What are the ethical implications of the Ben Sessa case?

Power imbalances always exist in psychiatry, but drugs can worsen them

Today The Medical Practitioners Tribunal Service (MPTS) ruled that Dr Ben Sessa was ‘impaired’ for having sex with a vulnerable ex-patient who subsequently took her own life. Dr Sessa’s medical license was suspended for 12 months.

The tribunal heard that there were ethical lapses by Dr Sessa right from the start. He met Patient A for an initial referral in a pub where she was drinking. He then began treating her, and I understand he referred her for ketamine treatment in Oxford (I don’t know if she also received treatment at Awakn, Sessa’s own clinic in Bristol). He knew she was a very vulnerable woman who had attempted suicide a number of times. Nevertheless, he ended the treatment in order to have sex with her. They then stopped seeing each other, and Patient A committed suicide. Her husband reported Dr Sessa to the General Medical Council.

Dr Sessa admitted all charges in the hearing and expressed remorse, but there are some strange aspects to his testimony. He told the tribunal that ‘Patient A was very persuasive’, shifting responsibility onto her rather than taking it himself, and ‘suggested that Patient A may have found it containing and felt safe by being in a relationship with her former psychiatrist’ – yes, transference and projection happens, that’s why therapists and psychiatrists are trained not to take advantage of it.  

 ‘Dr Sessa told the Tribunal that he saw no possible chance of any repetition of his conduct and that he considered ‘this chapter a tragic blip in my otherwise excellent career.’  I’m afraid that phrase will haunt him. I hear from mutual friends that Dr Sessa is in a very bad way. Clearly, this was a shocking lapse of judgement that destroyed one life and ruined another.

What are the ethical implications of this case, if any, for the psychedelic industry and culture?

I don’t know any details about Patient A, and I understand her family want privacy, so this will instead look at Dr Sessa’s psychedelic career, and whether this case has any implications for the industry, or not.

Dr Sessa is a very prominent figure in the ‘psychedelic renaissance’. Indeed, he coined that term in his 2012 book, The Psychedelic Renaissance. The book tells the story of psychedelics’ gradual return to mainstream western science, through the work of a handful of pioneers in the early Noughties. At the start of the 21^st century, a psychedelic conference would be lucky to attract 10 scientists, and there was hardly any funding available, except from Countess Amanda Feilding, a self-trepanned aristocrat. 

Dr Sessa was one of that small band, along with figures like Rick Doblin, Roland Griffiths and David Nutt.

Early days - Sessa (bottom left) with David Nichols, Robin Carhart-Harris, David Nutt and Amanda Feilding

He writes:

In 2005, while I was still a trainee in child psychiatry, I wrote a brief report of what I had learned about this fascinating subject, which resulted in the first published paper about clinical psychedelic therapy in the British medical press since the 1960s.

Through his publications, Sessa got in touch with Professor David Nutt, then of Bristol University, and they worked together to bring back psychedelic treatments, with the financial support of Countess Amanda Feilding. Sessa volunteered for the first psilocybin trial at Bristol Uni:

when David Nutt injected me with intravenous psilocybin in the Bristol Royal Infirmary in 2009, I became the first person in the UK to be legally given a psychedelic drug for over thirty years.

When the first MAPS study of MDMA for PTSD in the US  was finished in 2010, lead-authored by Michael Mithoefer, it was published in the journal David Nutt edited, The Journal of Psychopharmacoloy, and Sessa was one of the reviewers. Dr Sessa writes:

The data was in. MDMA Therapy could be delivered safely and effectively to treat PTSD. The paper was approved and the world's first human clinical MDMA study was published - a whole 35 years after it was inappropriately banned in the first place. Rick Doblin, whose dream to see this happen dates back to 1985, deserves a Nobel Prize for his perseverance.

Doblin and Nutt both wrote forewords for Sessa’s book. This is how the circle-jerk of science has always worked – a small group of people committed to a certain theory work together to propagate that theory via their influence over various institutions (universities, journals, conferences, industry bodies, funders), until the theory is recognized as ‘fact’.

[NB the phrase ‘the circle-jerk of science’ is just a joke, I respect the scientific endeavour, please don’t be offended].

In 2011 Sessa was one of the co-founders of Breaking Convention, the biggest psychedelic conference in Europe, and a unique blend of the scientific and the hippy-spiritual. Sessa portrays himself as very much the sober scientist among the hippies. He writes:

the hippies, and their wanton advertisement of chemically-induced utopia through the use of psychedelics, have almost (albeit inadvertently) ruined the party for psychiatric research. For this reason, I feel continually inclined to distance myself from them in all aspects of my work with psychedelic drugs.

