Intentions
‘What we have no words for, we cannot understand. It does not fit into our view of what is real. And if we stumble upon it . . . we may be taken by surprise and frightened. On the unknown places of their maps, the ancient cartographers wrote, “here there be dragons”’.
Jack Kornfield, Buddhist teacher
This morning we sat in a circle, took a deep breath, and set our intentions. Some intended to heal, others to surrender. There were tears and respectful silences and nods of understanding.
Now we take the magic mushrooms and everything goes dark. For the next two hours I watch my identity slide like guts. There is nothing with any recognisable form, only an endless churn of organic textures I cannot identify. Nothing, including me, has ever existed, only a single emotion: primal fear. Later, I push through into a vast space of light where love has a physical materiality that I can touch and of which every cell in my body is made. Orchestral music builds as my heart is broken wide open and I weep tears of love for the people around me. One of them has regressed to infancy and rocks back and forth. Another holds their head. Another sways softly, whispering to themselves. Another sheds ecstatic tears.
I take in the scene and have a thought: ‘What a bunch of assholes.’
I burst out laughing and turn away.
Someone is groaning like a child. Someone else sighs in bliss, unselfconsciously loud.
‘When are these assholes going to shut up?’ I say, pressing my face into the pillow, unearthing all of the laughter that’s been fossilising at the back of silent classrooms and solemn churches and po-faced yoga studios, where I buried it in layers over years, along with many other miscellaneous inappropriate thoughts and feelings.
I cover my mouth and laugh through my fingers as someone to my left battles an inner demon. His wailing is genuinely irritating, insufferably irritating, and I find myself wishing that he would re-repress some of that generational pain so that I can get a moment’s peace. Trying to stop the laughter only makes it worse.
What this means to me (the hypocrisy and sheer unreasonableness of slinging fatuous insults at friends during their most unguarded and transcendent moments) is unfolding with a wicked rush of revelatory energy. I see into the mechanics of the laughter and understand what I’m supposed to understand: that I can only find this funny because the love between me and these people is unquestioned, and that it is at this biting point of mutually informing reverence and irreverence that I know I must try to write this book.
It’s something I had been puzzling over (psychedelics have a mysterious ability to catalyse the solving of puzzles): how do I criticise our mental health system with the scathingness that feels necessary, while also respecting the people working within it? How do I challenge psychiatry’s framing of serious distress as disease, while honouring what that framing means to people? How do I appraise the ways in which my own ignorance has perpetuated unhelpful stories about mental health, while also showing myself compassion? How do I construct as much as I deconstruct? Offer hope as much as I call bullshit? I can only do this if there’s a mutual understanding between us from the outset that my critique comes from a place of love, and that it is my intention to write from that place.
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We are all searching for a story, an orienting narrative that shows us our place in the world. We use the tools of storytelling to make sense of ourselves. We keep a lookout for throughlines and patterns, recurring themes and the opening and closing of chapters. Perhaps you have a sense of the person you were, the person you are, and the person you’d like to be, as well as the consistent ‘you’, the central character, who has made mistakes, learned lessons and evolved along the way.
Within our stories, we use metaphor to give ourselves a landscape through which to unfold: plateaus, peaks, forks in the road, deserts, new horizons and rocky patches. Some people are able to navigate their inner landscape with a sense of exploration. Some of us are easily lost; our world has a strange incoherency, familiar and unfamiliar at once, homely in its unhomeliness. The maps we carry seem to sabotage us with wrong turns, and the ways out seem impossibly steep. When we’re stuck like this, disruption can be helpful.
Altered states of consciousness have been used by humans for tens of thousands of years to disrupt our habitual ways of seeing things. They can happen spontaneously and unbidden, or they can be induced and cultivated, alone or in group settings, by activities like sleep deprivation, extreme heat and cold, meditation, lucid dreaming, sex, breathwork, chanting, drumming, dancing, fasting, contemplation, and psychedelic drugs. They are sometimes called mystical experiences, non-ordinary states of consciousness or transpersonal states of consciousness.
