In this reported op-ed, Elena Hilton explores how the portrayal of psilocybin use in Hulu's Nine Perfect Strangers deviates from actual research on how controlled use of the drug may help adults with persistent mental illness.
Sitting in a perfectly lit room designed precisely for relaxation, Tranquillum wellness retreat leader, Masha (played by Nicole Kidman), whispers, “They come here for the suffering.” In Nine Perfect Strangers, suffering comes in many forms. Viewers suffer by listening to Kidman’s much-mocked Russian accent that comes and goes. The characters suffer throughout the entire retreat thanks to smoothie “health protocols” that are laced with drugs.
And people learning about psychedelic mental health treatments will suffer from the sheer amount of misinformation.
The Hulu series, which centers around nine retreat guests looking to escape their distressing lives and find their most-perfect selves, has been met with some disastrous reviews, accusing the show of being “hollow” and a “huge disappointment” despite its large viewership. It seems confused, vacillating between satire, a dramatic character study, and a campy showcase for over-the-top wigs. But the whiplash you feel watching Nine Perfect Strangers mirrors the retreat guests’ experiences, as Masha and her team drug them (at first, without their consent) with higher and higher doses of psilocybin.
Psilocybin is a naturally-occurring hallucinogenic found in certain kinds of mushrooms (often called magic mushrooms). While psilocybin is illegal in the United States, it has garnered positive attention over the last decade for the potential mental health benefits that can come with ingesting it. Using psychedelics to treat depression, anxiety, or addiction is still a fairly fringe idea within research communities, and more research is needed to fully understand the drug’s impact. Still, small studies have shown that adults using psilocybin in certain, controlled doses under professional supervision can help relieve symptoms of major depression, anxiety, obsessive compulsive disorder, and other mental health conditions.
Nine Perfect Strangers puts psilocybin front and center, and it could be one of the most mainstream ways the drug has been introduced to a good portion of the show’s audience. Most Americans are likely familiar with psychedelics even if they don’t know psilocybin by name, but it’s still uncommon to talk about these drugs with regards to wellness and mental health. Though the show raises some awareness around psilocybin, the amount of misleading information in the series has the potential to derail the progress researchers have made in calling attention to the benefits psilocybin can have.
Between giving psilocybin doses without consent, not closely monitoring patients while on the drug, not accompanying the doses with significant therapy, encouraging the remembrance of traumatic events without proper support, and incorrectly suggesting that it’s helpful to ingest psilocybin daily to live in a permanently altered conscious state, Nine Perfect Strangers seemingly demonizes a drug that, in reality, has the potential to successfully treat some people’s persistent illnesses.
Alan Davis, PhD, assistant professor at The Ohio State University, adjunct assistant professor in the Center for Psychedelic and Consciousness Research at Johns Hopkins, and clinical psychologist, has seen firsthand the potential of psilocybin treatment in adults. He says that in his team’s most recent psilocybin trial for people with depression, they found that 54% of people in the study had a remission of their depression after one month.
“And based on the findings we haven’t published yet, it shows that those effects last up to a year after their treatment was completed. For three quarters of people in the study, they saw a clinically significant response,” Davis says. “So even if their depression didn’t go away completely, many people saw their depression severity reduced by half or more.”
These clinical trials have shown such promising results that the FDA has twice labeled psilocybin a “breakthrough therapy” for major depressive disorder, signaling that, if these strong findings continue, it seems that the FDA may approve the drug for legal usage in the United States for this purpose. According to Davis, that approval could come in the next three to five years. So far, psilocybin has only been tested in adults, and therefore any positive findings can only be applied to populations over age 18.
“Psilocybin really helps to engage with the pain and work with it, rather than just numbing it like SSRIs do, and that’s why it can have long-term, very positive effects,” says Valerie Bonnelle, PhD, the scientific officer at the Beckley Foundation, an Oxford-based organization that designs and develops research and global policy initiatives regarding psychedelic substances.
