Last month (April 2024) I attended the Breaking Convention multidisciplinary conference on psychedelic research.
Breaking Convention is a charity dedicated to creating a multidisciplinary academic conference associated with the research of #psychedelic substances, promoting findings and publishing the contents of those conferences.
This was my second visit to a Breaking Convention conference and much like my last attendance, my pen was practically smoking as I wrote frantically trying to record even just a few of the many ideas, facts, breakthroughs, challenges and subsequent professional existential dilemmas I collected through the day.
Unlike many academic or professional conferences that we attend in the world of #healthcare and #medicine, Breaking Convention is truly multidisciplinary – and that’s because there are a few particular members of the multidisciplinary team present throughout… the patients and the public. It’s not just that they are there - it is that they are teaching, talking, asking, challenging and enriching the entire process.
It sounds so obvious doesn’t it? But for us, as healthcare professionals, when we attend events on clinical research, ‘new’ medicines, safety and ethics debates or meet to plan changes to care – we rarely do it alongside those whose lives will ultimately be affected by our decisions and #research. Of course we hold consultations, opinion gathering exercises, expert patient groups, patient peer involvement and other ways that we try to involve patients – but ultimately, we often still present ourselves as the guardians of the knowledge and hold separate initiatives to consult others. Breaking Convention just puts everyone in the same room and all knowledge, experience and ideas enrich the space.
This brings me to a word and concept that came up several times during this year’s conference. #Communitas.
Communitas refers to an unstructured social state. It is liminal in the sense that within that community, participants step outside of their prescribed social roles and into a state of equality, solidarity and shared experience. It’s a concept attributed to a chap called Victor Turner, a British anthropologist who used this term in his study of ritual. The word ritual is also important here, but we’ll come back to that.
Chiara Baldini delivered a talk entitled Mysticism, escapism or activism? Spirituality and politics in festivals today. I was so gripped by this talk that I made no notes whatsoever, for fear of missing a word. Chiara talked about the journey of psytrance festivals, from their initial home in Goa to their role in Europe today. What I felt Chiara weaved seamlessly through her talk was the importance of the collective experience of festivals – the #counterculture, the politics, the spirituality – the communitas! The transformational value of stepping away from hierarchical structures and expectations and sharing a collective experience centered around change, progress and spirit.
Throughout the whole of the conference the role of psychedelics as curators of transformational and countercultural spaces kept coming up for me. So too, the importance of the rituals in which we as individuals and communities try to reach these spaces.
So why should this feel so significant to me in my clinical work? Well, a clinical consultation is a lot like a ritual, in the sense that it is a series of actions, a journey, a dance if you like. For the most part, in conventional western clinical structures, it has a formula that is repeated each time. That is how we are taught to do it. The difference with a clinical consultation is that there is, more often than not, a hierarchy, with the clinician at the top. We’re the ones with the knowledge, right? We are the experts, and we are the ones with the names for stuff, the prescription pads, and the management plans. But for too long now, for me, clinical consultations have felt restrictive.
A consultation should be transformational too shouldn’t it? I mean, in terms of health and wellbeing. A consultation or relationship with a clinician should be about holding space, bringing about change, progress and enabling healing. But how much more transformational would that consultation be if we dropped that hierarchy? If we just sat in the space as equals – we as clinicians, experts in our craft, and our patients as experts in their experience, symptoms, story, culture, hopes and fears. If we allowed all of those things as much significance as their presenting complaint, blood results or biometrics then imagine how seen, heard and whole that person would be?
I’ve been banging on about ‘Personalised Care’ for years in the NHS. It’s an approach to delivering care that is built around what matters to a patient. It’s about giving the autonomy and choice back to the patient. Frankly, a lot of the time I’m shouting into an abyss and the only echo I get back is “there isn’t enough time to do that”. I’ve been asking myself how we might create elements of communitas in the rituals and interactions we have in healthcare. That element of communitas might help to bridge what to me, feels like a growing gap between the public and the healthcare system in the UK.
