, in which all aspects could be meaningfully integrated into a narrative account, an account that was under full control of consciousness, could be accessed and also put aside at will, and that formed a part of autobiographical memory (and thus identity) without being able to invade the present (and undermine identity) (p. 708)
Considering the capability of PAT to foster the experience of new insights and reflections, bring repressed memories to the surface, and alter conceptions of identity, further research is needed to understand how trauma sufferers confront, gain control over, reassociate, and thus narrativize traumatic memories (Watts et al., 2017).
Methods
This paper analyzes the experiences of two women who, after suffering decades of mental distress and being unsatisfied with orthodox mental health treatment, used psilocybin-assisted therapy while attending a legal psychedelic retreat in Jamaica. The data were collected alongside a larger sociological study which focused on (1) the retreat itself, which entails a group-based model intended for individuals who suffer treatment-resistant mental health conditions, and (2) the experiences and outcomes of 20 of its attendees.
This study was reviewed by the researcher's institutional Ethics Review Board and conforms to the standards of the Canadian Tri-Council Research Ethics guidelines, and all research participants gave informed consent to participate. A retreat staff member facilitated the recruitment of participants, and in each case outlined in this paper, semi-structured, in-depth interviews took place over Zoom around a year after participants attended the retreat.
Interviews were around two hours in length and probes were used throughout for clarity or to obtain more detailed responses. They were conducted, recorded, and transcribed over Zoom, and were reviewed for accuracy. Coding was done using NVivo, a qualitative data analysis software. In vivo coding was also engaged for capturing participants' perspectives and language in their own words. For this reason, and in keeping with the autobiographical storytelling tradition, many long quotes are used throughout these case studies, and inductive analyses were employed as a means of prioritizing the experiences, viewpoints, and meanings articulated by the research participants (Lofland, Snow, Anderson, & Lofland, 2006).
A storytelling approach (Berger & Quinney, 2005; Epstein et al., 2021; Polletta, Chen, Gardner, & Motes, 2011) was employed during the interviews to allow participants to reflect on and describe their autobiographies and psychedelic experiences in great detail. Interviews were organized both temporally and thematically: before the retreat (e.g., histories of distress, previous attempts at therapies, and the reasoning for attending the retreat), during the retreat (e.g., personal narratives of psychedelic phenomenology and its impact), and after the retreat (e.g., the perceived outcomes of psychedelic therapy, personal healing, and/or self-transformation) (see also Barone et al., 2022).
Data analysis was approached through a combination of narrative analysis and reflexive thematic analysis. Located in the humanist, social constructionist tradition, narrative analysis is a useful method for delving deep into subjects' experiences and sense-making. The purpose of narrative analysis is to allow the researcher to gain a closer look at how subjects' stories (used interchangeably with narrative), meanings, and perceptions reflect social and cultural norms, values, and morals (Bischoping & Gazso, 2016). This paper also borrows from reflexive thematic analysis (Braun, Clarke, Hayfield, Davey, & Jenkinson, 2023; see also Byrne, 2022) in adopting an experiential (versus critical) orientation to interpreting data. This means giving precedence to the research participants' thoughts, feelings, and viewpoints as reflective of “personal states” of the participants (Braun et al., 2023; see also Braun & Clarke, 2013; Reicher, 2000), although the researcher acknowledges the socially constructed nature of personal experiences and, as aforementioned, recognizes the issues of objectivity in memories. The following autobiographical narratives are understood as assertions of agency and as fundamental to the process of constructing one's identity (Holstein & Gubrium, 2000) and sense of self (McAdams, Josselson, & Lieblich, 2001, 2006; Presser, 2004). This approach follows research in mental health therapy, which views autobiographical interviews as an important avenue for sufferers to reconstruct healthier autobiographies (Crossley, 2000; Kaminer, 2006).
Case one: Annie's (un)fortunate revelation
“Annie” is a jovial, well-read 40-year-old white woman of Christian faith with a bachelor's degree. She has endured a lifelong struggle with her body weight and concomitant stress and depression. Once over three-hundred pounds, Annie received gastric bypass surgery, which made her “thin,” as she put it, though the results did not last. “I used to be a skinny kid,” she states, reflecting on her past. Yet beginning somewhere in childhood, personal and familial problems brought forth physical and mental health issues that neither she nor her doctors could resolve.
