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Trippy Talk: Health Care & Psychedelic Ethnography with Caroline Dorsen

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Caroline Dorsen never wanted to be a nurse. 

“In college,” Dorsen nods admittedly, “the first person I met who was going to nursing school I made fun of. My picture of a nurse was the cap, the cape, the handmaiden. I would have never considered it.” Though Dorsen had never imagined that she would ever be a nurse, she was destined to view any occupation she chose through the lens of social justice.

“‘An infringement of anyone’s rights is an infringement of everyone’s rights,’ Dorsen says. “This was said constantly in my family.”

Her father, Norman Dorsen, was one of the most influential civil liberties lawyers in the country. As the president of the American Civil Liberties Union (ACLU), he was involved in some of the biggest civil liberties cases of the second half of the 20th century. “He was president during a very formative time, the mid-seventies through the eighties, during the whole Skokie, Illinois Nazi march period,” Dorsen says. She grew up in a household that revolved around civil rights. 

“Fighting to maintain and advance civil liberties, in this country and globally, was the main theme of my childhood.”

Falling in Love with Caring for People

The same college student that laughed at the nursing student soon stumbled into the profession. One day, she happened to volunteer at the Berkeley Free Clinic, and thirty years later Dorsen is an established nurse scholar, educator, and practitioner. Most recently, she was awarded the NYU Martin Luther King Jr. Faculty Award, which recognizes outstanding faculty who exemplify the spirit of Dr. Martin Luther King, Jr. through teaching excellence, leadership, social justice activism, and community building. 

 “I fell in love with caring for other people,” Dorsen says, first and foremost. That love turned into a life purpose, which then became a career. 

Dorsen’s research focuses on health promotion, disease prevention, and reduction of disparities among underserved populations, including new immigrants, the homeless, drug users, and sexual and gender minorities (LGBTQ+).  She has been a primary care provider at numerous community health centers and of GYN care to homeless adolescents and adults. As if she weren’t busy enough, Dorsen has also worked extensively on drug use, which brought ayahuasca to her attention about ten years ago and led her to conduct a study on psychedelic therapy.

We sat down with Dorsen to talk about her career that spans from AIDS to the current mental health crisis, psychedelics, and what it means to be a caregiver. 

Meet Caroline at Meet Delic

Caroline Dorsen is one of the amazing speakers that will hit the stage for Meet Delicthe first-ever psychedelic wellness summit of its kind. We’re bringing the leading minds in psychedelic science and wellness to the Wisdom LA immersive art park. Don’t miss it!

RS + Caroline Dorsen Interview

Caroline Dorsen: When I went to Berkeley, I became interested in thinking about healthcare as a tool of empowerment for marginalized groups. In particular, I was interested in women’s health, and women’s rights.

RS: Why that area in particular?

CD: Well, it was an accident. Some of my friends were going to volunteer at a place called The Berkeley Free Clinic, which was in the basement of an old building. During the riots in the ’60s, it was where they would drag people wounded in the riots and demonstrations in Berkeley. People would be fixed up there by community healthcare workers. They have an incredible program to train community medical workers, still.

So, my friends were all going to volunteer and I didn’t want to be left out. They all quit after six weeks. I stayed for three years, and I loved it. I spent my entire time at Berkeley volunteering there once a week, doing mostly STD testing, and HIV testing. Those were the early days of the HIV epidemic in California.

I saw that in moments of vulnerability around health, there was an opportunity to be present with people in a way that far transcended people’s physical health. That you could have a real impact on people’s lives simply by being kind, non-judgemental, and present. People’s most difficult, or vulnerable experiences in life, could become something positive.

When I worked for Planned Parenthood as a medical assistant and health educator, women were making decisions to terminate pregnancies, for example. I saw it as a traumatic moment in people’s lives that could be turned into an incredible moment of empowerment. Simply by helping people see that they were making the best decisions that they could in a complicated moment in their lives. That alone is a beautiful thing that should be celebrated, rather than judged. That’s how I got into healthcare. 

While I was at Planned Parenthood, I ended up leaving the women’s health side and running their HIV testing program for a number of years. This, again, was in the early ’90s in San Francisco.

RS: What was that like?

CD: It was a time when the epidemic was really out of control in the Bay Area. Here I was 20 or 22 years old, and people my age were being told they were HIV positive. At the time, there was no treatment. The only thing we could do is offer people support. When we would tell people they were HIV positive, for example, we would have a car waiting for them downstairs to take them to a mental health crisis center.

We had a rule. When you gave someone a positive result, you didn’t speak. You would sit there, in silence, until they spoke. If you sat there for two minutes, that was fine. An hour, also fine. But it was your job to be there, to meet them where they were, and give them information and the support that they asked for. Not to give people all this information that they couldn’t absorb, or maybe didn’t want to, at that moment.

RS: When you entered the healthcare world, what were some of the things that you wanted to change about the relationship between a healthcare provider and a patient? You talk a lot about that. 

CD: One of the failings of our healthcare system is that there’s a power differential between providers and patients. This is not to bash physicians in any way, but they are in a different position than the patient. They wear white coats and have a title. They are doctors. Then, there’s the patient, who is vulnerable, doesn’t have the knowledge and any of the power. That’s not an effective way of caring for other human beings. Our shared humanity is the thing that can be most effective in caring for each other. Rather than being the person who knows everything, has the answers, and all the power.

If we–provider and patient–enter into a partnership around your health, it’s much more effective. Figuring out who you are, what your values are. Understanding the limitations of your environment. The ways that you can or cannot take care of yourself. Thinking about culture, family, community. These are all essential parts of who we are as human beings.

RS: What is the approach to having culturally sensitive care?

