Your friends’ Llamapalooza weekend conversations, leading scientific journals and the American mainstream are all talking about the same thing: psychedelics. Substances like psilocybin, LSD, ibogaine and DMT are experiencing a renaissance in Western medicine, media, politics and pop culture.
The Trump administration just fast-tracked research on ibogaine for treating veterans’ PTSD. The New York Times has increasingly showcased stories of politicians and journalists who experienced breakthrough healing through psychedelics. Internet biohackers have started peddling mushroom microdoses as part of their ‘productivity stack.’ And clinicians hopeful for novel treatments for our mental health crisis have decided to consider the substances that indigenous scientists have studied for millennia.
It comes as no surprise to me that Western psychiatry is opening its arms to psychedelic therapies. What does surprise me is how little the psychiatric establishment has examined whether its arms are ready to hold these meaning-shifting medicines correctly.
To understand why, it helps to know where psychiatry has been and how it has evolved through distinct eras.
For most of the twentieth century, mental illness was examined through psychoanalysis, where unconscious conflict, early experience and the stories people told about themselves framed our beliefs about mental illness. By the 1980s, the American Psychiatric Association stripped psychoanalytic theory out of mental health diagnosis completely, replacing it with observable, categorizable symptom clusters. Depression, for example, ceased to be a nuanced story about a person and their reality and instead became a checklist of symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This change made mental illness legible to pharmaceutical research and the introduction of Prozac in 1987 cemented the world we now live in: one of psychopharmacology, the epoch of drugs and talk therapy.
This psychopharmacological model premises that our anxieties, ruts of depression and experiences of mental suffering are essentially biological malfunctions in an individual’s brain. The problem with you is the dysregulated neurotransmitter systems inside your skull, not the unregulated tech-industry attention traps, the relentless tide of rent increases and the manufactured loneliness that follows a culture of holding profit closer than community. Your neurons and your brain circuits are held accountable, never the actors that produced the real material conditions of your suffering.
This premise has produced some undeniably life-saving treatments: antidepressants and mood stabilizers have helped millions — don’t fall for unnuanced anti-SSRI talking points. But results at a population level are a little harder to celebrate. Stimulants for ADHD are prescribed over seven times more in the United States than in Europe. The number of adults receiving mental health treatment has more than doubled in the last quarter century, while depression and suicide rates have reached historic highs despite rising antidepressant prescriptions. The United States is one of only two countries in the world where pharmaceutical companies can advertise prescription drugs directly to consumers. A major consequence of this is that advertising has inflated our belief in pills, causing the placebo effect to be more prevalent for Americans. It is against this backdrop that psychedelics have re-entered the clinical conversation. It is worth questioning whether we are bringing them into a system capable of understanding what they actually do.
Psychedelics are sometimes called “nonspecific amplifiers.” Rather than solely affecting the serotonin neurotransmitter system the way an antidepressant does, they occasion a brain-wide experience: a temporary dissolution of the rigid patterns of thought and self that trap people in cycles of depression, trauma or bad habit. They create a window of neurological “plasticity” in which new connections, perspectives and relationships to the world are possible.
Last month, I attended PsyCon, a psychedelic conference held in Denver, where I heard speakers such as Jyoti Ma critique psychedelics in our current model. A former psychotherapist of nine years, Ma closed her successful clinical practice when she became disillusioned by our approach to psychiatry. She believes that medical settings for psychological treatment reinforce conformity and control by forcing patients to seek approval from the therapist, clinician or other external authority. As nonspecific amplifiers, psychedelics tend to manifest and intensify whatever is already present in the user’s mind and environment, and thus, there is something deeply contradictory about receiving them within the clinical frame, where patients are primed to internalize their pathology and the sterile nature of the setting. There is also something contradictory about taking them recreationally without clear intentions or attention to set and setting, as I fear many CC students do. If you’re planning on using, I recommend visiting psygaia.org for a guide to approaching the experience safely.
The experience of an altered state of consciousness, influenced directly by the setting and mindset and not the drug itself, is precisely what produces healing effects. Our context-independent science of isolated variables and cookie-cutter clinical guidelines is not ready to embrace the environmentally dependent, transcendental nature of psychedelic medicines.
You don’t have to take my word for it. Cracks are already showing in attempts to integrate these treatments into the clinical model.
In 2024, the FDA rejected MDMA-assisted therapy as a treatment for PTSD. The FDA reviewers raised two concerns: first, it was impossible to isolate the effect of the MDMA from the psychotherapy itself — the two were too intertwined to evaluate separately. And second, because MDMA produces powerful psychoactive effects, most participants could tell whether they had received the drug or a placebo, compromising the study’s so-called objectivity. In the language of clinical research, this is called ‘functional unblinding’ and is a major roadblock in psychedelic studies. Unfortunately for our gold standard double-blind model, if you’re trippin’, you’re gonna know that you’re trippin’. Clearly, our leading health authorities have no framework for a treatment where the subjective experience is precisely the point.
