Trust, Let Go, Be Open: Psychedelic Harm Reduction in the Desert and Beyond

This article was written by Katherine MacLean, Ph.D. and appeared in the MAPS Bulletin, Winter 2014: Vol. 24 No. 3 Annual Report

“Once in a while you get shown the light, in the strangest of places if you look at it right.”
– Robert Hunter, “Scarlet Begonias” (1974)

I had just finished the graveyard shift and was resting in a back corner of the MASH-style Army tent, falling in and out of dreamy sleep as the morning light began to creep in. The incessant thumping of electronic music had finally given way to the familiar, happy sounds of our desert community waking up: light chatter and laughter, spoons in cereal bowls and boiling tea, a porta-potty door swinging open and shut. Then, suddenly, a scream ripped through the soft morning air.

I saw a small undulating mass of bodies appear at the opening of the tent, and it took me a few moments to realize that the young woman at the center of the mass was the one screaming. She was clawing at the air as her eyes darted toward things that no one else could see. She clearly had no interest entering this strange place, with these strange people who were so interested in her. Her friend explained that they had taken what they thought was Ecstasy around midnight, but the night had quickly gone downhill from there.

Slowly, we managed to get the young woman to lie down on the same air mattress where I had been napping. I sat on the floor next to her, one hand resting on her shoulder and the other holding her hand. Her friend sat at her feet and laid her arms over her lower legs. For the next hour or so, we remained in this awkward embrace, trying to stay as calm as possible while the young woman writhed and screamed. “It’s OK. You’re safe. Let it move through you.” Eventually, she began to relax and her grip on my hand loosened. Her breathing slowed and her eyes began to close. “You’re safe, we’re here with you.”

This kind of scenario wasn’t exactly what I had in mind when I first began my career in psychedelic science. After completing my Ph.D. in the fall of 2009, I had joined the psilocybin research team at Johns Hopkins University, one of the best (and only) academic research institutions in the world doing clinical trials with psychedelic medicines. Over the course of four years, I trained with two of the most experienced psychedelic therapists in the world: Bill Richards and Mary Cosimano.

I saw my fair share of full-blown mystical experiences and classic “bad trips.” I supported people as they revisited traumatic memories, and shared their joy as they raved about the beautiful music and the fascinating patterns on the ceiling tiles. I held hands with people as they cried, screamed, and even laughed their way through some of the most intense experiences of their lives. I did all of this in a comfortable, familiar environment, with people who were well prepared and trusted me to care for them. Harm reduction, on the other hand, is about sitting in uncomfortable and unpredictable environments with strangers who have usually taken large amounts of unknown substances. Even with all my professional training, I had a lot to learn out there in the desert.

My first opportunity to volunteer with the MAPS psychedelic harm reduction program came in the late summer of 2012. I had already made plans to return to Burning Man after a five-year hiatus when Rick Doblin (MAPS’ Founder and Executive Director) reached out to ask if I would be willing to help train volunteers for a new project that MAPS was launching. The Zendo Project would provide a safe space and trained sitters to help individuals who were having a difficult time as a result of ingesting psychedelic drugs. Although we agreed that there were differences between the methods used in controlled research studies and those used on the ground at festivals, Rick thought it would be good to include my perspective as a scientist and therapist. I was inspired to have the opportunity to do some good work while I was at Burning Man, as a purely hedonistic approach to the event had lost some of its appeal for me. I was also excited to learn from other therapists, clinicians, psychonauts, and good Samaritans who would likely be volunteering.

Although I was prepared for an intense experience, my time in the Zendo ended up being quite calm and uneventful that year. I had signed up for morning shifts, so most of my volunteering energy was spent giving water, granola bars, and farewell hugs to people who were finally ready to head back to their camps after a long and harrowing night. But I will always remember one special interaction I had with a young man who arrived at the Zendo just after sunrise.