Psychologist Abraham Maslow studied what he called ‘peak experiences’ in depth, noting reports of bliss and euphoria, sensations of warmth and vibration, a blurred sense of time and space and expansive connectedness with others and the universe. Writer Malidoma Somé described ecstatic trances in his accounts of initiation ceremonies in Burkina Faso. For his tribespeople, these trances meant voyages into other worlds and communion with spirits. The accounts of nineteenth century Indian mystics Ramakrishna and Vivekananda, with their repeated references to unity with the eternal, limitlessness and unboundedness, inspired psychoanalyst Romain Rolland to coin the phrase ‘the oceanic feeling’ in a letter to Sigmund Freud. Using only breathwork, psychiatrist Stanislav Grof induced what he called ‘holotropic’ states (holo meaning ‘wholeness’ and tropic meaning ‘moving towards’), when his research drug of choice, LSD, was outlawed in the US in 1968.
‘Cosmic consciousness’, wrote scholar Alan Watts, ‘otherwise known as mystical experience, otherwise known as moksha, nirvana, bodhi, satori, fana-al-fana or what you will . . . happens to people. It has happened as far back as we know. It happens all over the world, and in all cultures. We don’t know very much about it . . . But it unquestionably happens, and most people keep their mouths shut about it when it does.’
In this book, I use altered states of consciousness to disrupt two stuck stories: the mental illness paradigm, and my trauma, which are so interrelated as to be one and the same story.
According to the dominant story of mental suffering, which I grew up with and promoted for years in my mental health advocacy, the main causes of persistent, intense distress are organic problems in our brains, problems that can be categorised like diseases and treated like them. Because this story offers reassurance and surface level answers, and because it serves the psychiatric industry well, it’s become pervasive, calcified, and resistant to interrogation. Trauma is also calcification. It similarly freezes a story about reality in time and is just as reluctant to loosen its grip. Altered states of consciousness can be good tools for softening the sclerosis of both.
When we take mind-altering drugs or do mind-altering activities, leaving behind our predictable patterns and entering more unpredictable and dream-like territory; when, to borrow language from anthropologist Gregory Bateson, our everyday prosaic consciousness stands down and we enter the poetic consciousness of an altered state, rigid beliefs about the world can become more flexible, and new ways of thinking about problems can arise.
We desperately need new ways of thinking about problems in the face of our mental health crisis. The UK’s Office of National Statistics reports that millions of British people are often or always lonely. According to the World Health Organization (WHO), a fifth of the world’s children have a mental health condition, and someone dies by suicide every forty seconds. It shouldn’t surprise us that the suicide rate in the UK’s most deprived areas is almost double the rate of that in the most affluent. In this book, I come to the conclusion that treating misery as a primarily medical problem is part of the reason why so many people are miserable. Whether or not you agree with that, we can probably all agree that something about the way we are approaching mental health isn’t working, and that radical change is desperately needed.
The Maps We Carry is told through essays, articles, interviews and extracts from my journals. It unfolds over six years, 2017–23, during which time I underwent two transformations moving in lockstep: an intellectual transformation, from seeing my problems as self-annihilating symptoms of disease to self-protective strategies of survival; and an emotional transformation: from feeling suicidal to feeling fulfilled.
Altered states of consciousness (reached in various ways but most powerfully through meditation, ecstasy and magic mushrooms) were catalysts, not cures, and cannot be understood in isolation from my life, where supportive loved ones, financial privilege, professional satisfaction, and a skilled psychotherapist all contributed inextricably. While I would welcome the legalisation of psychedelics, I’m concerned about these drugs being plugged into psychiatry as it stands, where brain is decontextualised from body, present from past, science from traditional knowledge, individual story from social story. This book will look at the ways disadvantaged groups suffer when context is overlooked. Spoiler alert: psychedelics don’t solve systemic social problems.
Three scenes are fictionalised versions of conversations that happened either in real life or in my imagination. I’ve written them in screenplay format to distinguish them from the rest of the book, which is factual. I’ve occasionally changed names and identifying details to protect people’s privacy.
