Have you heard about the mental health benefits of psychedelics and want to know more? I have written this article as an introduction to the subject for those unfamiliar and, on a personal level, as a small contribution to the much larger conversation happening globally.
Psychedelic assisted therapy is becoming mainstream and, while this is happening, psychedelics are posing challenging questions of our prevalent Western medical model. At a recent talk I attended, a leading psychedelics expert proclaimed that psychedelics are the “psychiatric equivalent of a cure for cancer”. From this perspective, we are rapidly approaching a paradigm shift in the treatment of so-called mental distress. There is much about this to celebrate. Equally, viewing human distress as something to be cured at the individual level misses the deep political, socio-economic, cultural and environmental factors that are woven into how we experience ourselves; there is something distinctly Neoliberal about the placing of psychological distress, and sole-responsibility for health, in the individual. Saying that, as I will go on to explore, psychedelics have virtually nothing in common with current mainstream psychopharmacological medicines: psychedelics will never fit neatly into our current Western medical and pharmaceutical models and as such are not just another pill to pop. Psychedelics are fundamentally wild, baffling and untamable. Precisely because psychedelics disrupt, they both threaten established norms and carry immense potential for catalysing change at the individual and collective level.
An utterly incomplete potted history
I imagine most readers will have some sense of the politically charged history of psychedelics. Even if this is just the connection of LSD to the ‘Hippie’ culture of the 60s or wild tales of people jumping out of buildings believing they could fly. I remember a story that went around at my school that, if you took LSD seven times, you were ‘clinically insane’. I have since learnt that this was a common rumour amongst kids in the 80s and 90s. Thankfully, this, and other prolific scare-stories around psychedelics are, using the technical term, horseshit: the sticky residue of anti-drug propaganda campaigns. To help locate the present legal situation surrounding psychedelics for those unfamiliar, what follows is an utterly incomplete potted history of psychedelics up to the present day.
The present-day conversation around psychedelics usually begins here: there is some evidence that psychedelics have been used, in some way, by humans for millennia. It has been suggested that cave paintings in Algeria dating 7000 - 9000 years ago depict Cubensis Mairei, a variety of magic mushroom, and that cave paintings in Spain dating back to 6000 years ago depict Psilocybe Hispanica, another variety. There is strengthening evidence that native North Americans were using the mescaline-containing Peyote Cactus 5700 years ago. At an archeological site in the Balearics, chemical evidence of psychedelic use has been found in human hairs dating back 3000 years. Jumping forwards, the Aztec (c.1345 - 1521) and other Mesoamerican’s ritual use of psychedelics is well documented. Today, traditional rituals and rites of passage using psychedelic sacraments are present in various indigenous cultures including: the Mazatecs and Huichol peoples of Mexico, the Shipibo people of the Amazon, the Ebene and Yanomami people of Brazil and Venezuela, followers of the Bwiti religion in Gabon and Cameroon. For balance, the exact nature of the historical use of psychedelics amongst groups that no longer exist cannot be known as there is simply not enough evidence. It is worth noting that the modern conception of psychedelics as healing, mind-expanding medicines is probably very different to the way that these compounds were understood and used in past cultures. The use of psychedelics by indigenous peoples in ritual settings for healing purposes is thought about in the West in terms of ‘Shamanism’, a broad term denoting the employment of altered states of consciousness by shamanic practitioners to convene with spiritual realms in order to provide help and healing to individuals and communities. Often in shamanic cultures it is the practitioner who imbibes consciousness-altering drugs or uses other expansive practices in order to help and heal others, rather than the Western conception, that aligns more closely with the Western medical model, in which an individual with a problem takes the medicine.
Psychedelics were at the frontier of psychopharmacological and psychotherapeutic research across Europe and the US throughout the 50s and 60s. Clinical trials back then indicated that psychedelics can be effective in treating a range of ‘individual conditions’ including those that were by then being labelled as depression, addiction and PTSD. A recent meta-analysis of 19 studies of psychedelics for ‘mood disorders’ published between 1949 and 1973 found that 79% of patients showed ‘clinically judged improvement’ post treatment. Simultaneously, through the 50s and 60s, there was covert research happening into the possible weaponisation of psychedelics by the C.I.A. codenamed the MK-ULTRA operation.
The predominant narrative, at least amongst the psychedelic community, around why psychedelic research ended focuses on US president Nixon and the beginning of the ‘War-on Drugs’. It goes something like this: despite a large body of promising research data indicating the therapeutic efficacy of psychedelics, the passing of the Controlled Substances Act in 1970 by the US congress under Nixon effectively terminated the whole field of psychedelic research and other nations soon followed suit with their own prohibition laws. After 1970, an impenetrable red-tape blockade faced anyone wishing to continue psychedelic research legally and most were essentially forced to give up and move onto other things.
