By Tehseen Noorani and Neşe Devenot
Introduction
The academic discipline of bioethics is becoming a prominent arena for the discussion of ethics abuses in psychedelic therapy. With this being a relatively new topic of research for bioethics, it may be opportune to consider blind spots in the discipline’s own gaze and operations, which can otherwise hinder effective engagement with the issues at hand. We write in the wake of an extensive search by Gather Well Psychedelics, a psychedelic therapy training organization, to contract professional bioethicists to conduct an ethics audit of their organization. We ask, what challenges arise for bioethicists offering professional services when taking on commissions to work for organizations such as Gather Well that are emerging out of the psychedelic underground?
Gather Well recently rebranded from its previous incarnation as the Center for Consciousness Medicine (CCM). CCM itself emerged from the School for Consciousness Medicine (SCM), a prominent organization and community in the rapidly-professionalizing psychedelic ecosystem. For more than two decades, this lineage has sustained a leading, global, underground training network for psychedelic therapists and guides. Under the leadership of married couple Aharon Grossbard and Francoise Bourzat, and named after Bourzat’s book, SCM has been linked by multiple media reports to extensive and systematic abuses of power, including rapes promoted as “healing”. Although Grossbard and Bourzat deny the allegations, these accounts were vetted by leading news organizations, withstood legal threats from Grossbard and Bourzat, and have been substantiated by a growing body of consistent and corroborated accounts by survivors. The community around Grossbard and Bourzat has been linked to “a decades-long pattern of sexual contact between guides and clients, as well as Grossbard and Bourzat acting as leaders who felt ‘above’ professional and ethical norms.”
Without a meaningful reckoning with the factors that contributed to these reported harms, clients and students remain at risk. On the Gather Well website, Grossbard and Bourzat’s daughter and trainee Naama Grossbard recently acknowledged both Gather Well’s direct lineage back through her parents’ work, as well as a desire to break with the unethical practices they have been charged with. In the context of an organization like Gather Well—namely, a recent extension of a lineage that has failed to prevent, and even enabled, harm—bioethicists taking on ethics consultancies face complex challenges. We discuss such challenges, first in terms specific (though not exclusive) to bioethical engagement with the nascent psychedelic industry, and second, for the discipline of bioethics itself.
Challenges of the Psychedelic Ecosystem
What ought to be demanded of bioethical harm reduction work in this context? Within the contemporary psychedelic ecosystem in the global north – which intersects therapeutic, Indigenous, activist, and wellness communities – harm reduction is interwoven with the framework of transformative justice. This framework calls for dismantling, reimagining, and transforming the wider systems and structures of power that enabled particular harms to occur in the first place, linking resolution and repair to the prevention of future harms. Bioethical work in line with this more expansive meaning of harm reduction should—at minimum—neither subvert nor impede attempts at a thorough accounting of the systems and ideologies responsible for legacies of harm in the first place.
The reasons why this may be difficult in case of the psychedelic ecosystem have been articulated by insiders and harmed parties, who have described cultures of silence around abuses and harms maintained through friendships, professional loyalties, and referrals of clients and substance sources. This is exacerbated by the clandestine, underground nature of the field, as well as bonds forged by psychoactive substance use, especially MDMA, which facilitates strong affective ties. As a consequence of these factors, bioethicists (along with researchers and evaluators writ-large) who have insufficient appreciation of the communities’ own histories of discussion and debate risk missing that which has already been silenced.
SCM survivor accounts have called attention to the ways that the ideologies of healing promoted by the school were integral to its justifications of harm. Their accounts of SCM and the wider community’s practices align with the familiar social dynamics that make up destructive cults – signaling a robust literature that is not incorporated into conventional training for bioethicists. Psychedelics have long been associated with risks of inspiring grandiosity, and their suggestibility-enhancing effects have been exploited by charismatic authorities to conscript individuals into cultic communities. At a time when many are calling for psychedelic medicine to incorporate non-Western approaches to correct for epistemic injustices, such communities can be incentivized to launder authoritarianism and harmful practices as “Indigenous,” “Eastern alternative medicine,” or “nondual.” Ethicists who have not been trained to fully account for these contextual factors may then focus on developing the ‘right’ ethical standards and norms, at the expense of paying attention to the social dynamics that put these same standards out of reach.
