QMJC July 2020 – Narrating the unspeakable: Making sense of psychedelic experiences in drug treatment

Article: Shana Harris. 2019. Narrating the unspeakable: Making sense of psychedelic experiences in drug treatment. Journal of Extreme Anthropology, 3(2):116-140.

Link: https://doi.org/10.5617/jea.7365

Toronto reading group – July meeting: Carol Strike; Katherine Rudzinski; Andrea Bowra; Julia Edgar; David Kryszajtys; Cathy Long; Sarah Switzer; Tara Marie Watson; Jessica Xavier (Dalla Lana School of Public Health, University of Toronto)

Meeting summary:

In July 2020, members of Qualitative Methods Journal Club reviewed Harris’ 2019 paper, Narrating the unspeakable: Making sense of psychedelic experiences in drug treatment. In this article, the author analyzes the ways in which people struggle to narrate their experiences of using psychedelics for drug treatment. Using ethnographic fieldwork from two ibogaine treatment centers in Baja California, Mexico, gathered between 2015 and 2019, Harris examines how these “unspeakable primary experiences” are retold to the researcher and the ways in which participants make meaning of these events. Focusing on 30 interviews with people receiving or providing psychedelics for drug treatment, the author investigates the following research questions: how does narration work if psychedelic experiences have an ineffable quality? What kinds of narratives are possible and which types of narratives are foreclosed in the context of a psychedelic-based drug treatment approach? Harris argues that psychedelic experiences, especially those that have a therapeutic use, create a “unique challenge for the anthropological study of these substances” (p.117). She discusses how these experiences resist narrativization due to limits of language (e.g., lack of vocabulary, ‘unspeakable’ character of psychedelic experiences, etc.), history of trauma, “ego death”, lack of personnel support, short duration of treatment programs, and other obstacles.  Harris recognizes that the struggle to narrate psychedelic experiences is a significant endeavour, where even partial accounts provide therapeutic value (e.g., meaning making, processing experiences, providing self-reflection/awareness), worthy of further investigation.

Journal club members spent some time discussing the need for direct experience/self-experimentation in drug research. This issue was raised by Harris who asks “would having your own psychedelic experience provide a level of ethnographic understanding unachievable through other means?”(p.131). Like the author, we questioned: if researchers have to have the same kind of experiences as participants to really understand a phenomenon like drug use? Does having these experiences make for better research? We considered the value of researchers’ drug use disclosure and/or using their own firsthand accounts of experiences with psychedelics to create and document a shared understanding of substance use (e.g., Pollan 2018). Psychedelics are heavily influenced by the set and setting in which people take them. So someone can have an experience with psychedelics and it can be completely different from someone else’s experience. We also questioned whether researchers’ own experiences may limit what they can see in the experiences of others. This brought us to another interesting question – should you disclose your drug use experiences as a researcher/ethnographer? If so, when is it appropriate to do so? Historically there has been stigma in psychedelic sciences against using these substances and simultaneously studying them. Indeed, the ongoing stigma of drug use creates difficulty for researcher disclosure, particularly in academic settings. We acknowledged the politics around self-disclosure and agreed that the need for disclosure varied according to who the audience was (e.g., journal reviewers, funders, research ethics boards, etc.). The journal club welcomed the opportunity created by this article for reflexivity about these challenging issues. We considered where we personally sit with self-disclosure and the need for direct experience, how we understand this in our research/in our research teams, and how this is understood in different research contexts/fields (e.g., participatory action research, harm reduction, anthropology, etc.).

Harris acknowledges the inadequacy of language to convey mystical, spiritual, mind altering or intense experiences with psychedelics, yet she also argues that these experiences can nevertheless still be described in meaningful ways. Indeed, the author’s use of quotes throughout this paper showcases this vividly. We thought it was strong to utilize participant observation and interviews with both service users and providers throughout the study, as these multiple sources of data added meaningfully to the discussion. As much as the author relays the struggles of service users to put their experiences into words – many of the quotes from these participants provided graphic and powerful depictions of their visions while using psychedelics. This led the journal club to question – what is the standard for a good narration of a psychedelic experience?  We value that the author tries to draw out the narrative no matter how difficult/partial it is. The journal club also liked how the author approached challenging memories and experiences shared by participants in such a thoughtful manner. Harris conveyed what people told her with a great deal of respect for their experiences. Accepting that it was difficult for participants to talk about these events, throughout the paper Harris presents examples of participants’ narratives in large block quotes, giving them as much space as they need to explain their narratives and resisting the urge to cut them down into succinct or neatly packaged quotations.