The young man was basically non-verbal, and the helpful stranger who dropped him off said she had found him wandering and confused. I sat next to him for quite a while, unsure of what drug he had taken, what help I could provide, or whether he was even aware of me. So, I just sat there. I meditated a bit. I breathed. He breathed. I waited patiently. We said nothing. (Note to the reader: Sometimes, sitting with people on drugs is actually quite boring!) When I offered him a glass of water, he held it in his hands and stared at it for quite some time until I gently asked, “What do you see?” “Everything. It’s all here,” he replied. “We’re all in there!”

The next six or so hours of his LSD-fueled ride were not all as positive or illuminating as his encounter with the water glass. Nevertheless, as the young man departed the Zendo around noon, he admitted that, despite being generally embarrassed and slightly annoyed, he was really thankful that we had taken care of him. I was thankful, too.

“Everything. It’s all here.” This psychedelically-inspired kernel of cosmic wisdom sums up why I find the harm reduction work so important. We’re in this together, and we have much to learn from one another. Providing safe spaces at festivals is one of the easiest ways to turn intense, self-absorbed, potentially dangerous experiences into opportunities for shared insight and personal growth.

Fast-forward to the spring of 2014: I’m driving from Cape Town up to the Tankwa Karoo with Linnae Ponté (MAPS’ Director of Harm Reduction) to help coordinate and run “The Sanctuary” at AfrikaBurn. This was the second year that the Zendo Project had been invited to work directly with event organizers, rangers, and medical staff to provide psychedelic harm reduction and mental health support at the largest regional Burning Man event in the world. By the week’s end, we provided training in the principles and techniques of harm reduction to more than 30 volunteers, including medical staff, and our volunteers cared for 50 guests (51 if you count the infant left in our care for about 10 minutes one morning while her mom tried to locate their campmates).

The Sanctuary at AfrikaBurn is a model for harm reduction at its best. We were able to communicate and work directly with medical staff and rangers to comprehensively assess and meet the physical and mental needs of our guests. We often received and cared for individuals who had been cleared by the medical team, but who still needed a safe, warm place to spend the rest of the night. Sometimes, we would redirect individuals to the medical tent to receive close monitoring and physical care.

The most popular drug of choice at AfrikaBurn was alcohol (reported by 40% of Sanctuary guests), which too often leads to deadly consequences, especially when combined with other drugs. Sanctuary guests also reported use of MDMA or Ecstasy, LSD, psilocybin mushrooms, cocaine, cannabis, GHB, and methamphetamine. Nearly 70% of guests reported having taken multiple drugs. The reality of polydrug use, often combined with excessive alcohol intake, underscores the importance of coordinating psychedelic harm reduction efforts with emergency medical care in a festival environment.

Over the course of the week, we sat with many individuals who had gotten in over their heads and were struggling to regain a sense of safety and sanity. One night, Linnae Ponté and I took turns sitting with a frightened and confused young woman who had taken what she thought was a typical dose of LSD, but who continued to be plagued by intrusive and disturbing mental images more than 24 hours later. There were also playful moments, such as one young woman on Ecstasy who marveled at the “beautiful decorations” and “magical objects” on the meditation altar we had set up, and ultimately took it upon herself to visit with the other guests and offer words of encouragement: “Don’t worry. You’re in good hands. Two hours ago, I was where you are. But just look at me now! I’m doing great! These people really know what they’re doing!” She reminded me that it’s OK to play and laugh and not take things so seriously. There’s room for all of it. Trust, Let Go, Be Open—TLO.

TLO was the “mantra” that I had learned while training to be a psychedelic therapist at Johns Hopkins. The wonderful thing about TLO is that it applies to the person sitting as well as to the person journeying. I have silently repeated this mantra countless times while sitting with people. I have uttered these phrases aloud when individuals become lost in their experience or seem to be stuck. Trust your own innate wisdom, that you have the skills and natural abilities to make it through this experience. Trust the safe space that has been provided and the people around you to help you if need it. Let go of expectations about what should or shouldn’t be happening. Let go of concerns and judgments, as well as the inevitable feelings of wanting to control the experience in a particular way. Open yourself up to the amazing events that are unfolding, even (especially) the difficult and scary parts. Stay open to the fundamental truth that everything that is happening is completely and utterly OK.

