Psychedelic Therapy and Racial Trauma

Like most people of color in the United States, psychotherapist and researcher Monnica Williams has experienced myriad forms of racism. Early in her career, understanding its effects on her mind and body motivated her to help clients address their own racial trauma in therapy. But she found this was often long-term, painful work for them, punctuated by daily microaggressions and frequent reminders in the news of violence and oppression against people of color.

Williams often found herself wondering if there was a faster, deeper way to address the psychological effects of racial injustice—a way to heal the cultural and generational wounds of the past so that clients could feel stronger and readier to face new challenges. The field of trauma treatment was continually evolving. Was something out there that could help treat historical and racial trauma?

After years of research and meeting with scientists and other therapists looking for an answer to this same question, Williams decided to try for herself a promising but unconventional treatment she’d heard about. So, one afternoon last February, sitting in a room in Oakland with several spiritual guides at her side, she took a deep breath and swallowed a small handful of crushed psilocybin mushrooms. What happened next changed her forever.

“I saw my ancestors,” she recalls. “Generations and generations of women who were slaves, carrying heavy loads of cotton on plantations.” Williams had been shouldering the burdens of racial injustice for such a long time, she says, that after experiencing these visions and debriefing with the guides accompanying her, she was stunned to find that she “could finally start to put these burdens down.”

This wasn’t Williams’s first experience with psychedelics. Several years earlier, she’d taken MDMA—or as it’s often called, ecstasy—with several other therapists in an FDA-approved study in Colorado. The psychoactive drug commonly causes visions, as well as feelings of euphoria, wakefulness, empathy, increased well-being, and disinhibition. But for Williams, psilocybin went a step further.

That these drugs can provide such comfort and clarity is exactly why proponents say psychedelics hold rich therapeutic potential and deserve further exploration, even though they remain Schedule I substances under the 1971 Controlled Substances Act. In clinical drug trials, where they’re approved for study use, psychedelic-assisted therapy sessions last around six hours, during which time clients are lying down, wearing eye shades, listening to relaxing music, and occasionally checking in with the two therapists sitting with them.

But as someone who’s worked with trial participants, Williams says these therapists don’t direct the clients on their internal journeys. “We don’t say they have to revisit this or that particular trauma. People come up with thoughts or memories or images. Whatever it is, we encourage them to embrace it. We’re mostly there to provide a supportive, calming presence, to help them feel safer and more regulated.”

Williams says where psychedelics really excel is in helping clients achieve breakthroughs, and fast. Since many clients are eager to address challenges in their lives but often unsure where to begin, the psychedelic helps them cut through their psychological barriers and access deep, meaningful insights that might otherwise take weeks, months, or even years to uncover. And since MDMA doubles as an empathogen, therapists can use it to cultivate self-compassion.

“This is a real game-changer for mental health,” she explains. “Biological psychiatry and Big Pharma have failed us. Most of the medicines people are given for depression, anxiety, and trauma just numb them. Sometimes they have to take them for life.” That’s a low bar for healing, she says.

“We want people to be able to feel the whole range of emotion, to help them restore their functioning, not knock them out or tranquilize them. This is a catalyst for change.”

Today, Williams is one of the leading clinical voices touting the benefits of psychedelic therapy for people suffering from depression, anxiety, and trauma—especially people of color. She’s helped orchestrate numerous studies looking at the effects of psychedelics on PTSD stemming from racial discrimination, including an MDMA study currently underway in Tennessee and one on psilocybin being overseen by the University of Ottawa. She also helped coordinate a case study on ketamine-assisted psychotherapy at her clinic in Connecticut. A low-dose variant of ketamine received FDA approval for depression treatment in early 2019.

Last year, Williams’s work got a huge boost when she partnered with the Multidisciplinary Association for Psychedelic Studies (MAPS), one of the largest and best-funded organizations of its kind, for a study examining the effects of MDMA on racial trauma, tentatively scheduled to begin this year. Williams had become acquainted with MAPS several years earlier, collaborating with the associa­tion on a psychedelic drug trial at the University of Connecticut.

Although MDMA currently remains an illegal drug, its utility in trauma treatment was recently verified in MAPS Phase 3 clinical trials at 14 private practices and research institutions across the United States and Canada—the last step before it’s authorized for public use. Last January, MAPS’s efforts led the FDA to include MDMA in its expanded access program, which allows people with life-threatening or serious diseases and conditions to use experimental treatments outside clinical trials.

Williams calls the MAPS partnership for the upcoming study a breakthrough. “We have treatment manuals for just about everything out there,” she says, “but there have been no large-scale research studies on treatments for racial trauma.” She says the federal government—particularly the previous administration, which curtailed cultural competency and diversity training for federal employees—is generally hesitant to provide funding for studies that examine racial issues, let alone ones that involve illegal drugs. Historically, it’s been an uphill battle.