He is especially caustic about the spiritual woo-woo people come up with on psychedelics (as anyone who heard him on Radio 4 recently can attest) and blames psychedelic spirituality for the shutdown of research in the 1960s.

It was this spiritual element - and the hippies love of it - that blew the opportunity for medical psychedelic research in the past. This time round we need to be slightly more cautious…we certainly didn't get here through the efforts of the ravers or the hippies. Most of their mental twittering of the last forty years has been ignored by mainstream society. It was only through the more recent and considered change in direction of hard-nosed scientists that we are seeing this so-called renaissance…And all of us working in psychedelic research know that it is essential to downplay the more 'cosmic ' components of our work in order to get funding and publication. It is only through developing a language of conservative banality that we are where we are today.

Psychedelic researchers should be conservative and conformist:

We need to introduce these drugs gently. By working within the necessarily restricting guidelines of mainstream methodological practice, we can hope to avoid giving our influential press-writers any excuse to align the hedonistic recreational use of non-psychedelic, more destructive drugs with the sober intentions of the medical psychedelic community. Boring, I know, but essential . Like it or not, we need to appeal to the sensibilities of the herd.

It's the image he again tries to put out on Netflix’ How To Change Your Mind: ‘I’m a fairly conservative, sober, evidence-based kind of scientist.’ Really?

I think there may be more of a hippy side to Sessa than his writing suggests. He called two of his children after famous figures of the hippy counter-culture, and sometimes likes to portray himself as a former raver, DJ and rock and roller. In fact, in the same Netflix episode of How To Change Your Mind where he declared himself a conservative, sober’ scientist, he couldn’t resist sharing photos and video of him as an acid house raver and DJ.

‘There was no ego, no aggression, no patriarchy. I can remember one time after a rave, all of us lying around loved up. And someone said ‘let’s think of the worst possible things we can imagine’. And someone said ‘lets imagine our mothers dying.’ And someone said ‘it’s not that bad’.

Sober, conservative scientist by day, acid house DJ by night - a shot from How To Change Your Mind

He showed the fondness for media attention that many psychedelic scientists have:

In 2008, I was contacted by a producer for MTV who, for insurance purposes I assume, needed a medical doctor to comment on a host of unusual psychedelic drugs that she planned to give to people for a show they were developing. The show was called 'Dirty Sanchez' and entailed a group of young Welsh chaps travelling around the world quaffing various local psychoactive plants.

Then came Michael Pollan’s book and the ‘shroom boom’ in psychedelic finance, and suddenly the small band of psychedelic pioneers were Big Stars. Amanda Fielding became ‘the queen of consciousness’, Rick Doblin became an icon, Roland Griffiths became a saint. And Ben Sessa also got lots of media attention – he is one of the stars of the Netflix series How to Change Your Mind – and new business opportunities flowed his way.

He taught on several of the new psychedelic facilitator training programmes that have sprung up around the world – Vital and CIIS in the US, Atma in Canada, Mind Medicine in Australia. He also became head of psychedelic therapy at a ketamine company, Awakn Life Sciences. And he started up a psychedelic consultancy, CAPS.  

For someone who owed his fame and fortune to psychedelics, it’s unsurprising that he was quite a psychedelic cheerleader. In a TEDX talk, he announced that MDMA were psychiatry’s ‘new antibiotics’. In a presentation at Psychedelic Science last year he suggested we have gone past the point of needing any more research on psychedelics, it’s now time to roll it out at scale.

Ben Sessa’s talk notes from Psychedelic Science - I saw this shared on Twitter by Brian Normand

I don’t know if he did drugs himself anymore, but they do seem to have been a part of his identity – he even promoted them on his clothing. How’s that for ‘wanton advertisement of chemically-induced utopia’.

He seemed to over-promise regarding psychedelics’ therapeutic efficacy. There’s a scene in How To Change Your Mind when he is conducting the first ever study of MDMA for addiction, and he tells the participant ‘you’re in the good responder group’. This no doubt was meant to be encouraging but it’s priming for a positive response.

Then, suddenly, with all these opportunities coming his way, a year ago Dr Sessa abruptly ‘transferred’ his 49% stake in Awakn Bristol to the parent company and left the UK for Australia. He also deleted all his social media. I guess he knew this tribunal was coming – though apparently he didn’t tell Awakn.

So what does this case mean for the psychedelic industry?