Amidst all of these entertaining anecdotes and kernels of wisdom, however, I am continually reminded that the most important (and often tedious) dimension of psychedelic therapy is integration, or continuing care. An experience can be wild and terrifying and profound and hilarious and beautiful, but what do you do with it once you re-enter your ordinary life? Or, as Buddhist teacher Jack Kornfield put it, “After the ecstasy, the laundry.” I actually love doing laundry, so it’s probably no surprise that my most memorable and rewarding experience at AfrikaBurn occurred while working with someone who was completely sober.

Early Sunday morning at AfrikaBurn, toward the end of an all-night shift, I was introduced to a young man who had spent the previous night in the medical tent. Although the full story had yet to be pieced together, one of the paramedics explained that the young man had apparently overdosed on a number of different substances and was dangerously close to death at various points in the night. The fact that he was standing in front of us, lucid and physically healthy, was something of a medical miracle. But the young man didn’t see it that way. He was confused and suspicious, and felt that no one really understood what he had been through. He had the strong conviction of having died and experienced a world free of suffering. He didn’t remember being transported to the medical tent in the first place, and felt that he had been unfairly “brought back to life” by the medical team, without his consent. I knew from my research with psilocybin that a death-rebirth experience like this could be an important and healthy step on a person’s spiritual path. And a number of the study volunteers I worked with at Johns Hopkins had reported a profound experience of their own death. But I had never worked with someone who wasn’t thrilled about the “rebirth” part.

Throughout the morning, we took turns sitting with the young man, listening to his story and supporting him as he struggled to weave a meaningful narrative out of his experience. We made some progress, but he kept hanging onto the disconcerting feeling that he “wasn’t supposed to be alive.” Realizing that our words were offering limited comfort, I eventually offered to walk with him to the Temple, where offerings had been made throughout the week and would be burned in a ceremony later that night. We walked mostly in silence and when we arrived, I asked him to sit with me in front of the altar. We sat there for maybe 30 minutes, absorbing the full reality of the space. Among the various objects and drawings and inspirational phrases that people had added to the temple over the course of the week, what stood out were the photographs of people who had died. Young faces, old faces, beautiful faces, funny faces, along with pleas from their loved ones, asking for the fire to bring peace and help release the sadness and anger around their deaths. The Temple, of course, is about much more than death, but this was its message to me, and to the young man, on that Sunday morning. Something clicked as he turned to me and said, “I get it. I’m lucky to be here. I’m ready to go find my friends.”

I have no idea what happened to that young man after we managed to find his friends (another miracle, as anyone who has been to a Burning Man event can attest). Unlike with research volunteers, I have no way of contacting him, of following up to see how meaningful (or not) his experience turned out to be. But I can still see his face clearly in my mind. I’m happy that he survived his dark night and that I had the privilege of spending the first few hours of the rest of his life with him. I’m mostly thankful for that moment of simple illumination—“I’m lucky to be here”—and all of the moments I’ve shared with strangers while volunteering with the Zendo Project. These experiences remind me, again and again, that life is unpredictable and precious.

Everything. It’s all here. We’re in this together. TLO.

Katherine MacLean, Ph.D., is an academically trained research scientist and meditation practitioner with a long-standing interest in the brain, consciousness and the science of well-being. As a graduate student at the University of California, Davis, Katherine was supported by a prestigious National Science Foundation research fellowship to study the effects of intensive meditation training on concentration, emotional well-being and brain function. As a postdoctoral fellow and faculty member at the Johns Hopkins University School of Medicine, she was one of the only scientists in the world studying psilocybin—a psychedelic chemical found naturally in certain types of mushrooms. Her groundbreaking research on psilocybin and personality change suggests that psychedelic medicines may be the key to enhancing mental health and promoting openness and creativity throughout the lifespan.