When engaging with psychedelic communities, bioethicists are thus faced with multifactorial barriers to implementing effective harm reduction frameworks. In organizations where cultic practices are ongoing, the client organization is not likely to disclose whether past harms have been connected to their ideologies of healing. If ethicists are not trained in these phenomena, warning signs about cultic convictions and behaviors are likely to be missed, while private in-house ‘repair’ processes can subject those involved to the same pressures of loyalty. Meanwhile, due to ongoing cultures of silence, many testimonies about harm remain missing from the dominant discourse about these lineages of healing. As a result, survivor accounts might not be perceived by bioethicists as offering credible alternatives to organizations’ official narratives.
Implications for Bioethics
As bioethicists increasingly turn their attention to the complex social world of psychedelics, we are keen to see(d) more discussion around procedural imperatives. With the risk of missing that which has already been silenced, well-intentioned efforts to engage in bioethical work can result in ethics-washing, where ethical analysis obscures substantive ethical issues that are unresolved. We note how Gather Well states its ambitious intention to use the opportunity of an ethics audit to place itself as a leader and model in the ‘psychedelic ethics’ space, including through housing an ‘ethics casebook’ on their website. The casebook is a catalogue of ethical considerations intended to educate actors across the psychedelic ecosystem, with one goal being to reduce harms across the field.
Yet, from an approach to harm reduction informed by transformative justice (a framework Gather Well itself endorses), the move to rebrand Gather Well as an ethical pioneer risks mere reputational rehabilitation if it works to circumvent a deeper wrestling with the practices and ideologies associated with the organization’s lineage that have led to very serious harms. To pursue harm reduction that is informed by transformative justice, bioethical interventions would need to attend to social and cultural practices that render exploitation as healing, and enable, sustain, and incentivize harmful relationships. Even in cases where bioethicists give technically sound advice in accordance with a pre-determined, narrow scope of engagement, a failure to appreciate or account for the wider entanglement of the psychedelic ecosystem with cultic milieus can lead to ethics washing by providing what amounts to cover for an embattled lineage and its associated harms.
In such situations, those who hope to move the needle towards justice might appreciate how it is the harmed parties themselves who hold crucial data – and analyses – that can breach the psychedelic field’s legacy of silences. Client-commissioned work by professional ethicists – such as research, evaluation, and audits – could here draw upon systematic methods for prioritizing the most marginalized voices of the wider ecosystem, supporting those whose lived experiences highlight where systems break down or were broken. This requires attuning to the history of the power dynamics in which individual clients are enmeshed, and the voices of those most marginalized in relation to these dynamics.
We end with a series of questions for bioethics as both a discipline and a professional community, prompted by the foregoing analyses. How might the field create and/or further deepen norms, procedures, and incentive structures to ensure that ethicists can pause, pivot, and halt commissioned work when they learn that resources promised at the outset are too constrained, or the stakeholders involved need diversifying? Can we institutionalize transparency in the bidding – and peer accountability in the vetting – of contracts issued by community groups, as is routinely practiced in publicly funded grantmaking? And how might the field normalize speaking to the silences that it encounters when working in contexts of secrecy? As underground psychedelic lineages grow, and organizations scale the transmission of their healing modalities, we suggest these questions are increasingly urgent.
The authors acknowledge research and drafting contributions made by Will Hall, a survivor of abuse during his time as a student in the SCM lineage.
Tehseen Noorani is a Senior Research Fellow at the University of Auckland where he leads the project, Community Strategising about Psychedelic Therapy in Aotearoa. He is also a part-time Scholar-in-Residence at Tactogen Public Benefit Corporation and Ambassador to the Fireside Project.
Neşe Devenot, PhD is a Senior Lecturer in the University Writing Program at the Johns Hopkins University. Dr. Devenot is also an affiliated researcher with Project on Psychedelics Law and Regulation (POPLAR) at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.
Disclosures: Dr. Devenot is affiliated with The Ohio State University’s Center for Psychedelic Drug Research and Education (CPDRE), the Intercollegiate Psychedelics Network (IPN), the Psychedelic Educators Network (PEN), and Psymposia.