I asked friends in British psychedelic culture if Patient A was an isolated incident, or if Sessa ever used his status or access to drugs to get sex. There was not much response. I understand that – some may have liked Ben, and worked with him for many years, including in the early years when the psychedelic research community only had about 30 people in it. That must have forged strong bonds forged through a shared mission and shared experiences. I don’t think its unethical to stand by friends when they have seriously fucked up. Nor do I think everyone necessarily has to display the correct political attitude on whatever the burning injustice of the day is on Twitter.

Some female friends in psychedelic culture described him as the ‘Sid James of psychedelia’ for his inappropriate remarks. Male friends said he seemed to have had a mid-life crisis.

There is a scale of unethical behaviour. Sleazy comments are relatively low on that scale. Having sex with or inappropriately touching patients or recent ex-patients is much higher.  I asked the CEO of Awakn if there were any complaints about Dr Sessa from his ketamine clients. I didn’t hear back. There was at least one dissatisfied customer, who posted anonymously on Twitter (thanks to Sasha Sisko for alerting me to this):

Psychiatry has always had a power trip. For centuries, priests historically used their power over others to abuse women and children. Psychiatrists, who to some extent replaced priests as the doctors of our soul, also sometimes took advantage of their power over the vulnerable to cause harm. There is a long history of experimental psychiatric treatments promoted and dispensed without care (lobotomies, induced comas, addictive drugs), and of psychiatrists working with governments to develop techniques of control (Sessa barely mentions MK Ultra, one of the darkest chapters in the history of psychiatry, in his potted history of psychedelics).

Psychiatrists have a notorious inferiority complex compared to other scientists, which is why they tend to seize on miracle new drugs and get very defensive if anyone suggests these drugs have nasty side effects. Their professional status is tied to the effectiveness of the magic pills they dispense.

At the more banal level, there is a long history of psychiatrists (almost always men) taking advantage of their power to have sex with vulnerable patients. Before the 1980s, this was widespread, including in psychedelic psychiatry. Sidney Cohen had an affair with one of his psychedelic therapy clients, UN ambassador Clare Booth Luce. Fritz Perls, another pioneering psychedelic psychiatrist, had affairs with married clients. He wrote in his autobiography: ‘I like my reputation as a guru and a dirty old man…

Once we had a party in the "big house" at Esalen. A beautiful girl was lying seductively on a couch. I sat next to her and said something like this: "Beware of me, I am a dirty old man." she replied, "I am a dirty young girl." We had a short and delightful affair after that.

Male psychiatrists and psychotherapists having affairs with female clients was not apparently seen as a big deal before the 1980s – it is not even mentioned in the American Psychological Association’s first code of ethics from 1953. I think this is because women had much less power and voice at that stage in society, while scientists were held in high esteem.

Things only began to change slowly in the 1970s, through cases like Hartogs vs Roy, in which a Dr Hartogs persuaded a married female client that the only way for her to recover from schizophrenia was to have sex with him, several times a week, while paying him for the privilege. He was ordered to pay her $350,000 in damages, in the first case of its kind.

Since then, it’s become accepted that it’s unethical and malpractice for a psychiatrist or a psychotherapist to have sex with a client / patient, and they should basically never have a relationship with an ex-client (although the APA has a ‘two-year rule’).

So I think the main ethical implication of the case of Dr Sessa and Patient A is the power imbalance that still exists in psychiatry, between psychiatrists and patients, especially between white, male psychiatrists and female or non-white patients. That is changing slowly through citizen-led movements like Mad Pride, Hearing Voices or Surviving Anti-Depressants. I support such movements, not to overthrow psychiatry but to find a better power balance between doctors and patients.

We need to be particularly careful with psychedelic psychiatry because it increases the vulnerability of the patient and can increase the power trip of the psychiatrist. Dr Sessa’s case was not the only example of psychiatrists behaving unethically or criminally in the ketamine industry in the last six months. Here are three more examples.

As shocking as these stories are, at least the psychiatrists in these cases typically lose their license. That’s the argument for preferring overground medical psychedelic therapy to underground healing – if psychiatrists and psychotherapists misbehave, they lose their license. Frankly I’m surprised Dr Sessa didn’t permanently lose his.

Thanks to various people for their help with this story, including Sasha Sisko, and others who want to remain anonymous.

After the paywall, new PAT guidelines from Beckley Academy, FT article on issues in the Vipassana community, the Atlantic on a new start-up looking to mass produce jhana states of bliss. Plus, an upcoming event on march 28 on psychedelics and Christianity featuring a range of great speakers is free for paid subscribers.