It is for this reason that pharmaceutical companies are racing to find a psychedelic-like compound with therapeutic benefits without the trip, something prescribable that does not necessitate the expensive oversight of a guide. Needless to say, it seems like they’ve lost the plot.
Since Oregon became the first state to legalize supervised psilocybin therapy in 2023, over a third of clinics have closed under overwhelming overhead costs. For all but the affluent, the price tag of several thousand dollars per guided session is entirely prohibitive. A supposed breakthrough in accessible mental health care has, in practice, produced a system available mainly to people who can afford boutique wellness. It’s also hard to imagine a world where insurance companies cover long, labor-intensive guided experiences.
These failures might feel more surprising if we didn’t already have centuries of evidence that psychedelics can facilitate profound healing outside of any clinical framework whatsoever. Indigenous cultures across the Americas and beyond have used these plants ceremonially for generations, not as medications in the clinical sense, but as a method for meaning-making and accessing the divine. These traditions did not require FDA approval, licensed facilitators or liability insurance. They were embedded in community, ritual and a shared understanding of why the experience mattered and what you were supposed to do with it afterward.
Some practitioners are rushing to incorporate indigenous ideas into psychedelic therapy. Unfortunately, the successful ancestral model of natural medicine that we are borrowing from was not freely given and the communities they belong to are paying a steep price for our interest in them. Peyote, a psychoactive cactus sacred to numerous indigenous communities across the Southwest, is now an endangered species. As psychedelics become increasingly mainstream, overharvesting from the increasing Western demand for plant medicine experiences is having alarming consequences on indigenous communities’ access to their own medicine. In the same area of southern Mexico where the healer María Sabina first shared Psilocybe cubensis practices with Western researchers in the 1950s, the fungi are receding from the places they once grew. Meanwhile, the corporate Americans who fly to Ecuador to seek an Ayahuasca experience will fly home days later and resume their extractive roles at corporations that push for mining, oil extraction and agribusiness in the Amazon. We have a lot to learn about wellbeing from the indigenous natural medicine framework, but our turbulent attempts to on-board psychedelic medicine must stop extracting from and harming the original stewards of psychedelic practices.
I spoke with Santiago Guerra from the Southwest Studies department about how Colorado treats indigenous perspectives as the state attempts to integrate options for legal psychedelic use into society. After the popular vote passed the Natural Medicine Health Act in 2022, the law that decriminalized psychedelics and opened the door to supervised psilocybin therapy across the state (if you’re a senior, you may have voted for it), policymakers realized that they had failed to hear any indigenous input. So they put together a task force of representatives from various American Tribes and indigenous groups, which included Professor Guerra, to make recommendations about how to honor the rights and needs of indigenous communities while implementing a productive system for psychedelic therapies. After the report was made, policymakers ignored the advice. The people who preserved these medicines through centuries of colonial suppression were consulted late and incorporated minimally into a law that’s now celebrated as a progressive breakthrough.
So now, Colorado is implementing a system that will have us walk into a clinic, embark on a profound journey guided by strict rules and regulations and then send us back to the same jobs the next day without electing to change our habits and practices. All against indigenous advice. That model is not aligned with what these medicines are calling us to do.
It can be hard to imagine what comes next. What model can we adopt that is not yet another extractive frontier that takes from indigenous communities without reciprocity?
Because psychedelics are so sensitive to context, amplifying whatever is already present in the mind and environment, simply removing clinical gatekeeping without replacing it with something is not a solution. To explore what that something could look like, I spoke over Zoom with the founder of PsyGaia, an education and research organization at the intersection of psychedelics, ecology and systems thinking. What struck me most was his insistence that psychedelic wellbeing is not reducible to mental health treatment. These medicines, when engaged with seriously, tend to dissolve not just the boundaries of the self but the boundaries between personal wellness and the health of the communities, ecosystems and social systems we inhabit. We cannot be truly well inside systems that are politically, ecologically or socially unsustainable and psychedelics should be calling us toward something more significant than optimized individual functioning.
Thus, I believe we do not need to wait for a centralized medical authority to tell us how we may use these medicines. If psychedelics were newly engineered pharmaceuticals, I would say otherwise. But they are not. They are time-tested substances that have played a transformational role in healing rituals across most of human history. The evidence for their safety and efficacy, both clinical and ancestral, is already substantial. So instead, we need to imagine an alternative beyond clinical psychiatry and beyond our logic of expropriation. We need the humility to be open to something new with the input and direction from our indigenous peers and leaders.
The psychopharmaceutical era taught us to look for the answer inside a pill and inside an individual’s brain. Psychedelics, when they work, tend to do the opposite: they dissolve the walls of the self and point toward connection, meaning and relationship as the actual ground-zero of wellbeing. That is not a message our current mental health system wants to hear. Are we ready to build a new system that will listen?