Over the years I’ve seen a number of different therapists… Usually it was at a point where I was extremely depressed. And so, I would go see a therapist and psychiatrists and usually get prescribed some type of anti-depressant or anti-anxiety medication. And it always left me feeling very numb. It left me feeling better in the sense that I felt less depressed, but I also felt less happy. So I didn’t feel like the combination of therapy and antidepressants [were] a good solution for me.
At her worst moments, Annie felt grateful for the drugs, as they helped alleviate—or “numb”—the most challenging symptoms. While she preferred to be numb over suicidal, Annie wanted more than simply the masking of symptoms.
I had no experience with [psychedelics]… I didn’t even know [anyone] that had done it. So I didn’t feel safe [doing it] by myself. I wanted it to be legal and I wanted it to be with other people assisting me. That’s how I came upon [the retreat] and how I ended up, as a person who’s never done any drugs ever, flying off to Jamaica by myself for eight days to take three doses of magic mushrooms. I wanted to figure out if it could help me before, maybe, it [becomes] too late for me.
Arriving at the retreat
Well, the first group meeting—you know, the group therapy session—we were all talking about our backgrounds and our stories. I talked about my weight loss and my struggle with it. [After], the head facilitator took me aside… and asked me if I was familiar with [the book] The Body Keeps the Score. I knew where he was going with that [question].
I just kind of saw myself in that book. But I thought, ‘Well, I haven’t been sexually abused, you know, I’d remember that [sort of thing].’ So [at the time], I just put it out of my mind.
Annie confirmed to the retreat therapist that she had read the book. As she recalls, the therapist replied, “You know, you didn't bring this [information] up [during introductions], but have you ever had any sexual abuse or molestation in your past?” “No,” Annie answered. “No, I don't recall any of that.”
Dose number three: “I knew exactly who it was”
During [the third] mushroom trip, it became crystal clear to me exactly what had happened… I knew immediately. [In the psychedelic state] I actually saw my neighbor… I knew exactly who it was. I hadn’t seen this guy, this kid, in 25 years. I was molested by my neighbor. It was just this knowing… I saw his face. I sat up [and said out loud], ‘I knew it was you.’
It just all made sense to me—all the pieces of the puzzle came together. It felt like this huge relief because, finally I felt like it wasn’t my fault, it wasn’t my body’s fault, and there wasn’t something inherently wrong with me—that my body kept putting the weight back on in order to protect me, in order to prevent men from being attracted to me; that no matter what I did, my body was just going to keep putting weight back on. I spent most of my life blaming my lack of willpower or my lack of discipline for why I couldn’t keep the weight off.
I was very young when this [situation] happened. I’m sure it happened… between the ages of seven and ten. I don’t know how I would have ever come to this same conclusion in regular therapy. I don’t know how I would have accessed this memory, which I was clearly repressing.
Post-retreat integration: the learning continues
[When I was young,] I lived out in the country, and we had this little playhouse—it was totally private, and it locked from the inside. And we were surrounded by woods… For hours and hours, I would just be alone as a kid. Nobody knows where you are or what you’re doing. So, I [recently] had this dream, and I knew it [happened] in the playhouse. My mom was a single mother, so it was like I was raising myself for a long time. After [the retreat], I was trying to get my memory to give me more details, and it was.
[I realized that] my dad’s dad was a very abusive man. I heard rumors throughout the years that he had abused, like, all of [his] kids. [During the psychedelic experience], I had these visions of him where he was [the one] being abused, and I felt nothing but compassion and deep empathy and sadness for my dad. I saw him completely differently.
Instead of seeing myself as this victim—like, ‘Yeah, your dad’s an alcoholic and poor me,’ you know, [or] ‘I grew up without a dad and whatever’—instead, I felt like, ‘No, like, my dad had no idea how to be a good father,’ because his father was abusing him. So, I felt like I forgave my father, and I have been trying to get back home to see him and find him and tell him in person that I forgive him. I want him to know that, and I want to see him in person and tell him… before he dies. But I want him to know that I forgive him and that I understand why he behaved the way he did. This poor man, he suffered his whole life.
So yeah, I mean, these are major, major things happening from one [psychedelic] trip. The big epiphany was the sexual assault, but I had resolution on many, many things.
