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Key points
- Catharsis in therapy, as depicted by Hollywood, can be dangerous and retraumatizing.
- Psychedelic therapy invites patients to experience difficult emotions that are often avoided.
- "Nine Perfect Strangers" is fun television, but it misleads the public about the need for "breakthroughs" in psychedelic therapy.
Spoilers ahead. And if you haven't read the first part of this 2 part series, please do.
Putting aside the obvious violations of current psychedelic therapy protocols, the most troubling aspect of “Nine Perfect Strangers,” is a more insidious and veiled message and possibly the most dangerous one: that psychological change only comes from dramatic and painful moments of emotional catharsis, especially if the source of one’s emotional distress is a traumatic event (as it is for many of the characters in the show).
Catharsis (from the Greek “pure cleanse” — cathartics in medicine, are those drugs that stimulate defecation) was first described by Plato and Aristotle as one of the values of drama, in that it allows us in the audience to share in the powerful emotions of the actor, usually that of anguish, rage, or grief. Freud later described the value of catharsis in psychoanalysis, following abreaction (the elicitation of an emotion felt earlier in life) by the patient. Freud’s hydraulic model posited that repressed emotions from early life created a kind of pressure that could be released by the cathartic process of bringing these repressed emotions into conscious awareness within the context of analysis, often brought forth by the transference that the patient has towards the analyst. This explanatory model of psychoanalytic healing was described by Jerome Frank as a “psychotherapeutic myth.” (In CBT, the therapeutic myth is that our automatic thoughts lead to negative emotions. In psychedelic therapy, the therapeutic myth is that we possess an “inner healing intelligence that can be accessed using psychedelics supported by therapy). Later, Arthur Janov took this need for catharsis to its extreme, with primal scream therapy.
Like all myths, the belief in catharsis has taken on a subtle but persistent explanatory role within the larger culture. In the culture of psychotherapy, the idea that examining and intensely reexperiencing the emotions one had at an earlier time in life will inherently free the patient from the neurotic residua that these experiences have left, is rarely questioned. However, the value of unregulated catharsis has been subjected to intense criticism, especially from feminist theorists (who critique the power differences between therapist and patient) and more contemporary trauma theorists such as Judith Herman and Peter Levine who posit that such catharsis, in the absence of adequate resources to manage and metabolize the intense emotions that can arise, can be retraumatizing. Contemporary trauma therapies Eye Movement Desensitization and Reprocessing (EMDR) and Internal Family Systems (IFS) speak to the necessity of providing adequate resources for managing strong emotions to clients before beginning to work on traumatic memories and for this work to be carefully titrated to avoid retraumatizing patients. Masha does none of this, and merely throws her guests, metaphorically, in the deep end of the pool before they know how to swim.
This fantasy that the most impactful moment of psychotherapy is the catharsis is one that is beloved by Hollywood as it provides the same vicarious thrill to the viewer that Plato described centuries ago. However, it overprivileges sudden change and ignores what more commonly happens in therapy: the glacial, but stable change that comes with increasing willingness to tolerate emotions leads us to new experiences in daily life and relationships. These experiences can coalesce into something we consider to be insight. Unfortunately, because media portrayals of therapy indelibly marked the centrality of sudden dramatic catharsis into our consciousness, therapists can unwittingly steer their clients towards these large, uncontrolled emotional experiences, and clients, who have significantly less power than their therapist, may unconsciously seek to please the therapist by delivering them. In psychedelic therapy, this phenomenon can be significantly amplified.
Left unchecked, this closed explanatory ecosystem, fed by cathartic experiences, can hatch bizarre and improbable scenarios such as the recovered memory movement and “satanic panic” of the late 1980s and early 1990s, in which adult emotional distress was traced back to earlier life and reconstructed into baroque experiences of forgotten child abuse. The therapists who aided in creating these unlikely narratives were well-intentioned, but ultimately did harm by steering patients to what seemed at the time to be a necessary, but ultimately inaccurate, catharsis.
As we witnessed in Nine Perfect Strangers, I fear that psychedelic therapy may fall prey to this same need for therapists to drive patients towards intense emotional experiences while under the drug. Intense emotions are certainly part of the internal landscape occasioned by psychedelics, they rarely need encouragement to emerge. If anything, they benefit from gentle containment and guidance from the therapists. Acceptance and commitment therapy teaches that some of our malaise comes from the avoidance of strong feelings and that the amplification of these feelings under a psychedelic can collapse this avoidant strategy. It is in these experiences that patients need to lean heavily on a therapist to help them titrate the experience, and not to have the therapist recklessly encourage the patient to go unwillingly deeper into the experience as we see Masha doing with her guests. By doing this, patients can learn to tolerate previously unbearable emotions.
If psychedelic assisted therapy follows the guiding principle that the patient possesses an inner healing intelligence (emphasis mine) then the authoritarian actions of Masha, who presumes to know exactly what each guest needs to heal, implies that a guru or guide knows the patient better than they know themselves, are a key example of how this modality of treatment could quickly turn abusive.
Television is, above all, supposed to be entertaining. Nine Perfect Strangers succeeds at this. But the show should not be seen as an example of how psychedelic therapy should be safely delivered, nor should the public or therapists emulate its dangerous and reckless methods as substitute for the real, albeit sometimes dull but important, work of healing.
The author would like to acknowledge and appreciate Jen Leland, MFT, Bayla Travis, PsyD, and Jeff Guss, MD for their incisive comments on this manuscript.
