- Hulu’s new drama “Nine Perfect Strangers” could help raise awareness around psilocybin treatments for mental health issues but does not always portray the drug accurately.
- When watching the show, keep in mind that psilocybin-assisted treatments always require consent and precise dosing.
- Psychedelics research has historically faced setbacks due to misinformed public opinion.
The psychedelic series arrives at a time when interest is growing in the therapeutic effects of “magic mushrooms.” Over the past few decades, research has increasingly shown that the drug can assist treatments for depression, anxiety, and addiction.
But others fear that the show’s not-always-realistic depictions could “derail” progress made in research. Ever since various psychedelics were criminalized in the late 1960s and 1970s as part of the War on Drugs, which curtailed funding for research, many remain wary of the public’s sway over drug opinion and policy.
“The media can cause both harms and benefits,” Matthew W. Johnson, PhD, a psychiatry professor at Johns Hopkins University and a top researcher globally on the human effects of psychedelics, tells Get Meds Info via email. “To the degree that depictions reflect the medical evidence, this can serve a role in alerting people to an important emerging field of medicine.”
At the same time, he adds, “distortions,” such as understatement of risks and inaccurate portrayal, can do harm.
“Nine Perfect Strangers” sports a large viewership, and its portrayal of the drug could play out in real-life consequences. Psychiatrist Ben Sessa, MBBS, BSc, MRCPsych writes that psychedelics in medicine are “intimately tied-in with societal, technological, and cultural changes and continues to evolve.” So what did the show get right (and wrong)?
Psychedelic Therapies Always Require Consent
In the series, nine guests attend a wellness retreat, where retreat leader Masha Dmitrichenko (Nicole Kidman) is secretly, and regularly, dosing their smoothies with psilocybin. She is convinced that those who most need the psychedelic’s therapeutic effect are least likely to try it, so she begins “microdosing” them without their consent.
Masha’s retreat guests are in search of some sort of therapy. They’re grappling with a lot. Among them is a family torn apart by grief over their son, who died by suicide; a former professional football player who’s addicted to opioids; and a married couple who’s experiencing relationship issues.
But no matter how much a practitioner might think a client “needs” psychedelics, Johnson says, informed consent is “absolutely critical” in medicine and research.
“Psychedelics are no exception,” Johnson emphasizes. “In fact, even more broadly (outside of medical research), giving somebody a psychedelic, or any drug for that matter, without their consent is highly unethical. It is simply horrific to do this to somebody.”
Journalist and author Chris Taylor concedes that Masha’s “dumb decision” to drug her guests may just be a plot device. However, in real life, he adds, dosing people without them knowing could lead them to eerily feeling “off,” or not like themselves.
This can then produce negative thoughts that then lead to a “bad trip”—consequences of which can bring about medical emergencies and/or long-term negative outcomes.
What Is a Bad Trip?
The term “trip” refers to the period of intoxication after taking a hallucinogenic drug. It likely stems from an idea of what it feels like to be on the drug: that you have taken a trip to a strange, new land since the drug can alter perceptions of time and space. Bad trips can result from unpleasant perceptual alteration, and hallucinations can be anxiety-provoking or downright scary. To lower the chances of having a bad trip, experts recommend taking the drug in a safe and predictable environment with at least one other person who can care for you if you get upset.
Microdosing Does Not Just Mean Smaller Doses
“Microdosing” has become a trend in recent years. The practice typically involves consuming fractions of a standard dose over an extended period of time. Some say it helps boost their workflow, and that they prefer psychedelics to coffee.
This may be because psychedelics help inspire the daily grind. Emerging research shows that when microdosing on psychedelics like LSD and psilocybin, people feel that their work performance is enhanced—namely through improved “cognitive persistence,” flexibility, and creativity. However, more research is needed to compare performance between those who microdose and those who don’t.
But the practice in “Nine Perfect Strangers” doesn’t reflect the standard amounts.