I treat myself differently now because of those revelations. I would have never been able to [come to this perspective] had I never realized why I put on that weight in the first place.
Having this experience in Jamaica has helped me come to peace with how I’m treating my body and having more respect for it. [I no longer] punish my body by overeating, I don’t punish it by overexercising, and I don’t punish it by starving it either.
Even though it’s tragic, I’m grateful that I found out this information. No one wants to realize that they were abused, but just this sense of knowing how I’m treating myself differently has been really life-changing to me. I [attribute it all] to the mushrooms.
I [now visualize] myself as a hurt child… Instead of beating myself up, I now picture myself as a tough little girl… So when I feel bad or when I’m beating myself up, I realize that little girl is still inside me. [I recognize] that I wouldn’t treat a child [that way]. I wouldn’t treat a child the way I’m treating myself right now, I would not be talking to a child the way I’m talking to myself right now—in a negative way. So, definitely all of that is different for me.”
If I had, many years ago, seen how I am now—how I look now, how I feel now—I wouldn't have believed it if you would have showed me. Like ‘Annie, this is what you're going to look like when you're 40, what you're going to feel [like] when you're 40,’ I would have been like, ‘No way, I don't even know if I will still be alive when I’m 40 because I hate myself that much.’
Case two: the killing of Carrie’s childhood
I have a long history of mental illness, sometimes very severe. I had a childhood trauma that kind of molded some of [these issues]. But [I] mostly [have been dealing with] depression and anxiety. I’ve had different diagnoses over the years. My response to the trauma was to be kind of cold, [to have a] flat affect, that kind of thing. [Once] I was evaluated, I was diagnosed with mixed personality disorder with avoidant features. I no longer believe that diagnosis.
[Decades ago] I was actually an in-patient for a little over a month. I had tried several times from probably 13 or 14 [years of age] until my mid-40s to find a therapist, [but] I never found one that really clicked with me. I think a lot of that’s [due to] my suspicious nature and the thickness of the walls I had built up. I have been seeing a therapist now for five years and… for some reason, it might be just where I was in life, or it might be him—I’m not sure—but [the recent therapy has worked at times]. [But] I’ve been on SSRIs my whole adult life. Wellbutrin as well, [and] Benzos (referring to benzodiazepines) at times.
The combination of psychopharmacological and psychotherapeutic treatments had proven helpful in alleviating the most difficult symptoms for Carrie. She describes the last few years as being “pretty steady… without any big peaks [or] valleys. No major anxieties, no major depression.” At the same time, however, Carrie did not find herself thriving, but merely surviving. As the Jamaica trip approached, though she was uninterested in—or possibly simply nervous about—taking the mushrooms, Carrie nonetheless began to adhere to the protocol that the retreat recommends to all its guests: weaning herself off the pharmaceutical prescriptions she was taking (in order to achieve the full effects of the drug). She accomplished this via a “slow taper” method, as advised by her psychiatrist, that gradually decreased her medication over the several months leading up to the retreat. Despite the fact that Carrie was no longer on medication one month before heading to Jamaica, she was still uncertain if she would take the mushrooms on retreat.
Arriving at the retreat
The… personnel, the actual location, the place, the staff, the [area outside the retreat], the housekeeping and cooks—they just had a really good… I don’t want to say that they had a good “energy,” because that doesn’t really mean anything to me. But they felt familiar, and I felt comfortable. It wasn’t like, you know, one creepy hippie guy in the woods type thing (giggles).
I was like, ‘Okay, so that wasn’t too scary, it wasn’t bad. I think I can do this next time… use an eye mask and maybe listen to music that’s not quite so engaging (as was the jazz music she decided on the first time).’ I was convinced that I would be safe and that I didn’t need one foot on the ground. I knew that I had a lot [more to explore]. After years of therapy and lots of short-sighted pharmaceutical solutions, I knew that there was more in there for me, but I didn’t know what that would look like exactly (referring to going “deeper” into the psychedelic space and being more “curious” as to what she might find).
The relaxed first dose hence prepared her psychologically to resume the dosing protocol two days later, and what she experienced was something she could have never envisioned.