I work as a writer in TV, film and books. My first memoir, Pure, in which I wrote about my experience of intrusive sexual and violent thoughts as a symptom of obsessive compulsive disorder, came out in 2015 and boosted my profile as a mental health advocate. Through my advocacy, I promoted a set of ideas which I thought to be true: that mental illnesses are illnesses like any other; that mental illnesses can be scientifically categorised into diagnoses; that one in four people in the world has a mental illness. When I started to have these ideas challenged, I was resistant at first. I wrote this book to try to write myself out of my disillusionment; to find a new positioning system, a new way to orientate to suffering that didn’t involve ‘illness’. Without a coherent cultural story about what my suffering meant, I used what I had closest to me – my knowledge of story – to try to structure a healing experience.
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The topic of mental health is inscrutable and impossibly complex, ‘a beguiling mystery and brutally difficult’ as a friend and mentor said to me. It’s nothing less than the question of who we are and why we suffer, and any single model of understanding is bound to be reductive. The biomedical model, which tackles distress like pathology, has so far generally failed to improve people’s lives, and though the trauma model (the idea that suffering is the result of exposure in the past to adversity) is more common sensical and backed by more evidence, it too can be reductive. As Maslow famously said, ‘If the only tool you have is a hammer, it is tempting to treat everything as if it were a nail.’ Sometimes we hunt for causal agents in the past because we can’t see the normalised dysfunction in the present. Sometimes the search for ways in which we’ve been victimised can blind us to our considerable agency. The shift away from the biomedical model to the trauma model (which is now happening culturally but hardly at the level of healthcare) is often characterised as a shifting question: from ‘what’s wrong with you?’ to ‘what happened to you?’. I broadly agree with the direction, but I’d add a couple more questions: ‘what is happening to you?’ and ‘what role are you playing in perpetuating it?’.
This book is not an endorsement of psychedelics. The drugs are illegal in most places and they’re not for everyone. Though they can be immensely powerful in helping us to become unstuck, the psychological risks are real and serious. Even when taken under optimal conditions, psychedelics can destabilise fragile minds and lead to long lasting anxiety, confusion, hallucinations, and derealisation. However, harm has also come from fearmongering around the dangers of psychedelics. When used in supportive settings, psychedelics are, in the majority of cases and even when they profoundly challenge us, safe, and statistically far less harmful than alcohol, the nation’s favourite drug.
How I see psychedelics will be different to how you see them. This is an inescapably subjective story, not a manual that you can follow. Mental health science makes the mistake of trying to get around people’s subjectivity so that it can apparently arrive at objective conclusions. I’m of the view that any ‘treatment’ must embrace and work through a person’s subjectivity, not iron it out as though it were an inconvenience or dismiss it as placebo. Though the focus of this book is on psychedelics and mental health, I don’t primarily see these drugs as medicines. I think they’re valuable as conduits to have fun, goof around, let off steam, explore the weird and the dangerous, connect with others and with nature, philosophise, grieve, find creative inspiration and mark rites of passage. Because our various shades of despair have been framed as illnesses that need treating by professionals rather than problems that need preventing through community, we’ve drawn an unhelpful and arbitrary line between therapy and recreation. While good psychotherapy, if you’re lucky enough to access it and afford it, is an excellent conduit to healing through psychedelics, some of my most therapeutic altered states have been with friends in recreational settings: dancing, being silly and talking shit about the wider world, not lying down and talking to a therapist about my inner world.
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One thing this book is not, is an attempt to analyse the science of nature or nurture in mental health. I have no scientific training, and the dichotomy seems moot, since nature and nurture are not separate. I have tried to do that research in private, attempted to figure out the extent to which I was predestined to develop mental health problems or whether I was a blank sheet of paper, or where I sat in between. You can do it too if you’re interested, but it’s easy to get tangled in the weeds. Experts don’t agree on which factors contribute most to mental health problems. For every expert who expresses an opinion, there’s another equally credentialled, articulate and respected expert who has a different take. For every study that is published in a respectable journal, there’s a direct rebuttal published in another equally respectable journal. Every debunk is stridently debunked. Psychiatrists and critical psychiatrists are endlessly hashing it out on social media, the tone of which are often smug or snippy.
