A psychedelics renaissance is emerging in America, a second wave following the first of the ’60s and ’70s. Today’s psychedelic reboot, however, leaves behind the countercultural stuff of lore in favor of professionalism, doctors’ visits, and aggressively marketed treatments for diseases of the brain.
We are in the age of psychedelic psychotropics, in which the very compounds that up until recently were perceived by the public as illicit and recreational are on their way to becoming an everyday part of the psychiatric toolbox. MDMA — first used to enhance psychotherapy in the 1970s but currently an illegal and popular party drug known as “Molly” or “ecstasy” — has won breakthrough therapy designation by the Food and Drug Administration (FDA) as a potentially effective medication for certain psychiatric complaints. Ketamine, a staple of raves and dance parties, is now widely prescribed for treating psychiatric disorders. And psilocybin, the psychedelic substance found in “magic mushrooms,” is being researched in the hallowed halls of Johns Hopkins, New York University (NYU), Massachusetts General Hospital, and University of California, Los Angeles, as a possible cure for psychiatric symptoms.
There is little that is countercultural in this “new era,” as college students, college dropouts, war and rights protesters, underground psychotherapists and trip sitters, ravers and DJs, are replaced at the vanguard by scientists, doctors, and financiers. And in their hands, psychedelics are going through a rebranding, in which the aura of the underground is replaced by the legitimacy of conventional psychiatric pharmaceuticals.
“The biggest danger now might be that history repeats itself,” writes journalist Sam Wong, referencing the concern among researchers that the success of the new, doctor-prescribed form of psychedelics demands a scrubbing of the past, since that “first wave of psychedelics research was to a great extent doomed by excessive enthusiasm” — meaning the exuberant orientation toward these substances as both spiritual and political world-changers, catalysts for something bigger than the treatment of psychiatric symptoms — the chemical source of “turning on, tuning in, and dropping out,” as Timothy Leary put it.
But the end of the first wave of psychedelics research wasn’t really caused by acid trippers or excitement about a radical change in world consciousness. The overblown hysteria in magazines, newspapers, and the nightly news, based mostly on false reports and the subsequent manipulation of this hysteria into the “war on drugs,” played a much larger part. As Danielle Giffort explains in her excellent book, Acid Revival: The Psychedelic Renaissance and the Quest for Medical Legitimacy, the idea that Leary, in particular, spoiled the entire enterprise of bringing psychedelics into conventional medicine is more “performative” than fact, a way of creating a straw man in order to define and encourage a new, more surgical version of psychedelic use that is sober, hygienic, cleaned of politics and bias, and the antithesis of a hippie happening.
This shift in paradigm is endorsed by leading psychedelics researchers. “As contemporary psychedelic research results accrue, the field may be facing a fork in the road to clinical applications,” write authors David Yaden, Mary Yaden, and Roland Griffiths in their aptly titled 2021 article, “Keeping the Renaissance from Going off the Rails”:
One path forward allows for the same kinds of exuberance, utopian thinking and uneven clinical approaches that contributed to ending the previous period of research. Combined with the contemporary tendency to politicize science, the possibility of a repeat of the 1960s represents a significant concern. Another path forward, a more careful and systematic one, involves the appropriate integration of psychedelic treatments into existing evidence-based psychiatric paradigms.
Any field that seeks to ameliorate human suffering has deeply noble elements. But Yaden, Yaden, and Griffiths are wrong to characterize psychiatry as somehow cleansed of politics and bias. Its power as judge and jury in the incarceration of individuals in institutions and hospitals, its participation in the medicalization of natural human complexities, its history of draconian practices on and stigmatization of marginalized groups are a few examples of its political force. The authors are correct about the dangers of overexuberance. But, ironically, the talk of miracles and utopia is largely coming from their own professional community.
Psychedelics offer “unparalleled capacity to alleviate mental illness or behavioral problems” enthuses one psychedelic researcher. They are “positively transformative” and potentially “the holy grail” of a “curative psychiatry” write others, shifting psychiatry from a profession aimed at decreasing symptoms to one that can permanently cure certain mental illnesses. Most are focused on these compounds’ ability to treat post-traumatic stress disorder (PTSD) (MDMA rendered two-thirds of the subject “no longer diagnosable” for PTSD in one study), entrenched depression (“immediate, substantial, and sustained improvements,” shown in other research), and addiction (researchers finding “dramatic results”).