The Controlled Substances Act marked the beginning of the War-on-Drugs. From one perspective, the Controlled Substances Act was a response to a rise in drug use through the 60s that undoubtedly had a dark-side of abuse and individual casualties. From another perspective, the War-on-Drugs can be understood as an act of US state, military-backed aggression against the two main opposition groups to Nixon’s presidency: the anti-war left, and black people. In the 80s, Regan ran with the baton, introducing a policy of severe punishment for drug offences - incarceration, fines and the removal of basic rights - over treatment. This caused a surge in the U.S. prison population, disproportionately targeting black Americans and embedding the Western idea that drug use is a criminal rather than a health issue. It is easy to see why the U.S.’s giant prison-complex would oppose any reduction in its supply of inmates. However, unless one ignores the evidence, or is addicted to the proceeds, criminalising the personal use of any drug makes no sense. Along with the destruction of lives through excessive punishments, drug prohibition is inextricably linked to the thriving criminal underground and its violence, exploitation and unregulated end-product. Prohibition causes more damage than it prevents - the War-on-Drugs has always been absurd.
Back in 2009 here in the UK, Professor David Nutt revealed the establishment’s refusal to acknowledge the evidence around drug-harms when he was sacked from his position as Chairman of the Government’s Advisory Council by then Labour Home Secretary Alan Johnson for presenting his research that unequivocally ranked drugs according to their harm to individuals and society. Professor Nutt’s research demonstrated that alcohol is by far the most harmful drug. Psychedelics barely made the list. As far as we know currently, the classic psychedelics are essentially non-toxic to the human body, and other harms, including adverse psychological reactions, while a genuine risk, are mitigated when psychedelics are used with appropriate preparation and care in a safe setting. Alcohol, on the other hand, is a nerve poison, toxic to all known living organisms, with the potential for long term physical and mental health implications at a huge cost to individuals, their families, the NHS and society at large. Professor Nutt’s report fundamentally challenged the status quo and the establishment responded with a decisive and Shakesperian “Orf with his head”. Thankfully, Professor Nutt’s bonce bounced off down the road to Imperial College London where he has spent the last 14 years leading cutting-edge psychedelics research.
Although the War-on-Drugs narrative around the untimely end of psychedelic research is certainly a rabble-rousing cry, it is not often acknowledged that there was a tightening up of regulation around pharmaceutical research in the wake of the 1963 Thalidomide disaster, which compounded a general lack of interest in the pharmaceutical industry for pursuing the inherently expensive, and difficult methodology required for studying psychedelics in humans. This contributed to the lack of political resistance to the scheduling of psychedelics.
In perhaps the only genuinely positive thing he has done in his entire life, Boris Johnson agreed to reschedule psychedelics in the UK when he was PM but, at the time of writing, the classic psychedelics are still schedule 1 drugs meaning that, although this is unequivocally, factually incorrect, they are seen by the law as having “no currently accepted medical use and a high potential for abuse”. This makes it difficult to obtain licensing for research into their therapeutic potential. On the 18th May 2023, Labour MP Charlotte Nichols delivered an impassioned plea in the Commons for the necessary change in UK law regarding psilocybin to derestrict research into its therapeutic efficacy. She contextualised her argument with her own devastating experience of PTSD and how current laws are preventing those suffering the after effects of trauma, including herself, from accessing a treatment option. Nichols’ speech echoes a global shift over the last 20 years in people’s perception of psychedelics: a result of the growing number of research trials indicating psychedelics’ therapeutic efficacy. At the time of writing, psychedelic therapy trials are live in over 300 locations worldwide including many top-flight universities.
In terms of access to psychedelic treatments, things are even further ahead globally. Australia recently became the first country in the world to officially recognise certain psychedelics as medicines; from July 2023 approved psychiatrists can prescribe MDMA and psilocybin for what is medically labelled PTSD and TRD (treatment resistant depression) respectively. Consultant psychiatrist, founder of Bristol's Awakn Life Sciences and leading psychedelics researcher Ben Sessa is currently working with Australia’s Mind Medicine on their psychedelic assisted therapy training programme. In the US, Oregon legalised the use of psilocybin in supervised therapeutic settings back in 2020, while Colorado recently decriminalised personal use of psilocybin and other psychedelics. From January 2022, Canada amended its Special Access Program (SAP) to make it much easier to obtain the necessary permits to carry out psychedelic assisted therapy. In January 2023, Senate Bill 58 was introduced in California that, if passed, will allow for ‘facilitated or supported’ use of psilocybin from January 2025. Other countries have taken an even more progressive stance, with psychedelic retreats being legal and commonplace in the Netherlands, Portugal and Jamaica. The last decade or so has also seen a huge rise in psychedelic tourism in parts of the Amazon, particularly in Brazil, Colombia and Peru, where seekers can attend medicine ceremonies that resemble the indigenous practices of those regions.