To the limited extent that I’m able to judge, the body of evidence that past and present exposures to stress are the leading determinants of common mental health problems like anxiety disorders, depression, PTSD and OCD, is vast, whereas evidence that organic brain dysfunction or genetics are the leading causes of such conditions is comparatively scant. Many experts agree that with psychosis, schizophrenia and bipolar disorder, evidence for biological determinants is stronger, though others assert that these experiences are also, at heart, responses to trauma. It’s important to note that many people who experience auditory and visual hallucinations do not think of themselves as having illnesses at all. I should also make it clear that when I refer to ‘mental health problems’ in this book, I do not mean neurological conditions like Alzheimer’s, or developmental conditions like autism.
Mental health is multifactorial, and our genes play a large role in our personalities and mental capacities. But it doesn’t follow that I always had a latent potential for a brain disease called OCD. Despite the development of precise diagnostic tests in other branches of medicine, no biological tests can currently diagnose mental health problems. And while I can’t be certain, in the broadest strokes I think the idea that we get chronically distressed because of problems with our brains, more than problems in the world, is unfounded.
I believe that science will play a vital role in the future of healing. But science is not the whole story, nor in my opinion, even half the story, of mental health. Exploring what makes us desperately unhappy is just as much a question for everyday people (whose knowledge and intuitions have for decades been systemically subjugated by psychiatric authority), for philosophers, anthropologists, politicians, and artists, as it is for scientists. Maybe we shouldn’t expect science to explain mental health any more than we should expect it to explain love or grief. These are not things we can measure or capture or verify as real or not real, but they are profoundly true, and paradoxically, their mystery makes them more true, not less. Same goes, I would say, for mental health problems.
As I explored my internal life through altered states in this book, the precise language of science fell increasingly short. We don’t have an agreed upon definition of mind, or consciousness. Thought itself is inherently mysterious. There’s no way to independently test that what I might describe as anxiety is what you describe as anxiety. I’ve come to see my mental health problems as a counterintuitive expression of love: of my need for love and belonging, and of the fear of losing those things. Do we need scientific authority to tell us about love? Or do we already have that knowledge deep in our bones somewhere? ‘Do we need a story to tell us what is sacred?’ asks mythologist Joseph Campbell, ‘or do we already have the experience that matches the story?’ If we strip diagnostic language back to the raw experience of extreme distress – dark, heavy, lost, foggy, monstrous – we soon default to metaphor, our go-to mode, whether we notice it or not.
I owe a lot to mental health science. Without decades of work in psychedelics and trauma research, and the resulting zeitgeist, it’s unlikely I would have found healing. I owe even more to the wisdom of traditional societies, whose participatory ways of living (community rituals, rhythmic movement, communion with nature, psychoactive plants, storytelling), and common sense philosophies (strength in numbers, safety in numbers, resource sharing, the present as a continuation of ancestry), offer more guidance than a century of psych research, the findings of which are often corroborating and repackaging knowledge that the West has forgotten, stolen or destroyed.
I have had the dubious privilege of having spent two decades immersing myself in a wide variety of mainstream psych treatments, including most of the major psychotherapies, many ‘alternative’ therapies and antidepressants. This bird’s eye view has been helpful when interrogating a mental health system which is siloed by academic curricula, career paths, diagnostic categories, and insurance codes. Inevitably, mental health professionals tend to believe that their particular therapy, medicine or research area (the thing they’ve spent money and time training in; the thing for which they earn prestige) is what works best. Generally, they will be on board with a critique of the system until that critique is brought against their specialism. As we shall see, these incentives are part of what makes Western mental health care so abysmal and resistant to change.