Such excitement over the promise of these breakthrough medicines is understandable for any clinician or researcher who has witnessed the toll of psychic pain among patients and clients, and many of the results are impressive. But the current frenzy about the next big “quick fix” is often aided and magnified, if not led, by a sector of society that was not involved in psychedelics in Leary’s time: investment bankers and venture capitalists.
At a conference in October 2021, Christian Angermayer, investor in and founder of Atai Life Sciences, a biopharmaceutical company that is one of the largest players in psychedelic research, told actress Uma Thurman that “psychedelics are like packing 10,000 hours of psychotherapy into four hours.” Like many exuberant investors in psychedelics, Angermayer is not representing scientific or therapeutic traditions in his claim (which, to be clear, is not supported by science in any way). He comes from a world in which the driving forces are sales, marketing, promotion, and profit.
Psychiatry is socially vested with the power to define abnormal behavior and is the central place in our society where one seeks a cure for what that profession has defined as pathological — a sort of scientific parsing and cleansing of deviance once left to religion. What happens when you marry that kind of discursive power with well-funded marketing schemes and the quest for profits? If we’re going to worry about things “going off the rails,” we might want to keep our eyes on the coordination of medicine and money in the new wave of psychedelics.
With current corporate plans for large chains of ketamine clinics throughout the country preparing themselves for the introduction of MDMA in their clinics, the psychedelic experience is in danger of being commodified and turned into a kind of Botox or CoolSculpting for the mind. That’s happening in a preexisting landscape of for-profit behavioral health care that treats its patients as commodities — at best, machines in need of repair; at worst, ATMs.
This is the neglected story behind the current hype about psychedelics as miracle cures, one in which scientific exuberance amplifies a giant sales pitch. To understand what’s real and what’s hallucinatory about psychedelics right now and to protect these precious substances from being fully absorbed into systems of buying and selling, we have to understand their context within a decades-long triumph of corporatized behavioral health.
A Fateful Turn
A key advance in the corporate takeover of psychological suffering came with a very well-meaning piece of legislation. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, which required insurers to cover mental health conditions in the same way as other medical conditions. Former president Barack Obama’s Affordable Care Act, meanwhile, increased the number of people with health insurance, including young people who could be covered by their parents’ insurance until age twenty-six.
More insurance coverage was a good thing, of course, as was greater mental health care coverage. But absent a public health system, these reforms also meant a deeper well of potential insurance payouts from insurers on behalf of newly covered patients. Those payouts did not go unnoticed by investors.
With this influx of cash, the corporatization of behavioral health took off. At first, it was mostly about addiction recovery, a field subject to little of the oversight applied to psychiatric institutions. One glaring example of this unregulated growth was the massive development of “sober homes” — residential settings, unlicensed at the time, which often offered cheap rent while garnering most of their profits through kickbacks from drug treatment programs and testing sites, an arrangement that would be glaringly illegal if the programs were regulated as medical establishments.
As the opioid crisis brought addiction to epidemic proportions, private equity rushed to buy up treatment sites, from detoxes and day programs to hospital and sober housing, branding them with flashy marketing and cutting costs to make them more profitable. At a 2016 investor conference, one such treatment center chain’s CEO described the increased rate of heroin use as a “favorable industry tailwind.”
The results were disastrous. A 2020 Vox investigation documented the “Florida shuffle,” in which treatment centers employed brokers to recruit patients who had good insurance. These brokers sought out patients everywhere from twelve-step meetings to hotlines claiming to offer help to those suffering from addiction. Potential patients were bribed with cash, clothes, or even drugs in order to achieve enrollment. The goal was to maximize profits by keeping as many people in the system as possible.
Some cycled through corrupt centers for years until they overdosed or gave up. In an ugly and telling twist, the urine of addicts became a hot commodity at this time, since many treatment centers made most of their profits from large insurance payments for drug and alcohol tests as opposed to actual treatments. Patients were nicknamed “thoroughbreds” and treated as cash cows (to mix farm animal metaphors) rather than as the focus of therapeutic care.
When insurance companies and regulators caught wind of these tactics, they intervened — the former restricting the interventions for which they would pay, the latter shutting down some particularly abusive programs. The remaining treatment centers sought new legitimacy and a much larger market by developing conglomerates that offered a continuum of care for all manner of behavioral concern, shifting from addiction treatment solely to mental health care in general.