During the morning sessions I attended and listened to the Psychedelic Clinical Practice panel who talked about the practicalities, challenges and ethics surrounding clinical practice and research. The panel of Carolina Maggio (research therapist), Rosalind McAlpine (experimental psychologist) and Ashleigh Murphy-Beiner (clinical psychologist) were moderated by Claudia Canavan (health journalist). They talked openly, clearly and compassionately about their work, it’s challenges and kept patients very much the focus of their responses.
What was equally as powerful during this session was the audience participation in the Q&A that followed. The questions, concerns and hopes of people, in relation to psychedelic medicine. It really reflected trust, the need for an equal space, a sense of ownership and the cultural significance of psychedelic medicine. It really brought home the importance of how we hold the space for a patient so that we don’t take away those crucial things.
Breaking convention really nails this, in the way it explores psychedelic medicine without taking away its cultural context. The conference is full of art, music and creativity and all of that has as much value as clinical evidence in understanding how this medicine can help people, and why it MATTERS to people.
I work with medical #cannabis in my work outside of the NHS. Sometimes that work can feel challenging – not least because of the endless stigma, the fear of many colleagues and the dissonance I feel trying to incorporate into the healthcare model, the role that cannabis has played in people’s lives. How do we balance that with evidence, regulation, safety and clinical responsibility?
Working with medical cannabis is different to working with many other drugs that I may prescribe. Unlike many other medicine’s I prescribe, cannabis has a cultural significance to many people, and because of this people rightly have a sense of ownership about the medicine. In a number of cases, long before these patients come to us for medical cannabis, they have self-medicated for years. They have had ownership and autonomy with the medicine, they have chosen the environment in which to consume it, they have learned their doses and their routine. It’s important to invite that into the space too. The challenge, I find, is managing that alongside the regulations and processes that we are bound to clinically – many of which can make a patient feel as if we are taking away some autonomy.
In contrast to this, the cultural significance of cannabis may well be what presents challenges to both clinicians and patients who are cannabis naïve. I mean, when we prescribe someone Codeine or Tramadol, it rarely has much discourse, little stigma and less associations with criminality, though of course like all medicines people obtain these without prescription too. At Breaking Convention, the anthropology and culture of psychedelics sat in the space and actually bridged these barriers and I’ve been wondering how we could do that with cannabis too.
One of the talks towards the end of the day was delivered by Iryana Mosina. Her talk was about the recreational use of psychedelics at festivals and at the end of her talk she put up a slide. It simply said “People take drugs at festivals and these experiences influence their lives”.
I spend a lot of time talking to colleagues about medical cannabis. On the whole, they react with interest and discussion, but a large number of healthcare professionals still feel very uncomfortable at the idea of medical cannabis. Often they cite reasons around lack of evidence – and yet feel still comfortable with prescribing other medicines that may also lack evidence. We know for example that the evidence for long term use of opiates in the management of chronic pain isn’t great. Sometimes it’s a fear that the drug will be abused – yet so much of what we prescribe can be also be abused. Often it’s fears around the law and a lack of understanding about legal access. But I wonder how much healthcare professionals fear the conversation, the reality – people take drugs that aren’t prescribed by us. It’s not new. We so rarely ever ask our patients – are you using anything else that is helping? What about illegal drugs? Do any of those help? We are so ready to talk to patients about OUR drugs, the ones with our signatures on them but we are not ready to talk to patients about THEIR drugs – the one’s with their signatures on them. Both exist in the lives of patients – whether we are happy about that or not and they all intertwined in the experiences, cultures, identities, values and hopes of these patients.
Of course drugs have risks. Safety and wellbeing is the whole point of what we do as healthcare professionals. I’m saying that drugs with a prescription don’t automatically become safe and drugs without a prescription don’t automatically become unsafe. Yes, we need to move forward with more quality clinical evidence, but that isn’t the only evidence that shows us how people manage their wellness. We have to listen to the anecdotal, anthropological, cultural evidence – because that’s what people’s lives are about. We need to talk about drugs beyond what we write on a prescription pad – what they mean to people, how they change things, and how we work with people in the context of their lives as much as in the context of our consultation rooms and laboratories. All these things are valid, and Breaking Convention shows us that together, they are greater than the sum of their parts.
#medicalcannabis #psyhedelics #healthcare #health #wellbeing #clinicalresearch #medicine #nursing #personalisedcare #chronicpain #chronicdisease
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