Psychedelics & Race: A Call For Inclusion

As the field of psychedelic therapy makes its way closer to the mainstream vision of healthcare, the promise for supporting those people suffering from debilitating mental health conditions looks promising.

Research in the field has grown exponentially, and healthcare systems, regulatory institutions, and government organizations are starting to take steps to advance the field and access to treatment.

Research has already shown strong evidence for the benefit of psychedelics like psilocybin, LSD, MDMA, and DMT in treating trauma, but does this apply to racial and cultural trauma? Can psychedelics be as powerful in treating cultural trauma as they are in treating other diagnosed conditions?   

The truth is that underrepresentation and lack of diversity in the research significantly hinders our ability to even begin to answer such questions. 

This article will explore the socio-cultural forces that affect the representation and inclusion of BIPOC communities in research, trials, and access to the growing field of psychedelic healthcare. 

We will also take a look into what research is available so far and what it says about the potential of psychedelics to help heal cultural trauma. 

Understanding Racial Trauma

When we hear the words “trauma” or “post traumatic stress disorder” (PTSD), our minds normally go to a specific event that may have caused a trauma response. Common things that live in our general consciousness as sources of trauma are sexual assault, child abuse, or a violent attack.  

This type of traumatic event is known as “criterion A” and are a prerequisite to a PTSD diagnosis according to the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders). 

However, there are plenty of experiences that may fall outside the realm of the criterion A index that still generates trauma responses and can significantly hinder a person’s ability to engage in day-to-day activities or recover and heal from a criterion A type trauma [1]. This type of traumatic stressors includes acts of racism, discrimination, and other forms of oppression based on race, religion, gender identity, and sexuality, among others. 

When we look at racial trauma, we generally encounter either a compounding of non-criterion A stressors or a combination of both chronic stressors and a criterion A event. Because of these added levels of traumatic stress, marginalized communities such as people of color tend to have a higher risk of PTSD or some manifestation of traumatic stress. 

Studies observing rates of lifelong PTSD prevalence and exposure to traumatic events through different demographics have repeatedly shown that African-American folks have the highest rates of PTSD prevalence and exposure to traumatic stressors compared to non-Hispanic whites, Latinos, and Asians, among other demographics [2,3,4].

Why Do Ethnic Minorities Have Higher Risks of Traumatic Stress?

In order to understand racial trauma, we need to take a look at and acknowledge two major forms of collective trauma: Historical and Cultural trauma.

1. Historical Trauma

When we talk about historical trauma, we refer to the collective traumatic stress of a population that has been affected by a disturbing historical event. Wars, terrorist attacks, and natural disasters among others, fall into this category. 

A few examples of historical trauma: 

The collective distress after Nazi Germany’s holocaust, for example, is ingrained in the realities of Jewish people across the globe and has been carried forward through generations. 

War veterans from the Vietnam War in the 60s found comfort in therapeutic support groups where they quickly realized that members of the groups shared an experience that nobody else could understand. 

Indigenous peoples across Canada and Northern USA live with the traumatic burden of horrific abuse in residential schools as a tool of cultural genocide. 

Even as events unfold today, we could be almost certain that a post-pandemic world will have to carry the emotional aftermath of COVID-19, not to mention the large effect that the Russian invasion of Ukraine will have on those involved on either side of the battle. 

2. Cultural Trauma

Cultural trauma speaks to the collective distress experienced by a culture, ethnicity, or race that has had to face oppression due to their cultural identity, race, or ethnicity. 

Unlike historical trauma, cultural trauma may have less of a specific root event; instead, it’s a consequence of living the day-to-day reality of being a part of a racially or culturally marginalized community. 

Factors that can cause cultural trauma include:

• Systemic oppression is rooted in the constructs of social, political, and legislative systems
• Micro/macro aggressions based on skin color, ethnicity, culture, or religion
• Discrimination 
• Inequality of opportunities 
• Preconceived notions, prejudice, and unconscious biases 

Cultural trauma is manifested today at a large scale within most, if not all societies around the world. A few symptoms of this include: 

The collective fear among people of color confronted by police authorities given the widespread amount of police brutality against people of color and abuse of power from authority figures. 

