How to Brace Your Mind: A Brief Discussion of Risks and Eventualities in the Psychedelic-Medical Movement
If you’ve been keeping an ear to the ground, you’ve likely heard about the book and recent Netflix docuseries, “How to Change Your Mind,” by author Michael Pollan. As someone with a longstanding interest in the subjects of psychedelics and psychedelic-assisted therapy, I’ve been thrilled to hear friends, family, and the general public share a newfound sense of fascination with psychedelics after reading and watching the content that Pollan and other notable voices have produced over the last few years. Although it brings me great joy to see people changing their minds (pun intended) about psychedelics and their medical potential, this uptick in interest brings with it a few caveats that we all need to think critically about.
First and foremost, generating public interest in the subject of psychedelics will, and likely already has inspired a significant number of people to seek out and have their first psychedelic experience. It is no secret that there is a global mental health crisis; people are desperate to find relief from issues like depression, post-traumatic stress disorder, and substance addictions and dependencies. However, psychedelics may not always be the solution to those issues. Indeed, psychedelics could in some cases exacerbate, or bring with them entirely new mental health disorders. We know now with some certainty that people with a family history of schizophrenia and psychosis could trigger dormant predispositions for such disorders as a direct result of psychedelic consumption.[i] As a way to control for this, clinical scientists have carefully screened participants to ensure no one with a family history as described ultimately end up as research subjects. This is all great news in the context of research, as it ensures the data from clinical trials accurately and restrictively reflect outcomes for people who are appropriate candidates for psychedelic-assisted therapy. However, many people in the general population have little idea what their genetic ancestry looks like with respect to mental health disorders and may haphazardly assume psychedelics are a safe option to explore for self-treatment.
While I am always eager to acknowledge psychedelics can catalyze radically positive mental health transformations for consumers, it is crucial for anyone considering their first exploration of psychedelic states of consciousness to understand the long-term risks they may assume in doing so. I do not mean to be an alarmist in articulating this point: the population-at-risk I am addressing is quite small relative to the general population. [ii] These are also things that Pollan and others have carefully explained in their reporting. But as we know, it is far more likely for media to cover the most negative cases of any social subject than the positive. [iii] Thus, it seems likely that the increasing public interest in psychedelics will bring with it more consumption of psychedelics among the general population, a greater risk of for a small subsection of consumers to develop new mental health disorders, and a higher likelihood that media sensationalizes and obscures the healing potential psychedelics can offer. This could be bad for consumers, practitioners, and the psychedelic-medical movement at-large. While I recognize this reasoning is speculative to some extent, it is important for us to think about how history may repeat itself in a similar fashion to the moral panic of the 1960’s.
Second, as public interest in psychedelics grows, so too will corporate interests. Thus far, corporate actors have invested over $7 billion in the psychedelic market, [iv] and numerous attempts have already been made to patent various psychedelic compounds as well as some of the therapeutic methods and modalities therapists employ in conjunction with psychedelics. These efforts have been contested by prominent organizations like the Multidisciplinary Association for Psychedelic Studies (MAPS). However, actors like Compass Pathways – now notorious for their aggressive corporate posturing in the psychedelic market – are growing rapidly as psychedelic misnomers like ketamine are becoming popular mental health interventions. Recently Compass Pathways was even successful in securing patents for a synthetic form of psilocybin, and another company, MindMed, was successful in patenting the combination of MDMA and LSD (colloquially known as candy-flipping). [v] MAPS is surely a noble organization filled with many brilliant minds and inspiring voices, but they can only steer the conversation about psychedelics and their appropriate regulatory frameworks for so long when faced with opponents of this nature. Indeed, anyone with even a brief internet search history into mental health issues may now be spammed with misleading ads rife with misinformation, half-truths, and outright lies about ketamine and ketamine-assisted therapy on social media platforms like Instagram and Facebook. Ads with phrasings like, “just 3 sessions and I’m cured of my depression – it will work for me and it will work for you,” and, “ketamine is a miracle drug,” are highly problematic when trumpeted by corporate actors. On one hand, we must acknowledge businesses have an obligation to sell their products and share their potential benefits with consumers in order to stay afloat in any market. Ketamine has been an effective treatment for many people and my intention is not to minimize their stories. On the other hand, businesses in the field of pharmaceuticals are especially prone to misinform, disinform, and exert unchecked control over the discourse and laws about their products, as well as the diagnostic frameworks for the disorders their products are meant to treat. These things are part and parcel of the process sociologists refer to as ‘medicalization’ as it has unfolded in the United States. [vi] It is not outlandish to assume that corporate discourse and advertising efforts around psilocybin, LSD, and MDMA will mirror what we are currently observing with ketamine. Ketamine is not a magic-bullet, and psychedelics are no different. It takes serious work to integrate the lessons learned from psychedelic experiences to affect positive changes in our lives, as any practitioner of psychedelic-assisted therapy will tell you.
Moreover, the subjection of psychedelics to corporate interests and their eventual entanglement in the insurance industry will undoubtedly result in restricted access for psychedelic-assisted therapy along class lines. While this is the case with anything in a for-profit insurance system, it will be particularly pronounced in the field of psychedelic-assisted therapy. This is because psychedelics are in most cases long-acting drugs that have psychoactive effects ranging from 6-8 hours. Billing for an hour of conventional therapy today ranges from $90-$150, depending on the state you live in. [vii] The notion that anyone who is uninsured or underinsured will be capable of paying 6-8 times those rates for multiple sessions over many months is fantasy. We know with a high degree of certainty that social stratification is both a cause and consequence of health; bad health potentiates downward class mobility, and being poor increases the risk of developing health issues. [viii] And as we also know, insurance plays a central role in shaping these disparities in the United States. This means that the population which most needs access to the healing potential of psychedelic-assisted therapy will almost certainly be the one which never experiences it.