CD: You have to know the person that’s sitting in front of you, and you have to be able to take the time to get to know them in a way that they can tell you who they are and tell you the truth when you start talking about specific issues that they may have, or specific treatment recommendations that you may have.

RS: So you’re calling for a more individual approach to health care. Do you actually see health care going this way?

CD: In the ’80s and ’90s, there was this huge push towards what we call evidence-based practice. People started demanding that we take the best medical research we have and come up with standardized treatments for things. Because if we do the same thing for everyone if we know what the evidence is and do the best we can, then we’re not treating people based on, perhaps unconscious, biases that we have.

There isn’t a one-size-fits-all solution for caring for human beings. I propose a healthcare system that puts patients at the center of the healthcare system, rather than profits. A system that considers the best evidence from the scientific perspective, and who the person is in the context of their life. We make decisions with them, rather than for them.

RS: Why did you choose this as your profession?

CD: I fell in love with caring for other people. It’s always been my philosophy that people letting you in, in their most vulnerable moments, is an honor and a privilege. I get so much out of caring for other people.

RS: I had this experience recently. One morning, I left my house and crossed paths with a homeless man, trying to get my attention. I started to say what I always say, “I don’t have any cash on me.” But his simple question and sincere tone stopped me. I heard him say something about being a veteran. “Can you help me get something to eat?” I realized at that moment that part of my script, “I don’t have cash on me,” comes from a larger script, which is to say “this is a systemic thing,” what’s some money going to do? 

So I stopped. I didn’t have any cash though. He pointed to a diner up the way. I said: “let’s get you something to eat.” I ended up having a cup of coffee with this guy, and we had such a genuine conversation that moved both of us. I don’t know what that did to change his life beyond that moment, but that hour of being present with one another…

CD: Changed you. It’s not that you spent an hour feeding some guy, and having a nice conversation. I believe in the ripple effect of our lives. It changes you, it changes him, and it continues out from there. And you don’t know. You have to give not knowing what the end result is ever going to be. You can’t only do things because you want to feel like you’ve changed the world and want to see the results. It’s about believing that you’re the recipient of other people’s goodwill, that you’ve never met, that you’ll never know anything about.

RS: In health care, the communication happening between the provider and the patient is also an empathetic exchange. 

CD: For example, there are studies that say, if a physician asks a patient, “Do you smoke?” Just asking someone if they smoke has a measurable impact on whether or not they’ll continue smoking or whether or not they’ll start smoking, or whether or not they’ll quit.

RS: That’s funny.

CD: So what happens at that moment? It’s just about being seen and being heard. It’s just someone caring enough to ask you a question. That has an impact on you.

RS: You did a study on psychedelics, how did they first get on your radar as a nurse?

CD: Most of the research I do is on LGBTQ health, specifically around trans health and the impact of stigma and marginalization on health outcomes. I’m looking at both the negative outcomes, but also the potential positive outcomes of acceptance and affirmation. But I’ve done a lot of work around drug use in my career.

When I started hearing about ayahuasca about 10 years ago. People were talking about it in this way that was so diametrically opposed to how I heard people talk about other drugs. Yet we were still, as a medical community, lumping psychedelics with drugs of abuse. That’s when I decided that I wanted to do a study on the underground use of a few psychedelics, like ayahuasca and psilocybin. I wanted to know, from the ground up, why people were taking them, and how they were changing people’s lives or not.

RS: What did you do? And then, what did you find?

CD: I did what’s called a modified ethnography. Ethnography is the method used in anthropology where you immerse yourself in a culture, or a community, or an experience, to try and understand it from a multi-dimensional perspective.

I found that people who are using psychedelics for the treatment of mental health problems, and addiction, and trauma, is a tight-knit group of people. There’s a clear differentiation in most people’s minds between the substances that are being used for ceremonial and health purposes versus recreational drug use. Even if there was some overlapping. In ceremonies, people aren’t just doing it for the experience. They’re doing it because they want the experience to help them live happier, healthier lives.

My perspective on all this as a medical provider and as a health researcher is that there is incredible potential here. It looks like these substances may be an incredible tool for people who are suffering, and for whom there are no other treatment options or very few other treatment options. But we need to learn more. I’m a believer that we need to reschedule the psychedelics in order to facilitate good scientific research.

Big take-home message.

RS: What is it that the study illuminated, for the medical community, or your community?

CD: The medical community is pretty divided on this. There’s a lot of misconceptions around psychedelics. People still don’t see the use of psychedelics as a potentially viable treatment for common mental health problems and addiction. I don’t want the stigma to trump evidence. I want people to open their minds to the fact that these might be wonderful tools and treatments for people.

RS: Maybe this is my layman brain talking, but if you think about some of the prescription medications available, their adverse side effects, and the impact that some of them have on the body…

CD: It’s sort of ridiculous, right? I mean, people die from Tylenol.

RS: Really?

CD: A study about Tylenol that came out a few weeks ago found it may actually decrease people’s empathy. Yet Tylenol is over the counter. People don’t realize that it can cause liver problems, and even liver failure and death. I mean, this is a vital organ, you have to have a liver to live. Then we have other drugs that we say are drugs of abuse that have no therapeutic value.

RS: This is a big question. What is your perspective on why psychedelics are on the rise right now?

CD: My hypothesis is that we are in the middle of a mental health crisis. We’re in the middle of an addiction crisis, and that the common root of those problems is really a crisis of connection. Somehow our modern world has prevented us from having a real human connection with each other. When you feel alone and isolated, you are more apt to feel depressed, anxious, or turn to substances of abuse. 

I think one of the ways that psychedelics may work is helping us feel more connected to each other, to ourselves, and to the planet. When you feel part of a bigger plan, world, and universe, you feel less alone. And, you are more likely to have meaning in your life. 

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