When microdosing on psychedelics such as psilocybin, people generally aim to achieve “subtle but noticeable (acute) effects, [that do not] impair or interfere with daily activities.” For this, it’s recommended to follow the “Fadiman protocol,” which calls for one-tenth of a recreational dose every four days for a few weeks, followed by a “reset period.”
“Nine Perfect Strangers” veers far from this. Instead of feeding her guests a fraction of a dose every four days, Masha does so three times a day—more than 10 times the recommended amount.
“No wonder the guests started to feel loopy,” Taylor writes for Mashable. “No wonder Tony the football player had his PTSD flashbacks. No wonder Melissa McCarthy fell asleep in her oatmeal and dreamed of whacking her ex. They were all pretty whacked out.”
In addition, Johnson adds, most of the research on psilocybin focuses exclusively on full recreational doses. In fact, medical doses are even higher than what some users might consider recreational.
And of the few credible, double-blinded studies out there on microdosing, he says, they show a slight drug effect but no cognitive enhancement.
“In other words, folks feel just a little bit high,” Johnson says. But Masha’s style of microdosing has neither been studied nor recommended—especially not without consent.
What This Means For You
Psilocybin treatment in a clinical setting looks nothing like what happens on “Nine Perfect Strangers.” Instead, a patient is usually set up on a bed in a room during a four-to-six hour-long session, and attended to by one or two therapists trained in giving the treatment. Psilocybin wellness retreats, on the other hand, might look more like the show (with consent), and typically require waivers and paperwork (concerning your medical history). If you’re interested in a psychedelic retreat, experts recommend seriously considering the facilitators’ clinical and medical training. Retreat costs are typically high—in the thousands—and many have stirred safety concerns.
Psilocybin May Help with Grief, Addiction, and More
“Nine Perfect Strangers” doesn’t accurately represent consent and dosing protocols. Still, its characters could portray what it might feel like to be on a psilocybin trip.
Although research on the psychedelic drug “fell out of favor” in the 1960s and 1970s, due to its growing association with the counterculture in the U.S., research has been picking up recently and supporting initial findings. To name a few, studies show that psilocybin may relieve symptoms of depression and anxiety, as well as help people reduce problematic use of substances such as tobacco and alcohol.
Psilocybin’s ability to treat these types of issues is portrayed in the show. For example, Tony, the ex-football player who’s addicted to opioids, is encouraged to face tough moments in his life by microdosing. The OxyContin pills, a type of opioid usually prescribed to relieve pain and that is highly addictive, weren’t just for his knee, he says.
“They’ve been numbing [a lot] for a lot of years, and now here I am facing it all, and I’m doing it off the drugs,” he states on the show.
Of course, he wasn’t technically “off” drugs. He just didn’t know he was tripping on another one.
Still, his onscreen experiences could reflect reality. Studies show that psilocybin may work by reviving “emotional responsiveness” on a neural and psychological level, helping us relive locked-away experiences in a new way.
Johnson adds that psilocybin therapy—which usually delivers recreational doses instead of “microdoses”—may help with grief.
“For example, research suggests high dose psilocybin may be helpful in long term AIDS survivors,” he says. “Part of that syndrome is dealing with the grief of friends who were lost to AIDS.”
If psilocybin has helped survivors of the HIV/AIDS pandemic cope with traumatic loss, “Nine Perfect Strangers'” portrayal of the family grieving their son who died by suicide may have some truth to it. In the last episode, the family meets him while hallucinating. Through this journey, they’re able to find closure and forgive themselves.
Although recent research has clarified psilocybin’s effects on the brain, there’s still a lot more to discover. Johnson is able to conduct and collaborate in research, given that changing governmental, social, and academic landscapes are now more amenable to psychedelics research. In May, he was awarded the title of Susan Hill Ward Professor in Psychedelics and Consciousness at Johns Hopkins.
“To my knowledge, this is the 1st endowed professorship on the planet with psychedelics in the title,” he wrote in a tweet. A few months later, his psychedelics research received funding.
“Nine Perfect Strangers” could be playing a part in representing this new era of treatment—even though it doesn’t have all the facts straight.