Third, I am deeply concerned that the broadening public interest in psychedelics will spawn a wave of unqualified and underqualified people to begin establishing informal/underground psychedelic-medical services, which can potentially harm the patients who seek them out. I cannot offer the same breadth of empirics for this point as I have for my last two arguments; rather, I can only speak to the data I have gathered from the dozens of practitioners of psychedelic-assisted therapy I’ve interviewed in the course of my dissertation research. Psychedelics are incredible substances that can change how we look at the world, others, and ourselves. But they can also lead people to think that their breadth of personal experiences with psychedelic states of consciousness are qualification enough to guide sessions for friends or family members. In my research, I’ve found that both aboveboard and underground practitioners of psychedelic-assisted therapy overwhelmingly agree that any practitioner should have had at least a few, but more preferably many psychedelic experiences in order to guide sessions with patients. But they also largely acknowledge that personal experience is not enough to provide a safe environment for patients. People need to be trained to deal with and mitigate the potential issues that patients may encounter in the course of a session, and personal experience can’t provide the full perspective needed to conduct safe sessions. Panic attacks, ego death, and drastically elevated heart rate are among some of the many possible experiences people may have after consuming a psychedelic. These things can be terrifying to endure, especially for a first timer. Practitioners need to have real medical training to identify when someone’s issues are purely psychosomatic, and/or when they pose real threats to the physical well-being of patients. I do not personally believe that such training must necessarily come in the form of a medical credential, nor do the majority of my interviewees. But having a firm grasp on the potential health issues that may arise in a session and how to properly respond to them is an absolute must for anyone who calls themselves a psychedelic guide.
Finally, seeking services from someone who is unqualified or underqualified to guide sessions can put someone at risk of being abused by their practitioner. To be clear, I firmly believe that the vast majority of practitioners aboveboard and underground today are well-intentioned people who would never think to harm their patients. But a unifying viewpoint across the many interviews I have conducted is that psychedelics leave people in highly suggestible, vulnerable states which predatory actors can and will exploit for sexual or material purposes. We even recently learned that a small handful of researchers in a clinical trial for MDMA molested the patients who entrusted them with their well-being and safety. [ix] Every interviewee I have spoken with thus far reported either hearing about such an occurrence, or directly knowing someone who committed such disgusting behavior. While these happenings are repugnant, they are entirely possible and should be carefully considered by anyone thinking about employing an underground guide.
All of this is not to say that we should feel hopeless about the future direction of psychedelics and psychedelic-assisted therapy. To be sure, there are many things to be excited about with respect to this tidal wave of public interest that has arisen for psychedelics in the last few years which I will surely cover in the weeks to come. However, I firmly believe that the success of this movement hinges on our ability to think with scrutiny about how social structures and public behaviors will impact the trajectory of psychedelics and psychedelic-assisted therapy as they are gradually mainstreamed. Psychedelics have the potential to change the field of mental health for the better, but only if we remain vigilant and vocal about the issues that may damage their pathway to adoption. We need to brace our minds after we change them.
- Joshua J. Mason is a PhD student studying medical sociology at the University of California, Davis. The opinions expressed here are his own and in no way reflect the views of UC Davis.
[i] Collin M. Reiff, M.D., Elon E. Richman, M.D., Charles B. Nemeroff, M.D., Ph.D., Linda L. Carpenter, M.D., Alik S. Widge, M.D., Ph.D., Carolyn I. Rodriguez, M.D., Ph.D., Ned H. Kalin, M.D., William M. McDonald, M.D., and the Work Group on Biomarkers and Novel Treatments, a Division of the American Psychiatric Association Council of Research. (2020) “Psychedelics and Psychedelic-Assisted Psychotherapy.” The American Journal of Psychiatry, 177:5, 5.
[ii] Johnson, Matthew, William Richards, and Roland Griffiths. Human Hallucinogen Research: Guidelines for Safety. (2008). Journal of Psychopharmacology, 22:6: 603–620.
[iii] How Negative News Distorts Our Thinking. Perimutter, Austin. September 19, 2019. Psychology Today. https://www.psychologytoday.com/us/blog/the-modern-brain/201909/how-negative-news-distorts-our-thinking
[iv] Sanabria, Emilia. 2020. Vegetative value: promissory horizons of therapeutic innovation in the global circulation of ayahuasca. BioSocieties.
[v] “Judges Deny Challenge to Psilocybin Patent.” Love, Shaya. June 23, 2022. Vice.com.
[vi] Conrad, Peter. (2007) The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: Johns Hopkins University Press.
[vii] Make What You’re Worth: How to Set Your Psychotherapy Session Rates in Private Practice. SimplePractice Sessions Rate Report. (2018). Simplepractice.com.
[viii] Haas, Stephen. (2006). Health selection and the process of social stratification: the effect of childhood health on socioeconomic attainment. Journal of health and social behavior, 47(4), pp.339-354.
[ix] Footage of therapists spooning and pinning down patient in B.C. trial for MDMA therapy prompts review. Lindsay, Bethany. March 29th, 2022. https://www.cbc.ca/news/canada/british-columbia/bc-mdma-therapy-videos-1.6400256