Dose number two: “I killed… My wounded inner child”
It was all of a sudden. I was in this dark place—imaginatively, not emotionally. I didn’t remember ever being anywhere else if that makes any sense at all. When I was in the [psychedelic] space, I don’t know if it was me or where the perspective was… It was very odd. But then the place [in my mind] became one from my childhood that was a really special place that I liked. I grew up on the Mississippi Gulf coast… There was a little creek and the bank of it was washed out… There were these little cave cubbyhole things, and that’s where I was all of a sudden.
When I was there [in the coastal place] I came across this thing… It was white and translucent. As you can probably see (pointing to her face), I’m very fair [skinned], so it kind of had skin like me. I could see it, but I didn’t identify it as human. And I’m there with this thing and… it’s sick. It’s really sick, and it’s suffering. It doesn’t have a face. I don’t know that it’s a human, but sometimes I think… it’s me. I’m not sure if… it isn’t me. (Taking another deep breath.) Anyway, in this [psychedelic] space, I very violently put [the thing] to death. Because it was suffering, or I don’t really [know]. (Trying to find words.) That’s… that’s what I rationalized after the fact. But I knew that it was sick, and it was suffering, and it wasn’t going to live anyway. But [what I did] was very, very graphically violent. And then I took it and buried it in the bank of that creek where I grew up.
I was actually, like, vomiting—almost choking on my own vomit. The facilitators were of course right there, and you know, kind of tilting me up to make sure that I didn’t choke. And I immediately felt aware, like, ‘Okay, there’s all these people, I have vomit all over me, and I’ve just killed something and I’m not sure if they know if I did it. Like, I should probably go ahead and tell somebody, but I can’t really talk [due to being under the influence of psilocybin].
At this point in the retreat experience, Carrie decided to sit up, remove her eyeshades, and take a break. A female facilitator assisted her back to her room so Carrie could shower and change clothes. When she returned to her physical location and settled back down into her space, she began to cry—and did so for hours. “I cried for probably four hours without stopping,” Carrie told me. “And I don't cry. Like I don't ever cry. So that was a big deal.”
Digging deeper
I still don’t know exactly [what it all meant]. I kind of feel like it was me, [but I can’t be certain] … Part of me thinks it was the wounded inner child [in me], and that [the act] had already happened [long ago], but I was [only] just seeing it now.
Carrie: I think [the psychedelic journey] may have [depicted] a time when I was a child. I mean, obviously I didn’t kill something but… I think I had let go of that sick thing a long time ago.
Interviewer: You think that your inner child was metaphorically killed when you were a child?
Carrie: Yes. But I can’t really tell you exactly why I think that.
Interviewer: Do you recall the [actual] day that this all happened?
Carrie: No.
Interviewer: What do you think actually happened?
Carrie: Yes. I… I was sexually abused by a man when I was five. And it happened more than once. And I’ve never recovered the memories really well enough to know that it happened, but um… I think at some point, [when I was a child] I moved on from that—from these horrible things that happened to me—without that damage. You know, I just [tried] to leave that behind me and become something new.
In Carrie's perspective, the “thing” she found at the riverbank and put to death in her psychedelic state represented the death of her inner child, which was the product of the traumatic encounters she had when she was young. Those experiences, she believes, might have caused of her later mental health concerns, but she is not certain.
There’s this kind of nuance in the psychedelic space. Although I was violent and doing this horrible thing, I felt very powerful in doing it; I [felt] a great sense of relief. And that’s not something that I had ever felt really. It was a very strange feeling to me. […] I can’t pinpoint a time in the past where… I felt like I had just released something really big. I don’t know [how to describe it], but looking back from here, I can say that it felt like such a release. I’ve heard people say, you know, [some of these experiences] can be cathartic, [but I never knew what that meant]. I feel like, now, I know what that means, [because] that’s what that was.
Crying is just not something I can remember doing. I didn’t not cry [historically] because I was holding back from crying, I just never really felt a reason to cry. The [psychedelic journey] definitely broke through some kind of wall because I was able to cry after that.
This was an important epiphany for her, she claims, because “I'm different now. I'm changed. I can feel things [now].” Returning to a conversation she had with her therapist after the retreat—who she once told she was “dead inside”—the therapist proclaimed, happily, “Gosh, this [psychedelic therapy] is going to put me out of business!” (Carrie laughs). “We [the therapist and her] could have met every week for 10 years and not gotten to this point.”
