For over four years, a group of more than fifty volunteers from assorted walks of life, including doctors, therapists, scholars, psychonauts, artists, photographers, and many more—all united by a common love and interest—have been working on The Manual of Psychedelic Support: A Practical Guide to Establishing and Facilitating Care Services at Music Festivals and Other Events. The Manual is now complete and available for free download at psychsitter.com. In this article the editors of the project discuss what “psychedelic care” means and how this project unfolded.
“He was in despair and crying, whilst at the same time he was very disruptive and threatening… By now we were eight people working to detain him—four security personnel and four care givers—and still the man was putting up a fight. I ran to bring the stretcher, adding four pillows and two mattresses to make it softer… He was screaming and he kept saying, “I will beat you up! I know you now! I will find you and kill you!”, as well as things like, “Who am I?”, “Is this really happening?”, “Am I really?”, but quickly changing back to his violent threats…
I saw him later at a crossroads at the festival and he truly was thankful. He even fell on his knees when I told him we had a plastic bag with his mobile phone and dirty clothes. It was wonderful to see him so different and happy! I wish I could see him again and chat more…I felt so warm to receive thanks and to know that I protected him from the darker self we all hide inside. It is always amazing to see a human being like a wild dangerous beast one day, and the next day like a saint, the hope of humanity!”
This passage is an excerpt from a chapter in the Manual containing first-hand accounts written by psychedelic care-givers about their experiences helping guests. The account conjures up a frightening image of “that” man or woman on the edge of the dance floor who has “lost it.” Such individuals might be walking around naked, bleeding from falling down or crawling through bushes, and/or behaving violently. Perhaps they haven’t slept in three days, during which time they took half the drugs you can name before somebody gave them a line of ketamine, further splintering their fragile grip on reality. This is just one (extreme) example of a festival attendee requiring compassionate care.
At the other end of the spectrum is the individual who has taken LSD (or MDMA, or some other psychedelic, or even “just” a hash cake) for the first time, and is going through a difficult experience. The festival is loud and chaotic, a kaleidoscope of sights and sounds. The individual’s inner world is merging with their outer, everything is flowing, and there’s no conceptual anchor to hold onto. Separated from friends, cold and thirsty, this person is in desperate need of a quiet space and a holding hand. A third situation, perhaps the most difficult type of case, is one in which mental health issues—either with or without the use of psychoactive drugs—manifest in the midst of a music festival or similar event.
Photo credit: Zevic Mishor.
Where do these people go? Or where are they taken by their friends, security, or medical personnel for help? “Psychedelic care,” as the editors and authors of the Manual call it, has been around in its modern version since the 1960s. The first chapter of the Manual, entitled “A History of Psychedelic Care Services,” provides a survey of such efforts, beginning with the Hog Farmers at Woodstock and the Grateful Dead’s parking lot medics, and continuing with the Green Dot Rangers at Burning Man’s Sanctuary space, Kosmicare at Boom Festival, the MAPS Zendo Project, and others.
In the absence of a psychedelic care service, individuals requiring help are usually left to fend for themselves, or—in more extreme cases—they end up at the medical service. Medical services are a vital part of any event, and a few people experiencing a drug-induced crisis are also in need of urgent medical care. However, in most cases of difficult psychedelic experiences, the standard medical approach can be problematic. Medical staff may have little understanding of the nature of psychoactive (including psychedelic) experiences that have taken a difficult turn, and as a result the individual in crisis is “medicalized”—in other words, turned into a patient. A tranquilizer is often administered, and such patients often wake up deeply scarred on mental and emotional levels due to having their horrific experiences cut short without an opportunity to process them.
In contrast, the ethos of compassionate psychedelic care entails (in cases without medical complications) allowing difficult drug experiences to run their course while providing comforting support along the way. Often but not always, this resolution turns out to be valuable for the person who experienced it, due to what may be called a psycho-spiritual breakthrough or catharsis. In this case, an important distinction must be made between guiding and sitting. In some therapeutic settings, therapists serve as active guides for the client, helping choreograph the client’s psychedelic journey with particular objectives in mind. In a compassionate care setting, however, the caregiver acts as a sitter, basically providing “psychedelic first aid.” This involves allowing the experience to unfold while supporting the guest physically, emotionally, and intellectually as much as possible.