Legacies That Harm

There are other reasons why using these drugs to treat racial trauma hasn’t been explored extensively, Williams says. For one, there’s the longstanding absence—and sometimes, deliberate exclusion—of people of color in clinical research studies. According to Scientific American, the vast majority of participants in clinical drug trials—sometimes up to 90 percent—are white, even though nearly 40 percent of Americans belong to a racial or ethnic minority. Congress attempted to remedy this in 1993 by passing the National Institutes of Health (NIH) Revitalization Act, which mandated that NIH include more women and people of color in research studies, but it’s done little to move the needle in the research community at large, especially since NIH studies only account for about six percent of all clinical trials.

There’s also widespread mistrust of mainstream medicine in the Black community—and for good reason. Perhaps the most infamous case of unethical research undertaken with Black Americans is the Centers for Disease Control and Prevention’s 1932 Tuskegee study, which promised free medical care to Black syphilis patients but knowingly administered placebos instead. The study, which lasted 40 years, resulted in 128 deaths, and was shut down only after the truth was leaked to the press.

Psychedelic research, too, has a checkered past. Between 1953 and 1973, a CIA-backed study on mind control techniques, known as Project MKUltra, intentionally administered dangerously high doses of psychedelics to prisoners and people with psychotic disorders, many of them Black. It’s a subject Williams recently covered in a paper under review in The Journal of Medical Ethics. Decades later, she says, institutional problems endure.

“Most people of color have had numerous poor experiences in healthcare,” she says. “Doctors have ignored them, failed to listen to them, undermedicated them for problems they did have, and overmedicated them for problems they didn’t have.” Because of this, Williams expects it will be a challenge to find people of color who are willing to participate in the MAPS study. Luckily, she has the perfect partner in mind to win them over.

Darron Smith is a jack-of-all-trades: an educator, researcher, physician assistant, and faculty member at the University of Memphis’s Department of Sociology. So Williams encouraged him to be a principal investigator in the upcoming MAPS study examining racial trauma. Still, Smith says he doesn’t expect recruiting participants will be easy.

“Honestly, it’s going to be hard to find people of color who want to be involved,” he says. “American science and medicine have long histories of anti-Black behavior. Racial dis­crimina­tion—conscious and not—is alive and well in healthcare. Plus, in communities of color, there’s often shame associated with getting help for a mental health issue.”

But Smith has a creative method for changing people’s minds. He calls it a snowball approach—going door-to-door in some of Memphis’s most troubled neighborhoods, which remain rife with poverty and violence after decades of segregation, red­lining, and discrimination. He hopes to win over families one at a time, and that those he convinces will vouch for him at the next home he visits. And the next.

Rather than using the cold, sterile language of clinical persuasion, Smith intends to appeal to Black families in a way he thinks might resonate better. “I ground my approach in the history of African ceremonies and rituals,” he explains. “I’ll tell people that even though these drugs were created in a lab, the substances they’re derived from are rooted in the earth, in ancient African wisdom. They’ve been used by our ancestors for thousands of years. Plus, the research proves they’re safe. I want to try to educate people, to help them realize that psychedelics aren’t your typical pharmaceutical compound.”

He’s excited to see how the trial pans out. Given his experience studying the effects of MDMA-assisted psychotherapy, he says that psychedelics are unlike any treatment he’s encountered before in his 25-year career, not only in their ability to address trauma, but also to head off the physical comorbidities that often follow it, like diabetes, hypertension, weight gain, and headaches. What’s more, he says, these substances can help Black people rewrite the stories they tell themselves about who they are.

“We’re undoing lifetimes of suffering and poor coping mechanisms,” he says of the work. “We’re helping people reintegrate into society much faster. We’re helping them experience more empathy for themselves and others. And after generations of trauma, after African slaves came to this country in shackles and chains, we’re helping Black people let go of the notion that they’re somehow less than, the notion that they don’t matter.” He pauses for a moment. “All I can say is, it just freaking works.”

Competency, Clarified

Smith’s plan on how to approach potential participants highlights an important takeaway for any therapist doing psychedelic-assisted therapy with people of color: your approach needs to be culturally informed. For instance, he says, his understanding of Black history will be helpful when clients on a psychedelic journey have visions of ancestors.

Williams agrees. She adds that although it’s important for participants to be accompanied by a therapist from their own racial or ethnic group who has a shared sense of their cultural background and lived experience, it’s not always necessary. In fact, when Williams took MDMA several years ago, she was accompanied by two therapists, one white and the other Hispanic. She says the experience was helpful nonetheless.

The main requirement, she says, is that therapists come prepared. “It’s incumbent on the clinician to make people feel safe,” she explains. “These are powerful substances, and there are risks. People in a psychedelic state are essentially being stripped of their defenses, and therapists can do harm if they don’t know how to manage cultural material when it arises. They can even end up enacting the patterns of racism that brought clients to therapy in the first place.”

Williams has her own approach for putting anxious clients at ease.