The mistrust of healthcare, legislative, and governmental systems from BIPOC communities given the long history of abuse, misbehavior, and negligence experienced at the hands of the institutions that are supposed to serve and support. 

The significantly higher ratios of poverty, addiction, mental illness, failure to launch, suicide, and other difficulties in marginalized communities. 

3. Intergenerational Trauma

We know intergenerational or transgenerational trauma as traumatic stress that passes down through generations. Cultural and historical trauma are two significant forms of generational trauma of which repercussions we are becoming more and more aware today. 

Generational trauma and the passing down of behaviors that are products of trauma responses are especially prevalent in communities that have experienced extended oppression, discrimination, and violence. 

The effects of intergenerational trauma can be seen in first nations people across Canada today whose ancestors from not too far back were survivors of the abuse and neglect of residential schools. For Latinx communities, the exposure to ongoing structural violence makes this population more vulnerable to generationally recurring traumatic distress, and the aftermath of slavery has led to trauma being passed down through generations by rendering the master-slave relationship as the model for all human relationships, therefore propagating hurt and patterns of violence [5,6,7].

Acknowledging these types of collective trauma is important when unpacking racial trauma. Because people of color experience both historical and cultural trauma at such a significant level and trauma responses are passed down generations, it is important to have these types of collective trauma in mind as a baseline of emotional distress that many BIPOC communities face just because of the realities of existing within a non-white ethnicity and identity. 

Can Psychedelics Help Heal From Racial & Cultural Trauma?

The short answer: We don’t truly know. 

Although many psychedelics have been researched and proven to potentially support PTSD recovery processes, most of these conclusions have been made from studies where the large majority of participants were non-Hispanic whites. Unfortunately, most current psychedelic research lacks significant representation of BIPOC folks within research, surveys, and clinical trials, and therefore the results of most trials are not really relevant to the experiences and potential effects for people of color. 

Literature reviews in psychedelic studies from 2000 to today show that most research in the last two decades shows that roughly 2.5% of study participants were African-American, 2.1% Latinx, 1.8% Asian, and 4.5% indigenous [8].

This makes generalization of results to people of other ethical backgrounds and experiences impossible, therefore, as of now, we don’t know much about how effective, safe, and feasible psychedelic therapy can be in treating racial trauma. 

A handful of studies have shown that people of color have reported improvement in symptoms attributed to racial trauma and other mental health issues following the use of psychedelic substances (specifically MDMA, LSD, and psilocybin) [9,10,11]. However, due to the studies’ self-reporting nature, they lack clinical relevance and are not enough to make any generalized judgments about the medicinal effects of psychedelics in people of color.

Given the higher rates of trauma and mental health challenges experienced by people of color due to historical exposure to cultural and racial oppression, violence, injustice, and discrimination, BIPOC communities may, in theory, really benefit from the promise of psychedelic treatments. 

Although most researchers hypothesize (and hope) that psychedelics could be a powerful healing tool to help heal the deeply embedded wounds of racial trauma in our society, the truth is we currently don’t have enough information to support any claims. 

Psychedelic Research: Factors Affecting BIPOC Communities

Although the field of psychedelic research has been growing exponentially, there is still a significant lack of substantial research when it comes to psychedelics and BIPOC communities. 

Though efforts are being made to diversify the field and include more comprehensive and inclusive research, there is still a long way to go and much to learn in order to truly study and understand the potential effects of psychedelics for cultural trauma and BIPOC experiences. 

To understand the lack of evidence and studies relevant to BIPOC communities, it’s imperative to look at the systemic issues that affect psychedelic research around racial minorities and oppressed communities. The following is an overview — by no means an exhaustive one — of some of these factors: 

1. Under-Representation

As is the case with general medical trials, BIPOC communities are not properly represented in psychedelic research trials in the shape of both researchers and leaders or trial participants. 

Throughout the history of psychedelic movements, mind-altering healing practices have been — for lack of a better term — whitewashed. The Eurocentric evolution of this field has led to a lack of diversity in the field, and research in this area has been done predominantly by white men with not a significant amount of women or people of color, and attempts to change this have started only recently and with much work needed in order to catch up. 