Where are we in the UK right now? Trials are happening in various locations around the UK. In 2019, Imperial College London opened a dedicated psychedelic research centre with Professor Nutt at the helm. Notably, in conjunction with Bristol and London-based psychedelic research company Awakn Life Sciences, the University of Exeter is conducting a phase III trial into the efficacy of ketamine assisted therapy for alcohol addiction. Ketamine - a dissociative anaesthetic with psychedelic-like effects - is further ahead than the classic psychedelics, mainly because it already has a legal status as a medication. In the pharmaceutical model, Phase III trials are usually the last step before a treatment enters the market, so it appears that a change in UK law is only a matter of time as the evidence for the benefit of psychedelic assisted therapy mounts. There is some hope in the field that psychedelic assisted therapy treatments will be available in some form on the NHS within the next five years.
With the scene now loosely set, I will now move onto the psychedelic experience and how this can be therapeutic.
The psychedelic experience
The psychedelic experience is impossible to pin down, having more to do with the mindset of the individual and the setting in which psychedelics are taken as some measurable action upon the biology of the human organism. This is partly why, as medicines, they do not fit into our accepted Western medical paradigm, which mostly understands drugs in terms of biological action, rather than action at the level of experience.
I cannot state this strongly enough: psychedelics bear no similarity with current psychopharmacological medicines. The ubiquitously prescribed antidepressants (mostly SSRIs), for example, when effective seem to dampen down negative thoughts and feelings so they are less troubling. Antidepressants are taken daily and often for long periods of time, if not indefinitely. At best, antidepressants offer a useful technology for the dulling of distressing inner experience. Psychedelics, on the other hand, amplify what is there, rather than dampening it. While this might sound frightening - and psychedelic experiences can often be difficult - it affords the opportunity to work with and modulate our experience by turning towards it, rather than away. Stanislav Grof, who spent 30 years researching LSD therapy, called psychedelics “Non-specific amplifiers of the human unconscious”. Through this amplification, or expansion, psychedelics connect us with the deep psyche (layers of unconscious process and experience) often in an immediate, visceral way. While sometimes challenging, if experienced in a safe-setting, psychedelics can powerfully aid our getting unstuck, to process the energetic disturbances of past experience, and to start moving in new, growthful directions.
Often, people who have had a deep psychedelic experience will say it is ineffable: words cannot accurately capture it. I think that this is partly because human language exists within the structures of everyday “consensus consciousness”, whereas psychedelics take us into alternative realms, or expanded states of consciousness which cannot be captured with our existing repertoire of linguistic concepts in a satisfying way. What we can communicate is that most psychedelic experiences of medium to high dosage involve pronounced perceptual changes including visual, auditory, olfactory, tactile and taste. For example, colours appear more intense. Objects in the visual field move and morph, there might be moving geometric patterns and textures that are not perceived when in everyday consensus consciousness. With eyes closed, brightly coloured geometric patterns and dream-like visions may appear. The experience of listening to music can be greatly enhanced. All the senses are intensified. There may be synesthesia - the experience of one sense being perceived through another, for example, seeing lights and patterns that move in time with music.
There are powerful emotional and cognitive expansions: enhanced feeling states and spontaneous, novel cognitions. Memories often surface, which are then available for exploration. People often report being able to think in new ways about their lives: their history, their personal lived experience, while ‘feeling out’ their own inner emotional truth in new ways. Psychedelics rekindle a sense of childlike novelty; every day experiences take on a renewed sense of meaning: interest, beauty, humour and significance.