Having more feelings [led me to become] suicidal quickly. And I think it was because I didn’t have the walls, the mechanisms that I used to have to deal with depression. I did not make any attempts [on my life], I cleared my home of everything dangerous. (The family member she went to the retreat with) came here and sat with me for a week, and I went right back on SSRIs again.
Overall, I think I’m in a much better place than I was before. It did big things for me that are still lasting. But it didn’t make me [never] depressed again, and it didn’t make me [never] anxious again. But maybe I can’t fix everything in a week.
Discussion
This qualitative study analyzed two cases that, while idiosyncratic, have a common theme in childhood sexual abuse and resulting negative mental health consequences. As seen in the first story, Annie had no previous recollection of what happened to her, which made understanding her symptoms (e.g., weight fluctuations, stress and anxiety, suicidality, etc.) impossible. Carrie, on the other hand, had somewhat understood the unfortunate circumstances of her childhood and could vaguely narrate the symptoms those experiences produced, but lacked a precise memory of the trauma and thus could not comprehend nor pinpoint with assurance the myriad ways it impacted her life. Though neither had been diagnosed with PTSD, both lived with a cluster of symptoms recognized by the DSM as associated with PTSD: hypo- and hyper-arousal, depression and anxiety, flat emotional affect, and relationship difficulties, amongst others. However, according to both Annie and Carrie, under the psychedelic state, the reactivation of traumatic memories and the concomitant emotional charge enabled each to better understand what they had experienced decades earlier and how those early experiences impact them today. This was particularly the case for Annie, who remarked that recalling the original trauma enabled her to understand the myriad symptoms she subsequently experienced: “It felt like this huge relief because, finally I felt like it wasn't my fault, it wasn't my body's fault, and there wasn't something inherently wrong with me…”. As well, Carrie reported the important impact the symbolic nature of her memory had on her: “I [felt] a great sense of relief. And that's not something that I had ever felt really.”
As outlined by both participants, the recovered memories played a fundamental role in their healing. Though psychedelic experiences can overwhelm sensory and cognitive processes, as these case studies have shown, the ability of psychedelics to assist in revealing memories—whether previously avoided, forgotten, too painful to consciously recall, or if they are abstract, symbolic, metaphorical, difficult to discern, unprovable, or simply false—can have important therapeutic efficacy. While trauma scholars have explored issues of memory, the therapeutic value of the classic psychedelics to bring forgotten or repressed memories back into consciousness—where they can be reconsidered and managed—has been less studied through in-depth interviews. This phenomenon is brought into relief by the stories presented here.
Psychedelic experiences, as a means of self-transformation and healing, implicate narrative and narrative autobiography in several ways. In producing an altered state of consciousness and, concomitantly, an altered sense of self for a short period of time, users are able to reframe and reinterpret their identity and biography. This experience is especially significant for individuals suffering various forms of mental distress: the psychedelic state temporarily removes them from their suffering (e.g., psychological, physical, emotional, and biographical) in a way that provides the distance needed for reflection. As Annie's case suggests, the new perspective she was afforded through the consolidation of her memory produced a renewed autobiographical narrative that was used to make better sense of her childhood and life trajectory. The contrast between her current, adult sense of self, and her past, childhood self, reveals how much the therapeutic psychedelic experience adjusted her biographical narrative. Whereas previously it was not unusual for Carrie to experience self-hatred, her reflection on and ultimate acknowledgement of the “tough little girl” who endured abuse—who she now recognizes still makes up a significant part of her contemporary self concept—suggests a different path forward and hence an updated, healthier narration of her autobiography. As well, Annie was also able to reconsider her relationship with her father—who was both abusive to her and was himself abused as a child—in a more compassionate way. The pain and confusion that previously enveloped her life can now, as her interview exhibits, be placed into a narrative that encompasses more of what she believes happened to her, giving her the ability to offer herself and her father compassion as opposed to blaming herself or feeling guilty.