The same is true for study participants. Historically people of color have been grossly underrepresented in clinical trials and research. In 1994 the National Institute of Health (NIH) published its guidelines on the inclusion of women and minorities in clinical research and mandated that efforts must be made to include these populations. 

The guidelines stated, among other things, that extra expenses would not be a valid reason for the exclusion of minority groups in research, that the NIH itself would initiate outreach programs to recruit women and people of color into clinical trials, and that research that does not meet the guidelines will be subject to loss of funding [12].

Unfortunately, despite the NIH efforts, the representation of people of color in clinical research has not grown significantly. According to NIH reports, between 1995 and 2016, the percentage of minorities represented in research and clinical trials only grew by 0.5% [8].

Underrepresentation is also seen amongst researchers and leaders in the field. Although most psychedelic practices have been borrowed and appropriated from indigenous and non-white spiritual traditions from around the world, most sources of mainstream westernized psychedelic research and practices have omitted or severely underscored the work of indigenous women and people of color in the field [13].

This lack of visibility of people of color in leadership and research positions in the psychedelic field leads to higher rates of hesitancy from ethnic minorities to participate in trials. 

In addition, when looking at mental health treatment, ethnic, language, and cultural matches between therapist and client generally lead to better treatment outcomes [14]. This is especially true when addressing issues of racial and cultural trauma. 

2. Historic Abuse From Health Institutions

“Dangerous, involuntary, and non-therapeutic experimentation among African Americans has been practiced widely and documented extensively at least since the eighteenth century.” -Harriet A. Washington 

People of color have historically faced abuse in healthcare settings since the early days of colonization. Much of today’s medical knowledge rests on the backs of slaves, incarcerated people of color, and indigenous people who were experimented upon without consent and many times to their physical and emotional detriment. 

Many know of the Tuskegee syphilis study where the CDC and PHS observed a group of roughly 400 African-Americans with syphilis to observe the effects of the disease when untreated. The study participants were not informed about their diagnosis and remained untreated even after a proper cure had been developed, leading to the death of over 100 participants. 

Although Tuskegee is a well-known scandal, it is far from the only case of unethical treatment of people of color for the sake of medical research. 

From Cartwright’s pro-slavery diagnoses of black-only diseases like Drapetomania (which had as suggested treatment severe whipping and amputation of the toes) to Canada Health’s nutrition studies in residential schools where indigenous children were intentionally malnourished to evaluate the effects of different supplements, to the use of black slave bodies to demonstrate surgery in medical school, the history of medical research is riddled with abuse, violence, and unequivocal discrimination. 

The more modern psychedelic research field is not free of such unethical experimentations. The Addiction Research Center (ARC) had several instances of unethical research in psychedelic substances, one of them being their research at the United States narcotic farm in which African-American males convicted for drug crimes were coerced into participating in trials where they were treated significantly different from the counter group in the study (white, free-living professionals who voluntarily agreed to trials). 

The researchers made sure to provide the LSD dose to the second group in their homes and went through efforts to create an environment conducive to reducing anxiety, measures that were not taken for the group of inmates, creating a very different experience given the known importance of set and setting for psychedelic experiences [1].

Centuries of sustained abuse and inequality in medical fields have led to a general, and rightfully warranted, mistrust toward western practitioners and health systems. 

The extent of abuse of BIPOC communities in the medical field goes far beyond the scope of this article, but with such a history, it should not come as a surprise that ethnic minorities are hesitant to participate in medical research, let alone research that may directly address collective cultural trauma. 

3. Stigma Regarding Psychedelics in Black Communities

False stereotypes around drug use in black communities have led to disproportionately higher incarceration and conviction rates for drug use among black Americans and people of color worldwide. 

Black folks are 3.5 times more likely to be arrested for drug-related offenses; however, surveys show that black youth are less likely to use drugs in the first place [15,16].

Since the start of the war on drugs, drug-related laws have not been enforced equally to black Americans in comparison to white folks. The higher rates of incarceration and longer sentences for equal crimes among black communities upheld—and continue to uphold — the narrative that drugs are a problem of people of color. A narrative that has been fed to the public eye ever since. 

