What will RFK's appointment mean for the psychedelics community?
We wanted change, but not like this.
Welcome back to Reality Test, where we’ve been trying to surf some big waves of emotion and, tbh, mostly crashing on rocks. But it’s nice to be back.
In the ocean of terrible news days in which we’ve been swimming (drowning?), Thursday stood out as a particularly horrifying one as RFK Jr. was confirmed as Secretary of Health and Human Services.
When I was in undergrad in Berkeley, I never could have guessed that so many aspects of the crunchy granola, anti-establishment, DIY culture that so delighted my little teenage heart would one day become signifiers of the Republican party. But in the post-COVID world, we’ve seen Democrats become the party of institutions while the RFK Jr.-led anti-establishment raw milk Republicans have gained power which now threatens our entire system of public health with its rejection of research and medicine and embrace of pseudoscience and conspiracy theories.
Much has been written about the peril we face with the appointment of the man whose brain has, among other things, been literally eaten by worms. But for the purposes of this newsletter, I’m more interested in how his denouncement of psychiatry and support of psychedelic-assisted therapy in particular will shape policy and media narratives, in public discourse, and among providers as we navigate an already-turbulent environment.
Psychedelic-assisted therapy is a modality that has been subject to a tense and unpredictable regulatory environment, capitalistic greed, infighting within the community of providers and advocates, and access inequity. The movement is already divided: Many legitimate, ethical providers are working underground in order to provide care outside an inhospitable system. That same underground is also plagued by grifters who overcharge for questionable services, taking advantage of a paucity of structures of accountability. Many advocates, providers, and researchers are working toward stricter above-board regulation in order to increase accessibility and accountability; others find the medicalization of psychedelics exploitative, colonial, or otherwise doomed to fail. Venture capitalists have shown up to the movement in droves to take advantage of a potentially lucrative new market. The environment does not make it easy to know who to trust.
The psychedelics community now faces a new hurdle: RFK Jr., Elon Musk, and the unfortunate MAHA (Make America Healthy Again) movement have bizarrely become its most powerful champions.
To take the movement at face value, MAHA is characterized by mistrust in a system that often fails to keep us “healthy,” a problem many of us can legitimately relate to. As part of this ethos, RFK Jr. condemns the pharmaceutical industry and is a vocal proponent of psychedelics. A longtime survivor of heroin addiction himself, RFK cites his son’s experience with ayahuasca as inspiration for his stance. He wishes to decriminalize or even legalize certain psychedelics in order to increase access. He is backed by Elon Musk, whose fondness for ketamine (technically a dissociative anesthetic, but with psychedelic-like effects at higher doses) is well documented, as well as his experience with psilocybin and LSD.
The regulatory environment over which RFK now presides is complex and unstable. Last year, a surprise decision from the FDA failed to approve the use of MDMA for mental health treatment. Legal status is patchy and varies state by state and drug by drug: In Oregon, several cities have voted to ban psilocybin despite its legalization statewide. The controversial Measure 109, which regulated psilocybin on the state level for therapeutic use, prohibits facilitators to use the word “therapy” to describe their services. Licensed psilocybin facilitators who are also licensed mental health clinicians are prohibited from using their clinical licenses in sessions. If this is confusing to you, it’s because it is confusing.
If the regulatory drama surrounding legalization has shown us anything, it’s that psychedelics are really hard to fit into our existing structures and frameworks for mental health treatment. People have been using plant medicines to heal and get high basically as long as we've existed – tens of thousands of years longer than we’ve had neuroscience or psychotherapy. Psychedelic experiences are nonlinear, long-lasting, and largely unpredictable. They leave the user highly vulnerable and easily influenced. They can be joyful and they can be scary and they can be multiple contradictory things at once. How does something so intrinsically different from our existing standards of care fit into a landscape that prioritizes strict guidelines, manualized treatments, and diagnosis?
These are complicated questions. They need to be explored in good faith with curiosity, accountability, nuance, and a willingness to be wrong. (There are plenty of people doing this already - read some of the great articles under the “resources” page here.) This is ultimately the problem with MAHA’s standard bearer: It clearly won’t happen under the man whose claims include that SSRIs and school shootings have a causal relationship, poppers might cause AIDS, and that COVID was “designed” to spare Jews and Chinese people. His lack of credibility as it relates to the basic definition of truth, not to mention tenants of health and science, makes him a disastrous standard bearer for the movement. And Kennedy has not demonstrated that he understands the nuances to oversee the regulation and implementation of what would inevitably be complex and divisive policies.
As someone who is excited about the power of psychedelics, it’s uncomfortable to reckon with today’s political environment. Some advocates are already publicly enthusiastic about working with our new HHS secretary. Some are privately navigating conflict with RFK supporters within the psychedelics community. Even if we do see increased access to psychedelics, a community that is already so divided is in danger of becoming even more starkly polarized by chaotic implementation and political polarization.
Sometimes, we have to fend for ourselves in order to find true health and wellness. That’s what MAHA purports to believe, and I get it. But there’s no chance we see that kind of person-centered ethos under this administration. We wanted change, but not like this.
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What do you wear to therapy?
Fun piece this week in the Times about how…what you wear reflects how you feel? Gotta give that a one-star on the insight rating scale. But I got a true lol out of reading this therapist faux-pas:
Isa Toledo, a 34-year-old artist living in Lisbon, broke up with her therapist partly because of a seemingly offhand comment about something she was wearing.
One day, she arrived at therapy in a cherished vintage wool coat. Her therapist complimented the garment and asked if she had purchased it at Desigual, a fast-fashion chain. “I was very taken aback,” Ms. Toledo said. “I didn’t want the compliment and was stunned she thought it was Desigual, I’ve never been in their stores.”
Lmao. Also, there’s a story in there about how an eating disorder therapist commented on her client’s improvement by no longer wearing “unflattering” clothes...?! A word scooped straight from the diet culture handbook? Wild.
Of course I do think about what I wear to sessions, particularly in-person. I want to look professional and competent but normal and cool and chill. Mostly, I want to wear what I like to wear. A client told me once that I don’t dress like a therapist, which I took as a compliment, I guess because of my own internalized therapistphobia. Maybe something for me to unpack there in my own virtual therapy room where I am usually in my pajamas.
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Babygirl
I had a great time watching the recently-released movie Babygirl, but predictably I have a bone to pick. (Spoilers.) The story of Nicole Kidman’s character, a powerful robotics CEO, and her sexual affair with a younger intern is interspersed with scenes of her sitting in front of a light bar doing EMDR, a trauma treatment she presumably uses to process the fact that she was raised in a cult. This annoyed me a little bit. In a New Yorker profile, the writer/director Halina Reijn said the therapy scenes were meant to add to the impression that Nicole Kidman’s character is always trying to self-optimize (reminds me of the excellent “Always Be Optimizing” in Jia Tolentino’s Trick Mirror). But in context, it seemed to also allude to a connection between some kind of childhood trauma and kink, a subtle but distinctive perpetuation of a pesky and inaccurate stereotype. I find myself so tired these days when trauma is a plot device. But maybe I’m reading too much into it. Thoughts??
Thanks for reading! I’m pretty sure there’s no right or wrong way to engage with the news right now, except to follow how you feel in the moment. We’re together in it. Take care of yourself. All the good candy usually goes on sale the day after a holiday…just saying. Put your thoughts in the comments and send me ideas of what you want me to write about. <3