Journal club members appreciated the author’s discussion of what makes certain experiences ineffable and considered other issues that may add to this. We reflected on how difficult it may be for participants to describe visual and visceral experiences that can last for up to 24 hours. There is an inherent issue with recall involved, leading us to question: How do participants condense these experiences and which moments do they focus on? We also considered how long these experiences remain ineffable? Over time can we develop the vocabulary necessary to speak about psychedelic experiences so that they become as familiar as other substance use narratives (e.g., alcohol, cannabis)? Or do you need some other form of data collection in order to make the experience understandable (e.g., body mapping, visual methods)? This also led to a discussion about how such experiences translate into randomized controlled trials (RCTs) of psychedelics, where the typical quantitative nature of assessment means that everything is reduced to structured interviews trying to document the ineffable aspects of this experience. This made us appreciate Harris’ key point about the value of ethnographic research in this endeavour – as providing a way to examine lived experiences and meanings of psychedelic use, by focusing not only on what people experience but also on what they make of those experiences.

Ibogane is one of the few psychedelics that works as a physical interrupter of addiction and withdrawal, and has a psycho-spiritual component that gets people to recontextualize their experience. As the author explains “a common claim of many providers I worked with is that ibogaine in particular helps ‘break the cycle of addiction’ in ways that other treatments cannot. I heard more than one provider assert, ‘It’s like 20 years of psychotherapy in one night.’ This is a source of ibogaine’s reputation as an ‘addiction interrupter.’” (p.129). Thus, this treatment may create more of a solitary process rather than a need for talk therapy. Harris points out the contrast between psychedelic treatment and other mainstream treatment contexts/modalities (e.g. 12-step programs, residential programs) where telling “your story” is natural and necessary, as a way to access services or evaluate someone’s progress. However, the author recognizes that part of the process of struggling to create a narrative is therapeutic – the point is that these are ineffable experiences but just struggling to express or convey them may create some sense of meaning that helps people.

There is also an interesting tension throughout the article about what is unspeakable/speakable and what is unknowable/knowable. The author argues that the ineffable quality of psychedelic drug experiences, does not “prohibit or invalidate” attempts to describe them. She does recognize that this process will be a struggle and take time, but there is value in that struggle. We really liked that Harris spent some time talking about the challenges of knowing something. We appreciated that the author conveyed that the production of narrative can be difficult for the participants trying to relay their experiences, especially when those experiences are spiritual/mystical/intense, and how this can also be “confounding” for the researcher/ethnographer. This raised some interesting larger methodological questions about the nature of qualitative research. We considered how we as researchers can get at drug related experiences, what the limitations of this are, and what assumptions we make about our own research. Indeed, assuming that any qualitative narratives can be coherent, whole, and fully accessible to researchers may be problematic. As researchers, we never really know if someone is narrating something for the first time or struggling to tell us something. The author made us realize that we need to spend more time talking to people about what it is like to take the drugs that they take and examining meaning they make from these experiences. Harris invited us to think a little more deeply about these issues through her paper.

Additional reading:

Argento E, Capler R, Thomas G, Lucas, P, Tupper, KW. 2019. Exploring ayahuasca‐assisted therapy for addiction: A qualitative analysis of preliminary findings among an Indigenous community in Canada. Drug and Alcohol Review, 38(7): 781-789; doi: https://doi.org/10.1111/dar.12985.

Brown T K, Noller GE, Denenberg JO. 2019. Ibogaine and subjective experience: Transformative states and psychopharmacotherapy in the Treatment of Opioid Use Disorder. Journal of Psychoactive Drugs, 51(2): 155-1 65; https:// doi.org/ 10.1080/02791072.2019.1598603.

Pollan, M. 2018. How to change your mind – what the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence. New York : Penguin Press.

Tupper KW, Wood E, Yensen R, Johnson MW. 2015. Psychedelic medicine: a re-emerging therapeutic paradigm. CMAJ, 187 (14): 1054-1059; doi: https://doi.org/10.1503/cmaj.141124.