What if someone harms you while you’re on psychedelics?: 5 Questions for social worker Erica Siegal

Siegal discusses harms and abuses perpetrated on people while they are on psychedelics, and how to better protect people from them.

Erica Siegal was born too late to be a nineties rave kid, but as a teenager in the early 2000s, she caught the tail end of rave culture and with it an interest in psychedelic drugs. After earning a master’s degree in social work, she volunteered with the Zendo Project, a harm reduction non-profit run by the Multidisciplinary Association for Psychedelic Science, or MAPS. The project provides peer support and crisis intervention for people experiencing challenging psychedelic trips at festivals like Burning Man. Siegal then received MAPS training and served as a study coordinator in the organization’s MDMA clinical trial for adults with autism. By 2019, she had already begun to have misgivings about the trial, wondering whether it provided adequate support to participants. Then a patient in another MAPS-run clinical trial submitted an ethics complaint about two therapists’ inappropriate sexual behavior during psychedelic sessions. Siegal was disappointed by MAPS’s response; it felt to her like the organization was “actively sheltering sexually abusive men.” 

Siegal, a licensed clinical social worker, decided to found her own psychotherapy practice called NEST, which stands for Network of Emotional Support Teams. NEST focuses on providing psychedelic-assisted psychotherapy, harm reduction, and education programs. From that work came the SHINE collective, a non-profit organization that supports survivors of all types of harms and abuses perpetrated on people while they are on psychedelics, including sexual assault. The Microdose spoke with Siegal about those harms and how to better protect people from them. 

What made you decide to start the SHINE Collective?

Professionals who work with survivors of sexual assault are sometimes like, “Well, just never do drugs again, because that's an unsafe environment.” Survivors of sexual assault might feel rejected, because they’re often blamed for putting themselves in unsafe situations — even though they shouldn't be unsafe. The whole experience can be confusing. It's an immediate, complex trauma. There's so much grief tied up in it, and so much shame and self-blame, because when you are on psychedelics you are in a confused, highly suggestible state if you are assaulted. The sexual assault people often don't understand the psychological complexity of the psychedelic state. 

And then there are the psychedelics people who either don’t believe you, or want to give you more psychedelics, and that's not what you need either. What you need in that circumstance is somebody who's going to understand the complexities of a traumatic assault while in a highly suggestible state. There’s a very small subsection of therapy providers who even want to do that work, but there's a need for people who understand what it's like to be a survivor of psychedelic harm. I’m getting messages from people about that at least once a week.

What kind of harms are people approaching you about?

There is a spectrum. There can be unintentional harm, like harms that stem from therapist burnout — maybe the therapist wasn’t paying attention and caused unintentional harm by not being present in a session. But then there are things like, a client is having a really rough time and freaking out, and the provider physically restrains them. And then there are cases where a facilitator grooms a client during psychedelic sessions and then sexually assaults them.

There's a spectrum of harm. The vulnerable, suggestible experience that people are having while they’re under psychedelics can cause all sorts of confusion. The last thing that we want to do is gaslight our clients — like, “no, that's not what actually happened.” But I've also heard from someone who identified as a person who was harmed during their psychedelic sessions — they genuinely thought they were harmed. But then — and thank God the facilitator videotaped all the sessions — as the client went back and watched the session, she discovered that no one touched her the entire time. That doesn't mean the experience or trauma response she's having is any less valid, but it also means that there was no criminality and no intentional harm caused. There are all of these nuanced situations that we're dealing with, especially when we're dealing with altered states, and I think that really needs to be addressed. Nobody is immune from causing harm, intentional or unintentional, and opening up a dialogue around risk and harm is necessary and vital.

How do the survivors of harm you’ve spoken to want to see these harms addressed?

None of us want to see psychedelics become less accessible, which I think really speaks volumes to the potential power of psychedelics. What we want is accountability, and for the community to facilitate conversations about restorative justice, when that’s appropriate. We want consequences, or some sort or reeducation for facilitators who are acting out of alignment, and requirements of sabbaticals and breaks and consultation groups. When harm occurs, we’d like to hear: “Oh my God, I'm so sorry. How can I help?” We don’t want to hear “Well, that person never did that to me, so I don't know what you're talking about.” That kind of reaction perpetuates this patriarchal violence — like, “Well, you're already doing something illegal, so you should have known better. If you didn't go to that ayahuasca ceremony, then you never would have gotten assaulted.” And it's like, yeah, but also, if I didn't go to the ayahuasca ceremony, I might still be suicidal. 

With state-legal psilocybin programs launching in Oregon and Colorado and potentially more on the way in other states, do you think there are adequate safeguards against harm? Put another way: do you think things are moving too quickly?

I think that the industry is going to move as fast as it possibly can; it’s late-stage capitalism. But let's at least get some lab testing going. I don't want to put a psilocybin gummy in my mouth until I know it's lab tested and I know where that lab is, and I can see published results. Know your drugs, know your source. Even the edibles industry can be dangerous. I’ve noticed in some cases, people misuse the term “microdose.” I recently asked someone about the dosage of these mushroom chocolates and the makers said half a gram. That's not a microdose! 

Part of this is education, but it would be great to have more information as consumers. When we get a prescription at the pharmacy, there's a piece of paper with safety guidelines stapled to it; I think everything should have those safety guidelines on it. Drug dealers should be printing business cards with dosing guidelines and reminders that if you're experiencing a medical emergency, call 911, or if you're having a hard trip, call The Fireside Project. In these decriminalization efforts, we’re often not talking about how our general knowledge base about dosing and psychoactive substances is extremely minimal — if we’re giving everybody access, then we should really also give everybody education. 

How do you think education and harm reduction programs should fit into the current field of psychedelics?

I think of all of the biotech, pharma, and tech companies that are profiting off psychedelics right now, and how they should be contributing a percentage of their profits. There could be, say, a 5% donation of all profits given to harm reduction organizations, addiction treatment, survivor support, educational programming, or BIPOC causes in whatever way they want to break it down. If you are going to make billions of dollars off of psychedelics, a percentage of your profits need to go towards harm reduction and survivor support.

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