To achieve these results, therapy is a critical component of psilocybin-based treatment, but you won’t see that in Nine Perfect Strangers. According to Davis, the typical practice is around eight hours of therapy before a dose of psilocybin, close monitoring while the patient is on the drug, and then many hours of therapy in the days, weeks, and months following. The general guidance is usually only one to three sessions of administering psilocybin accompanied by therapy over the course of a few months — not the every day, intense dosing that’s featured in the show.
“We want to help build a sense of trust and rapport so that if anxiety, fear, panic or these distressing memories come up, we can work them therapeutically to help people process it, understand it, and integrate these types of experiences in a path forward in their life,” Davis says.
One of the more disturbing scenes in Nine Perfect Strangers occurs during the sixth episode, when Heather (Asher Keddie), while on a much-too high dose of psilocybin and left to wander the woods, recalls a traumatic memory that may have led to her son’s suicide. Her subsequent breakdown is the result of overall bad practices with a malicious lack of therapeutic support, and it’s exactly the type of depiction that researchers caution against.
“Shows like this bring the conversation [about psychedelics] to a wider audience, and when it’s done well, it helps to educate the public about what these substances are,” Davis says. (Ed. Note: Davis hasn’t seen the show, but reacted to the description provided by the author of this piece.) “However, when it’s done poorly, or when it perpetuates stigma or misinformation, it adds fuel to the flame of those who are skeptics or those who are in leadership roles in the country who might see it and assume that these misconceptions are accurate.”
Collin Reiff, MD, who specializes in addiction psychiatry at NYU’s Grossman School of Medicine and has primarily researched MDMA and ayahuasca, sees the benefits of these drugs in hyper-controlled settings, but remains hesitant about how the public is learning about the advancements, emphasizing that currently, they can — and should — only be taken in a clinical setting.
“I worry that the enthusiasm around these compounds could lead to the [public] use of them outpacing the research,” says Reiff. “It’s very rare that any drug is all good or all bad. There’s often a middle ground, and we haven’t found the middle ground with these compounds. More research is definitely needed.”
There’s also the risk that irresponsible pop culture portrayals or media coverage of psychedelics will lead people experiencing mental illness to take matters into their own hands without the guidance and monitoring of a clinical specialist.
“A lot of people whose mental health issues are resistant to treatment can feel they’re in a desperate position, so they might be tempted to give it a go by themselves,” says Bonnelle. “But if we start seeing major incidents of people who are trying to self-medicate, that could make the whole movement completely collapse. So we need to be really clear about our message [of safe practices with psychedelics].”
There will always be underground, ceremonial, or unregulated spiritual usage of psychedelics as there has been for centuries, and being a medically-trained clinician is not the only way to safely administer these drugs. As Bonnelle puts it, “In a way, we are rediscovering something rather than bringing on a new treatment to the market.” Still, given that therapy and closely-monitored experiences are part of protocols that can actually help mental health, individual, unsupervised use can be dangerous.
While psychedelics aren’t yet legal in the United States, Americans who want some level of guidance are going abroad to psilocybin retreats in Europe, and there are few that do offer help for those with mental health concerns. But with any unregulated or nonclinical psychedelic experience, there is always a higher risk for things to go wrong, especially if the person is unaware they have a genetic predisposition for bipolar disorder or schizophrenia.
“There is a subculture out there that is doing some pretty ethically dubious things in terms of dosing people inappropriately, not preparing them, charging them a lot of money for it, or maybe giving them many different types of psychedelics in the same retreat setting,” says Davis. “These are things that, from a research or clinical standpoint, are not ethical and can be unsafe.”
But the long-term future of psilocybin in the United States likely looks a lot less like one of those ethereal wellness retreats, and decidedly more like a run-of-the-mill visit to the psychiatrist’s office. For those in the United States who suffer from severe depression, anxiety, and addiction, psilocybin could be the solution, but Nine Perfect Strangers is putting in some serious effort to be a speed bump along the road to progress.
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