This false stereotype and the legislative and law enforcement systems that have upheld it generate fear among black communities and people of color to use psychedelics or participate in drug-related trials, as they are more likely to be scrutinized and unjustly persecuted. 

4. Access Inequality 

As psychedelic therapy treatments gain popularity and move into the medically approved mainstream, ease of access to participation in the field (be that through trials or access to treatment) is a key factor to consider and one that disproportionately affects people of color. 

Low-income neighborhoods and demographics in the US are majorly composed of black and Latinx folks. According to the 2019 census report on income and poverty in the US, poverty rates in the US were around 18.8% for black Americans and 15.7% for Latinx, compared to 9.1% for white Americans and 7.5% for Asians. This means that the lack of affordable or economically sane access to trials and treatment disproportionally affects non-white communities.

Furthermore, as psychedelic treatments become more readily accessible, healthcare services, which will already have a big backlog due to increasing interest in psychedelic interventions, will see themselves unable to provide equal access opportunities to treatment to lower-income citizens, as is the case already with most healthcare issues. These treatments will potentially be expensive and more easily accessed by those with higher economic wealth. This, by definition, will disproportionately hinder BIPOC folks’ ability to access treatment easily and in an affordable manner [17].

5. Practitioner Unconscious Bias & Lack of Cultural Awareness 

Lack of cultural awareness and care amongst healthcare practitioners, therapists, social workers, and other service providers is a big factor playing into the outcome of therapeutic practices for people of color and even their intent to participate in the first place. 

The maintenance of white comfort is ingrained in inter-racial social relations across America and most of the western, Eurocentric world. People of color often feel the pressure to sustain this white comfort by staying silent about past experiences of oppression or any form of racially charged content. Unsurprisingly this can create a great barrier to a good therapeutic process as space for open communication is a fundamental part of therapy [1].

Culturally uninformed practitioners, clinicians, and counselors can easily fall into the pattern of perpetuating oppression by intentionally or unconsciously upholding the idea of white comfort as a perceived right. 

In addition, unexamined unconscious bias can further perpetuate oppression toward ethnic minorities, especially in a therapeutic setting where a clear power dynamic is at play. This hinders the safety of the therapeutic space for patients who have experienced racial oppression. 

Self-awareness and knowledge of systems of oppression are critical components of psychology and clinical counseling [18]. Therefore, regular training, continuous learning, and constant self-reflection is essential and should be required for practitioners (especially those who have benefited from systemic racism and systems of oppression). As psychotherapist Dr. Gávi Ansara states: 

“Anti-oppressive practice emphasizes the importance of therapists taking responsibility for our own implicit biases and privileges to ensure that we can be safe professionals. This means seeking out our own education and awareness outside of sessions, instead of expecting people who participate in psychotherapy to educate us.” – Dr. Gávi Ansara 

Guiding patients through the vulnerable and delicate space of psychedelic therapy requires immense care, and even more so when cultural and racial experience is at play, so being culturally aware and actively anti-oppressive as a practitioner is just as important as being trauma-informed and properly trained. 

Calls to action, Efforts For Inclusion, & Moving Forward

It is non-debatable that the field of psychedelic medicine needs extensive efforts to improve the relevance of studies to diverse communities, generate more means of inclusive research, and invest in educating practitioners and researchers about racial trauma and the effects that the BIPOC experience may have in research. 

Although there are still miles to go in matters of equality, representation, accessibility, and social justice, in the psychedelic field, there are many organizations advocating for more diverse and culturally aware research and practices. 

Here are a few of the initiatives being led by practitioners and organizations to work toward a more equitable and inclusive field:

• MAPS Health equity campaign: Generating funds to invest inequitable access, training, and treatment.
• Sage Institute: Advocating to create accessible treatment and training
• SoundMind: Training scholarships for BIPOC folks, symposiums, and conversations around inclusion and diversity 
• Psychedelic Equity: Developing guidelines for culturally attuned psychedelic care
• EQUIP Health Care: Providing equity-oriented, trauma-informed, and culturally aware health care and harm reduction initiatives.