What happens when an anthropologist embeds in a psychedelic clinical trial?: 5 Questions for researcher Amadeus Harte

Harte discusses how anthropologists can study psychedelics and what trends she’s noticing in her work so far.

Amadeus Harte first learned about psychedelic drugs as a 10-year old in a doctor’s waiting room. The pamphlets she saw there warned about the dangers of LSD and MDMA, but what Harte remembered was the gorgeous artwork. “The pictures made them look quite attractive,” she said. A few years later, when her family got the internet at home, she stayed up all night reading Wikipedia articles about drugs. 

For a time, she thought she wanted to study drugs and become a chemist, but in college, she realized chemistry couldn’t answer the questions she had. How does class and socioeconomic status intersect with drug use? Is it the drug itself or the environment in which drugs are taken determine outcomes? Anthropology, she decided, would be a better path to answering these questions. Now Harte is a medical anthropology PhD student at Princeton studying how psychedelic clinical trial participants and researchers talk about psychedelic experiences, and how they construct meaning from those experiences.

What does the history of anthropology tell us about drug use and identity? 

In the 70s, a school of thought emerged in the humanities called post-structuralism; the main idea there is that there's no ultimate truth, and that meaning is culturally and historically contingent. People construct meaning. And so it follows that how people construct meaning around drugs in very different ways depending on what time they exist in and what parts of society they inhabit. 

For example, pharmaceutical anthropology looks at the role of prescription drugs in how people construct their sense of self. Anthropologists Emily Martin and Janice Jenkins have written about the pharmaceutical self; they've interviewed all these people on different cocktails of psychiatric medications, and they'll ask them to explain what a drug means to them. Those accounts suggest that these people feel the drug is fundamental to who they are. For instance, somebody who's on drugs for bipolar disorder will say, “This drug is my true self.” You also hear this discourse around psychedelics; people say psychedelics changed their lives, and we have this understanding that they can change somebody's sense of self. There's this notion that drugs have so much power, but anthropologically, we have to ask: how did we get there? At what point in time did we start talking about drugs and relating them to our sense of self? 

The sociologist Nicholas Rose charts the historical, sociological, and philosophical trajectory of neuroscience and his work has shown that we have come to understand ourselves by virtue of the language we used to describe neuroscience. We’re in a moment where people tend to think about themselves in very neurocentric terms, and that has implications for how we think about drugs, too. If we think that mental health problems are “hard wired” in the brain, then it makes sense to think that if we take a drug that will “rewire” or “reset” the brain, like many say psychedelics do, then that could fix the problem.

So if drugs can affect our sense of identity, does our identity also shape our attitude towards drugs?

There’s definitely a socioeconomic component to all this. Where I grew up, I saw people using drugs like heroin, which many regard as dangerous. But scholars like Carl Hart have argued that this type of drug use can be a rational choice  If people come from this underclass and the options available to them are limited — say, a 6 Euro-an-hour job in a supermarket, without the potential for higher education to find a new path — heroin might be seen as a viable option for the future. But if you come from a higher socioeconomic status, you're going to see heroin entirely differently, as a drug that inherently devastates people and creates addiction. If you look at psychologist Bruce Alexander’s “rat park” study, perhaps these so-called hard drugs don’t necessarily have an inherent, addictive quality. In that study, he separated rats into two types of cages: one cage which has all the resources that a rat could need or want, like other rats, lots of food, and space to play. The other cage didn’t have those things. Then he put drugs in the water in both those cage types. You would assume that if these drugs are inherently addictive, all rats would get addicted all of the time, or at least most of the time. But they don't. The rats that had more options in their life just recreationally partook in those drugs, and some didn't touch it at all after trying it once. But the rats in the “abject poverty” type cage get addicted immediately. 

When you see how these patterns of drug behavior are so tied to resources, it’s interesting to think about psychedelics, and the role of the upper middle class in popularizing them. Ultimately I think we need to understand drugs as context dependent, and those contexts are always shaped by politics, discourses, power, status, opportunity, aesthetics, and culture. 

How does an anthropologist study psychedelics? 

So the method that anthropologists use is called ethnography: we immerse ourselves in a given social environment, and we do it long term, usually at least a year. We observe people in their social environments, but we are also participants; we understand that our presence in the field impacts how the field itself is structured. It's different from the work of experimental psychologists, who try to isolate and control variables. Instead, we recognize that our subjectivity plays a role in the dynamic, and that subjectivity can be a valuable means of gaining knowledge because it can give us a deeper understanding of the stories that people tell about themselves and their lives. We ask a lot of questions and listen, and sometimes do more formal interviews. 

I am embedded in a handful of clinical trials in London, and I’m trying to understand the complex social systems that interact to produce people’s understanding of psychedelics. That includes participants who are enrolled in a clinical trial to understand how the drug impacts them on a long term, real world basis — if they feel the drug changes their lives, for instance. The accounts that we have right now of how psychedelics work come from when you're in a brain scanner or right after a session — we don't really have accounts of how psychedelics work in people's everyday lives long term. Generally speaking, they have quite dramatic and profound accounts of how the drug has affected them — certainly a lot more dramatic than what you might get with Prozac or Lexapro.

I'm also trying to understand the scientists’ and clinicians’ notions of how a drug works, and what language they use to describe that. While participants might say the drug changed their lives, I want to know what kinds of quantitative, standardized measures psychiatrists are using to understand what that looks like, and how they define clinical efficacy. Is it a change in participants’ values, their belief systems, or the way that they see themselves? Has it affected their relationships or their mood? 

You’ve been embedded for a few weeks. Are you seeing any interesting trends so far?

The inclusion and exclusion criteria for these trials are quite limited and often hyper specific. That makes me wonder if the participants represent the general population experiencing a given disorder, like, say treatment-resistant depression. 

I'm also witnessing a real refreshing epistemic humility from physicians and scientists. Everybody's aware that this is a very nascent field and that there is so much complexity happening, and we are all very much in learning mode. I haven't met anybody who's like, “I know the answer.” 

There's also a sense that we're moving away from a biologically deterministic model where the problem is in your brain and you have to take a drug every day. Instead, it feels like we're moving towards a paradigm of relationality and healing. The understanding is that you heal with and through a therapist, which then maybe changes our understanding of what it means to have a problem in the first place: that maybe these issues are lack of relationality or support. 

From the participant side, many people believe the process requires active participation of not just the psychiatrist or therapist, but the participant, which is a departure from this earlier conception of a patient as someone who just takes a pill and waits for it to work. The word I keep hearing in relation to this is “work” — it makes participants more active agents in creating a path to healing, rather than passive recipients of a drug that's going to fix us. 

Psychedelics have forced a lot of people and clinicians to consider the relational aspect of psychedelic-assisted therapy and the role it can play in helping people heal. In fact, some companies believe that the relational aspect is not as important as the drug, and are designing their business models around that. Do you think psychedelics are actually unique in requiring that connection to see results, or might other drugs share this quality?

If we understand the mechanism of action of psychedelics to be fundamentally context dependent, and if we understand healing to be relational — that is, also context dependent — then why wouldn't the notion of disorder also be context dependent? Why wouldn't the mechanism of action of previous drugs also be somewhat context dependent? 

There isn't as much discourse around this topic yet, but I’ve definitely talked with people about it, including Leor Roseman at the University of Exeter, who’s one of my advisors. You can't take people out of their environment, and all of these things — drugs, healing, mental disorder — are all embedded in dynamic social environments with histories, values, ideologies, and norms. I hope that we can begin to see ourselves and our notions of disorder as a bit more complex, because that hopefully then also allows for more change. 

This interview has been edited and condensed for clarity and length.