“I’ll just be honest with them,” she explains. “I’ll say, ‘I can totally understand if you’re a little nervous right now, because a lot of previous researchers haven’t been ethical and looked out for the participant’s best interest.’ But I’ll add that we’re looking to do something different here—that we care about people of color and want to give them a culturally informed experience. We want them to get better too, not just white people.”

She has a message for white therapists looking to do this work with Black clients: they need to do their own antiracism work before they begin. This means taking an inventory of how well they understand racism and how comfortable they are having conversations about race. They need to look at whether they have friends of color—and if they don’t, find out why that is and what they can do to fix it. After all, Williams says, if people of color don’t want to be around you as a friend, you’re not going to do any better with them in the therapy room.

“You don’t want your own garbage to be hurting the people you’re trying to help,” she says. “And just going to a seminar or workshop where you do antiracism work isn’t enough; this isn’t a one-and-done thing. Fighting racism is ongoing work.”

A Shifting Landscape

The marriage of psychedelics and therapy may seem like a fringe movement, something relegated to the far corners of the clinical world. But there’s increasing buzz around psychedelic-assisted therapy and a growing number of therapists who are coming to recognize its potential, especially for hard-to-treat issues like trauma and severe depression.

Deran Young is one such convert. For years, the idea that psychedelics could be beneficial never crossed her mind. Growing up, she’d watched her mother struggle with addiction, and witnessed how the federal government’s War on Drugs tore Black communities apart. Later, while serving as an officer in the US Air Force, she was surrounded by people who adhered to a strict antidrug code.

After leaving the military and a short stint in private practice, she founded Black Therapists Rock in 2016, deciding to focus her efforts on highlighting issues affecting the Black community and helping Black therapists address them. She became particularly interested in using the Internal Family Systems model to treat trauma, and soon found herself at a workshop being led by its developer, Richard Schwartz. In it, Schwartz showed the audience a video clip of an MDMA-assisted therapy session that helped a military vet break through combat trauma that had haunted him for years. For Young, it was a revelation, the moment when everything seemed to come full circle.

“I was blown away,” she recalls. “I’d never seen someone with such intractable trauma experience such a turnaround.” Right then, she says, using psychedelics to heal what Schwartz calls legacy burdens—extreme feelings or beliefs coming from traumas that happened to ancestors and were passed down the generations—“was a no-brainer for me. It just made sense.”

Like Williams, she felt she had to try it herself. Early last year, in a small suburban Maryland office, Young made herself comfortable, popped a small psilocybin capsule into her mouth, and waited.

After a few moments, she experienced what she describes as mild euphoria and a warm, tingling sensation. But over the next four hours, something else happened. Young saw a vision of herself at three months old, swaddled in a blanket, at the neonatal intensive care unit. Down the hall, she saw her teenage mother anxiously wringing her hands together in the hospital waiting room. It was the middle of winter, and since her mother had been unable to afford the heating bill, baby Deran had come down with a bad case of pneumonia.

It was a transformative moment, Young says. She asked herself deep questions she’d never thought to ask before: Was my mother a poor teen mom because of systemic oppression? Was it because my grandmother—and all the Black mothers before her—faced oppression and passed that trauma down?

Young didn’t have all the answers, but she was able to forgive. She realized that her mother had been so overwhelmed that she couldn’t possibly have taken care of a child. “It changed everything in my life in terms of how I see myself and navigate the world,” Young explains. “Call me a hippie, but it opened me up in ways therapy never had before.”

Young says the experience also shifted how she thinks about conducting therapy. She’s met with shamanic coaches who’ve helped her integrate Indigenous healing methods into her more traditional clinical work. She’s working with a clinic in Maryland that’s currently studying the antidepressant effects of psychedelics on terminal cancer patients, to great response. She’s thinking about how, maybe one day, she’ll incorporate psychedelics in treatment in ways that haven’t been explored before, like in group therapy targeting racial trauma or complex PTSD. Of course, she’s also sharing her excitement with colleagues at Black Therapists Rock, hoping that, with this new tool in hand, they’ll be an even greater force for change against the systemic racial oppression, injustice, and trauma that continues to plague American society.

Until that day comes, Young says she’ll remain a vocal advocate for psychedelics, even if it still raises a few eyebrows. “We live in a society that tells us McDonald’s is food but mushrooms are drugs,” she says. And to those who’d shun psychedelics for legal reasons, she encourages them to remember that alcohol was once illegal in America, and slavery was not.

She urges therapists to keep an open mind, to accept that as a field, we can go deeper in helping people unlock insights into their trauma, even if it sometimes feels as if these insights defy logic.

“Who are we to tell people what they see on their psychedelic journey isn’t real?” she says. “I’m a Black woman. I navigate a world where a lot just doesn’t make sense. So I’ve let go of the need for everything to feel logical. To be able to go inside my own experience and find something that finally made sense? It was the realest thing I’ve ever had.”

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