While the more unethical shenanigans of early corporate treatment may have diminished, the sales pitch mechanism of pathology and quick fixes has only grown stronger: a one-two punch in which certain experiences of mind and mood are defined as “sicknesses” by experts who then offer a cure — an already-growing tendency in psychiatry in the United States that shifted into overdrive when behavioral health became a hot commodity.
Sick in the Head
“Stop the Stigma” is the central campaign of the National Alliance on Mental Illness (NAMI), the largest advocacy group in the United States for individuals who have been diagnosed with mental illness and their families. NAMI’s main strategy in fighting stigma is to educate the public about the science behind mental illness as a brain disease, a similar approach to the one taken by advocates for individuals engaged in addictive behaviors, in which the source of a certain behavior is framed as a disease of the mind instead of a moral choice.
Such approaches are laudable and match society’s larger view that diagnoses liberate individuals from stigma. They are also sociologically naive.
Stigma was developed in cultures for many reasons, but one clear purpose of stigma is to ostracize sick people by removing them from the body politic and keeping a distance from them in order to protect against infection. That means that calling people “mentally ill” may not really remove stigma but is, in fact, stigmatizing. More important to our discussion, the narrative of a brain disease does not free individuals from moral judgment: it shifts the site of their morality to decisions they are making about getting better.
The famous sociologist Talcott Parsons defined “the sick role” as divided, like all social roles, by both rights and responsibilities. When one is sick, they are freed from the typical obligations we assign to “well” individuals, like attending school or going to work. But they are also assigned new responsibilities having to do with seeking out medical care and complying with expert courses of action — to recover promptly and get back to school or work, in other words. When those who are sick don’t demonstrate that they are seeing the right professionals in order to heal, we tend to view them as not doing their part in meeting the responsibilities of their role, typically seeing them as irresponsible, lazy, and deviant.
There’s some obvious logic to such negative sentiments. We should want people who feel sick, whether mentally or physically, to get better. But psychiatry and behavioral health have a history of often getting it wrong more than right.
They also work in areas that, say, an orthopedic surgeon doesn’t: spiritual, existential, and social suffering — experiences that exist on a continuum in all of us. You can’t solve a broken leg by seeing a cleric or shaman, striking up a new friendship, developing greater social support, a sense of purpose, more economic or educational opportunity, or falling in love. But you can solve a lot of behaviors psychiatry defines as abnormal in these ways.
That’s why clinical psychology is not the only social science; rigorous research in sociology and social psychology shows that many behaviors are less psychological traits and more related to social states. In this light, the message that medicines and sanctioned therapies are the only cures for psychological pain can be understood as more of a monopolistic grab on psychological well-being than a solid truth about the best or even only way for people to build better lives for themselves. And, whether intentionally or not, this monopolization is aided by society’s general belief that individuals who do not choose the medically sanctioned way to get better are doing something deviant.
The story of psychedelics as a miracle cure participates in a deeply disempowering approach to healing, one that implies a moral choice (who, in their right mind, would refuse a miracle?) regarding treatment in which the righteous decision is to place one’s recovery solely in the hands of professionally legitimized others. In this mode, psychological transformation becomes something you purchase or submit to in order to become more “normal,” while refusals to take your medicine are seen as ill-advised, amoral, or even part of the illness (i.e., “denial” or “resistance” in “professional” psychological terms). In this medical hegemony, people start to sound like machines to be fixed with just the right screwdriver or wrench for what ails them.
We’ve Got the Very Best in Store for You!
The medicalization of psychiatric suffering has increasingly led to a segmenting of therapeutic treatments designated as “evidence-based best practices” to treat specific diseases of mind and mood: cognitive behavioral therapy for depression or dialectical behavioral therapy for borderline personality disorder, for example. These are the models sold by treatment centers today, a menu of cures for particular ailments that mimic in many ways the panoply of cosmetics at your local CVS, each a way to remove or cover this or that blemish.
Psychedelics as magic pills for depression, PTSD, and addiction fit within this approach. This new segmenting of illness and remedy might be all well and good, if it worked. Yet there is scant evidence that it does.