The idea for The Manual of Psychedelic Support grew out of its creators’ experiences at Kosmicare, the psychedelic care service provided by the iconic Boom Festival in Portugal. Although psychedelic care services have been in operation for decades, and have been growing in number and in scope in recent years, a general guide on how to establish and run them did not exist in the public domain (though training Manuals for specific approaches to psychedelic care are available, such as MAPS’ Zendo Project Psychedelic Harm Training Manual: zendoproject.org/manual). We envisaged a book that would address all aspects of such a project, containing material for care service leaders, team leads, caregivers, and others who provide vital supporting roles including psychiatrists and nurses. The Manual of Psychedelic Support provides information that spans an entire project, including preparation, training, logistics, operations, and wrap-up.
From the beginning of the work, one of our core principles was that the Manual should be independent of any external organization, with its content open for adaptation and implementation, and never be used for commercial purposes. Towards this end, the work has been publi
shed under a Creative Commons License, and it is now freely available as a PDF download.
Following the 2010 Boom Festival, a small group of activists began working on the book, including a number of people from the United States’ West Coast Burning Man community. The project quickly grew to involve numerous volunteers worldwide, about 40 of whom authored text for the Manual. Forewords for the work—emphasizing support for psychedelic care services and for the Manual as a tool to help people establish and facilitate such services—were written by web mavens Fire and Earth Erowid; Boom Festival founder Diogo Ruivo; clinical psychedelic researcher Alicia Danforth, Ph.D.; Sam Cutler, the former tour manager for the Rolling Stones and the Grateful Dead; as well as MAPS’ own Rick Doblin, Ph.D.
The scope of material covered in the Manual is comprehensive. Two chapters have already been mentioned in this article: one giving case studies of real-life care experiences, and another covering the history of psychedelic care services. Additional chapters include: “The Principles and Ethics of Psychedelic Support,” “Legal Considerations,” “Recruiting a Team,” “Building and Training a Team,” “Logistics,” “Complementary Therapies,” “Team Welfare,” “Risk Management and Performance Improvement,” and several more. One appendix provides a reference to numerous “street names” (in six languages) for commonly encountered psychoactive drugs, while a second discusses “Monitoring, Evaluating, and Researching—Recommendations from an Academic Perspective for an Evidence-Based Approach to Psychoactive Crisis Intervention.”
Work on the Manual has emphasized for us, as editors and authors, a fundamental issue regarding psychoactive drugs in contemporary societies. This issue, at its core, involves the conflict between prohibition and harm reduction in different states and countries around the world. The act of setting up a psychedelic care service, as well as the form that it can take, is highly dependent upon the laws of the particular jurisdiction in which it is located, the norms and expectations of that society, and the culture of the specific event that the project serves.
Accordingly, the Manual seeks to cover a wide spectrum of viewpoints and possible circumstances. On one hand, there are countries or states in which festival organizers cannot formally acknowledge that drugs are likely to be consumed at their events; as a result, care services therein may be wary of openly discussing the subject during training or operations. (The irony and absurdity of such situations is painful.) On the other hand, there are some jurisdictions, such as Portugal, in which harm reduction has become the norm. At Boom Festival in recent years, for example, a partnership has been established between the Festival organizers, the Faculty of Education and Psychology at the Catholic University of Porto (Portugal), and the Portuguese General-Directorate for Intervention on Addictive Behaviors and Dependencies (SICAD), with the purpose of developing an evidence-based crisis intervention model for psychoactive substances in recreational settings. At Boom, drug testing (enabling festival-goers to voluntarily have their compounds analyzed for purity) and warning signs like those shown in the photograph above (unthinkable in some jurisdictions) have become the norm.
It is our hope that The Manual of Psychedelic Support will aid not only in the establishment of care services that bring light to people in truly dark places, but that it will also serve as an educational tool in a battle that is being fought—on several different fronts—to encourage societies to abandon the absurd and damaging fantasy of prohibition, and to pursue in its place a saner approach of harm reduction, firmly grounded in existing reality in order to produce a more beneficial future.
Zevic Mishor grew up in both Australia and Israel, and has an academic background in neuroscience and anthropology. He was a care giver at the “Kosmicare” service for people having difficult drug experiences at Boom Festival 2010 in Portugal, and subsequently a team leader in 2012. Zevic teaches an undergraduate neuroscience seminar at the University of Sydney called “The Science of Psychoactives,” and is currently completing his Ph.D. in anthropology, based on fieldwork with an Orthodox Jewish group in Israel, and studying their relationship with God and the lifeworld that emerges out of it.