In one sense, I don’t think we’re searching for answers about mental health. We know that we become unhappy when we’re isolated from each other and from nature, when there’s scarcity of resources, and when we are compelled into work that lacks meaning and maroons us further from the people we love. In another sense, when faced with any one individual’s mental health, we ought to leave any assumed understanding at the door. I have no idea what you’ve been through and what your mind is like and why. You have a far more accurate map of your self than anyone else does. ‘You’re the expert on you’, as my brilliant former psychotherapist Joyce Blake often reminded me.
This book tells the story of how, since writing Pure, I fundamentally changed what I think about mental health. But there are throughlines between that project and this one. Embracing uncertainty is one of them. It’s a skill you can learn (meditation and psychedelics help): cultivating uncertainty about what our thoughts and feelings mean, and trying, in the spirit of most good psychotherapy, not to avoid what scares us. ‘Certainty is the greatest of all illusions,’ writes psychiatrist Iain McGilchrist. ‘The only certainty, it seems to me, is that those who believe themselves to be certainly right are certainly wrong.’
I’ve been consistent on another important point which I want to emphasise: mental health problems are real and devastating. How you feel is not your fault. You didn’t choose this. You didn’t imagine it or make it up. You are deserving of all the compassion and care and non-judgement that would be afforded to a person with any other kind of illness.
Take OCD, for example. The experience of having repetitive ego-dystonic thoughts that cause extreme distress, and engaging in compulsive rituals to neutralise them, is a very real and often debilitating phenomenon. Same goes for experiences that people call anxiety or depression or bipolar disorder or personality disorder – absolutely real.
We can question the validity of mental illness as a construct without taking any of that off the table. We can assert that our experiences are real while also interrogating the conceptualisation of such experiences as diseases with primarily biological determinants, the organisation of these experiences into discrete categories, and the assumption that such experiences are ‘disordered’, as opposed to in some way functional, i.e. adaptive responses to a disordered environment. It may sound counterintuitive, but it was only when I stopped framing my distress as the symptom of disease that I reached a deeper appreciation of its seriousness.
That said, I believe the medical model should remain an option for those that find it helpful, as long as it’s signposted as a model, i.e. as a map of reality not reality itself, and therefore intrinsically limited. (A map of the coastline will be accurate in one sense, but it won’t tell you anything about the essence of a beach. How the seaweed smells, the chalky sound of pebbles underfoot.) If seeking biomedical treatment has helped you map your problems and has led to lasting contentment, keep going and do whatever works – each person’s way of making meaning of their own mind is valid.
This book is for those who’ve tried everything that the medical model has to offer, and still suffer.
A psychiatrist at South London and Maudsley, an NHS Trust that annually provides 40,000 people with mental health services (I’ve been one of those people), confided in me with a heavy heart that they’re often treating people knowing they’ll probably still be treating them in twenty years. I’ve heard this despondency echoed by dozens of other mental health professionals. Treatments that we’re told are evidence based don’t seem to work that well in the long term, not because clinicians lack skills or expertise, but because they have such a limited range of tools. I’m writing this book because I think there are better tools out there, and better stories.
I’m interested in the functions that stories serve and the way we use story structures like physical structures. We gather around them, we use them as weapons and shields, we hang ideas off them, we live in them. When a story gets so big – like the story that mental distress is a symptom of disease – it becomes like a city, full of architecture so familiar we barely look at it. I felt compelled to write this book now because I believe that psychedelics are about to transform the way mental health problems are conceptualised, offering us a unique opportunity to stop, look around, and think deeply about the stories we’ve built. Which structures could be improved? Which are keepers? Which provide necessary shelter? Which could be modified? Which should be razed to ground?
The Maps We Carry is predicated on the possibility that below the level of conscious awareness, our mind–body systems intuitively understand story structure; that there is a part of all of us that is always seeking to unfold, like a story, and that the hallmarks of storycraft are uncoincidentally the hallmarks of healing from the fragmentation of trauma. Metaphor, imagery, narrative arcs, expansion and contraction, meaning making, patterns of cause and effect. I will make the case that you, like all good stories, had the blueprint for wholeness written into you from the start. That when you are supported, trusted, empowered and loved, you know how to find your way to resolution; you know how to heal.