Decades of what is called “common factors” research in psychotherapy shows that only 15 percent of change in therapy is the result of any particular model, while the effect of a patient’s social experience and their willingness to change is almost triple that, and the effect a warm and collaborative relationship with the therapist is double. (The remaining 15 percent of cure is due to the placebo effect.) Basically, this research is about what Leary called “set and setting” (something he attributed as more important than psychedelic compounds in a person’s awakening), the complicated but curative space between two people in which one comes with their own capacities to metabolize care and another does their best to make the space hospitable for change.
When Yaden, Yaden, and Griffiths suggest that we integrate “psychedelic treatments into existing evidence-based psychiatric paradigms,” they are lauding the smallest element in therapeutic change, while minimizing the much more important common factors that are actually at work when change occurs. When Angermayer describes the ingestion of psychedelic compounds as “10,000 hours of psychotherapy into four hours,” he’s doing the same and to the extreme, claiming human agency and human contact are a waste of time.
By selling a brokenness that only experts can fully see, define, and remedy, the exuberant proponents of the new, medicalized version of psychedelics are “iatrogenically” participating in a particular kind of social sickness — one that has become pandemic in our culture but is less and less likely to be recognized due in large part to the pathologizing of human behavior. This sickness is what sociologists call “alienation,” a malady in which a person “does not experience himself as the center of his world, as the creator of his own acts,” instead feeling “estranged from himself,” as Erich Fromm described it.
Psychedelics are not palliatives swallowed to instantly eradicate psychopathologies (and neither are any of the pills your psychiatrist might prescribe, for that matter). They are liberating medicines which, when used in a supportive context, can enable people to fathom and deal with their suffering on their own terms. Used correctly, they can enhance our sense of our agency in the world. These chemicals work in a beautifully inefficient way, with the imprecision of poetry. And like poetry and art in general, they bring us back to what it’s like to be human here on earth.
Can psychedelics help with those forms of suffering psychiatry labels as depression, PTSD, and addiction disorders? Yes, they can, in remarkable and even revolutionary ways. But their ability to help with specific kinds of psychological suffering has to do with what they do in general: free our minds from repetitiveness and rumination. Forcing them into the sterile cast of a psychotropic pill that supposedly cures a pathology automatically, as a kind of “one weird trick,” carries the real danger of crushing that expansive effect, since it removes human agency and human connection from the scene.
When psychedelics work (and they don’t always work), their specialness lies in their ability to open our minds not only to ourselves but to the world around us. In doing so, they not only help us question personal narratives that may keep us stuck but social narratives that might hold us back. When used correctly, these substances are not quick-fix cures for illness but consciousness raisers — and raised consciousnesses tend to find the public causes for personal pain. This, too, is the danger in the current medicalized approach to psychedelics: a profound reductionism that doesn’t only reduce individuals into clusters of complaints but brands compounds that can help us see outside ourselves and comprehend the effects of social forces on our lives and the lives of others into just another little pill for skull-bound ailments.
The current mood around psychedelics is one of exuberance, but the changes that mood can bring also give us reasons for hope. Oregon is the first state to make psilocybin legal for therapy, and two omissions in the law there are particularly important: you don’t need to be labeled with a psychiatric diagnosis to enter therapy, and mushrooms will not need to be prescribed by a doctor. Perhaps that’s a sign that there will be room in this new renaissance for more than one approach to psychedelics: a way of seeing things more fluidly, with more openness and plasticity.
Like all cures, this will take human effort, since any attempt to decommodify psychedelics as magic pills for pathologized problems threatens to weaken a remarkably eloquent and powerful sales pitch. The most conscientious of healers and the most dedicated investors have one ethic in common: a commitment to place the needs of their constituents above their own. The current renaissance would do well to protect the Hippocratic mission of the former group. That doesn’t mean a complete abandonment of the latter, many of whom are opening their pocketbooks for altruistic reasons. But it does mean a prioritizing of “do no harm” over profits. And to get there, doctors and scientists would do well to welcome the elements in the psychedelic space that are focused on expansiveness, a heightened sense of encounter with the world, a connection to something bigger than us, sacredness, and even something as unscientific as “universal love.”
Despite the best efforts of the war on drugs, the psychedelics movement never actually died — it went underground, spreading fungally through nightclubs and warehouses, and in the apartments, homes, and offices of a growing number of therapists, “space holders,” and trip sitters willing to risk their own freedom to help others. This group, made up of individuals with decades of experience in the use of these medicines, holds an antidote to the current trend of pathologization in service of sales.