For Carrie, the symbolic and metaphorical revelations of the psychedelic state helped her understand her personal history. While Carrie knew that a “childhood trauma” produced within her a “cold, flat affect” and the diagnosis “mixed personality disorder with avoidant features,” the memory-infused experience she had during psilocybin-assisted therapy enabled her to recount a different life history. As stated in the interview, with the recovered symbolism of her childhood, she now believes that after she endured the abuse as a child, she had “moved on” from the “horrible things that happened” to her as she tried “to become something new.” This restructured autobiographical self permitted her to better explain her past and hence her present. This transition was clear in her statement that she is “different now,” that she “can feel things” again. Ultimately, both Annie and Carrie, through recovered memories during PAT, developed new stories of themselves.
The findings of this research add to the literature in PAT and trauma studies in several ways. First and foremost, this paper highlights some of the healing mechanisms of PAT for PTSD that have been less explicitly analyzed in psychedelic science and therapy. While neurological and cognitive mechanisms have received outsize attention in the field of psychedelic science and therapy (Letheby, 2021), the psychological and narrative aspects of PAT need further research (Dupuis, 2022a, 2022b; Amada et al., 2020; Hipólito & Tzima, 2023). This study provides qualitative evidence of the beneficial effects of psychedelics with regard to memory and narrative, their interconnection, and their impact on self-transformation. The analysis provided by this research thus suggests that as individuals retrieve hidden or repressed traumatic memories and construct novel frameworks for understanding their traumas, they can develop healthier relationships with their experiences and replace self-defeating cognitive schemas with healthier ones (Nutt et al., 2020; Watts et al., 2017; Yehuda et al., 2015). Concurrently, these case studies contribute to the social science literature on narrative self, self-transformation, and the social construction of the self (Bischoping & Gazso, 2016; Chandler, 2000), as well as in the trauma studies literature on the self-transformation from victim to survivor as important for empowerment and self-growth (Hockett & Saucier, 2015; c.f., Williamson & Serna, 2018). Finally, this research provides further evidence of the way storytelling can operate as a coping mechanism to turn “challenging experiences” or “bad trips” into positive or growth-oriented experiences (Gashi et al., 2021).
The study's limitations include a small sample size and homogeneity of the research participants (e.g., both female, White/Caucasian, experienced sexual abuse and PTSD). In future research it will be important to consider a more diverse sample with regard to race/ethnicity, gender, etc. (see Buchanan, 2020; George, Michaels, Sevelius, & Williams, 2020; Hewitt, 2019; Neitzke-Spruill, 2020; Vallely, 2020; Viña & Stephens, 2023; Williams, Reed, & George, 2020). Forthcoming studies should also consider the ways narrative is situated in the “cultural repertoires” (Linde, 1993) of distinct psychedelic subcultures, the therapeutic use of psychedelics being only one form. For example, DeGloma's (2010, 2014) “sociocognitive” approach to narrative analysis locates autobiographical narratives in “awakening” stories, or “autobiographical revisions” that are influenced by different thought communities. Considering the unique set and setting and interpersonal dynamics of group-based retreats, research should consider the social-psychological and cultural dynamics that take place in group-based psychedelic events (Rose, 2022, 2024). Lastly, more investigations are needed on psychedelic retreats as they are growing in popularity as an alternative method for self-transformation and healing (Dupuis, 2021, 2022a, 2022b; Dupuis & Veissiere, 2022; Fotiou, 2014, 2020; Fotiou & Gearin, 2019; Gearin, 2022; Lutkajtis, 2021; Lutkajtis & Evans, 2023; Rose, 2022, 2024).
Conclusion
This paper considered the impact of psilocybin-assisted therapy in addressing PTSD, a form of mental distress difficult to heal via orthodox mental health treatments. The narratives of two women suffering decades-long treatment-resistant mental health conditions were analyzed after they used psilocybin-assisted therapy on a group-based, weeklong psychedelic retreat. The findings of this research suggest that, in addition to how psychedelic drugs are typically considered therapeutically effective, memory and narrative—particularly their interconnectedness—serve important therapeutic functions in healing PTSD. This research showcases the ability of PAT to bring repressed or forgotten traumatic memories into conscious awareness, where they can be recognized and reconciled. After unresolved traumatic memories have been recovered, a significant progression in the healing process is the re-narrating of one's identity and biographical circumstances. Future research in psychedelic therapy and trauma studies should continue to explore the impact of memory and self-narrative in the process of healing.
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This information is contained in episode #464 of The Tim Ferriss Podcast, entitled “My Healing Journey After Childhood Abuse.”