At higher doses, psychedelics can also induce peak ‘non-dual’ states that are described in our culture as either ‘mystical’ - a term that links psychedelic experiences to religious concepts, or an ‘ego-death’ - which owes more to Western, psychoanalytic thinking. In both senses, people of our Western culture commonly report a reduction in the sense of an individual self, a sense of connection, unity or oneness with nature, the planet and the universe, often with a sense that ‘love’ and an all-encompassing intelligence are core structures of reality. There are obvious connections between the peak psychedelic experience and religious concepts related to the transcendence of suffering such as the Buddhist Nirvana, Christian Heaven, Hindu Svarga and so on. When viewed through this lens, for example, the teaching of Jesus as recounted in the Gospels certainly accord with the expanded states of consciousness commonly accessed in peak psychedelic experiences:
“..behold, the kingdom of God is within you.” (Luke 17:21)
For many people, throughout history, the hyperreality of the non-duel (no-self) experience - induced by psychedelics or other means - precludes all explanations other than the spiritual. Herein lies the origin of all religion.
Conversely, the materialist view argues that, while no less beneficial to the human species, mystical experiences are simply the product of the altered brain states; whether caused by psychedelics, meditation, sensory deprivation, fasting, breathwork, or human experiences which we commonly label as psychosis, there is no such spiritual reality that exists independently of the biological organism.
Either way, completely unlike current mainstream psychopharmacological treatments, it is the inherently experiential, participatory nature of the psychedelic experience that is the healing potential.
Across the trials, it appears that the psychedelic experience bookended with preparatory, and integrational talking therapy seems to be most effective. In the next section, I will explore more about the psychedelic experience, how and why it is therapeutic, especially in conjunction with talking therapy.
The integration of psychedelics with talking therapy
What we currently know about the biological mechanism of psychedelics is that they mimic one of our neurotransmitters (usually serotonin) producing the range of subjective, often profound, alterations to everyday consciousness. Functional MRI data - brain scans - appear to show that psychedelics induce entropy into the brain: they disrupt our usual patterns of neural communication and create new, novel connections between brain regions that do not usually appear to communicate; is is suggested that this creates a widow of neuroplasticity through which molecular and subcellular changes can occur in the brain. Changes in the subjective sense of self are explained with reference to a range of brain areas called the Default Mode Network, or DMN. The DMN is believed to be the brain-system through which our sense of self arises; psychedelics reduce activity in these areas of the brain which can result in drastic changes to our sense of self. It is also suggested that certain distressing experiences that involve excessive self-rumination, such as we label depression, anxiety, OCD, and body-dysmorphic conditions show heightened activity in the DMN. That psychedelics reduce activity in the DMN may be a reason why they seem to offer relief in these types of distressing experience.
To compare this with the individual, non-psychedelic counselling process, something I notice that connects many individuals who I meet in my counselling practice is a sense of stuckness and counterproductivity around certain ways of thinking, feeling and behaving. The work we do often involves a deep exploration of these lived experiences. It is through this process, occuring within a co-created intersubjective relational field - two unique people engaging in a focussed interaction - that new, more satisfying ways of being can emerge.
Neuroscience now demonstrates how such stuck, repetitive patterns of thought, feeling and behaviour correspond to neural networks in the brain. Think of a canal boat that can travel freely forward and backwards on the canal, but it cannot travel in a different direction, out of the water, so-to-speak. Building new canals i.e., novel ways of thinking, feeling and behaving are much more difficult to achieve as adults as our brains are naturally less flexible. The canal boat analogy is not mine. Professor Robin Carhart-Harris, now Director of Psychedelics at The University of California, coined the term ‘canalisation’ to conceptualise the physiological process underlying the human experiences that are categorised and labelled as mental-health conditions. People who we label with depression, anxiety, OCD, eating disorders, addictions and so on have, in one sense, become stuck in their mental canals; they have lost a degree of flexibility within their psyche and are thus temporarily unable to change, heal and grow out of their self-defeating patterns. The process of counselling, therefore, can often involve working through this stuckness in order to - hopefully - step out of whatever ruts we are caught in to find new, more satisfying experiences and ways of being: to move from rigidity to flexibility.
Here’s the thing.. psychedelics seem to facilitate exactly this process. They can be seen as a tool that can connect us to the deeper layers of our own psyche, facilitating deeper understandings of our own emotions, behaviours and motivations outside of our everyday frame. Psychedelics widen the lens through which we perceive and experience. As this parallels a core aspect of the counselling process, it is no surprise that psychedelics are useful therapeutically, and that the two approaches complement one another. While a part of me winces when I hear the trope “A psychedelic experience is like 10 years of therapy in one night”, another part of me nods - psychedelics often catalyse therapeutic breakthroughs.
Psychedelics within the Western medical model
While a full discussion of the following is beyond the scope of this blog post, I want to acknowledge that there are challenges ahead in terms of how psychedelic assisted therapy is funded and accessed. There is an obvious tension between the positive shift in attitudes, laws and increasing access to these incredible, undefinable compounds, and the current capitalist system, with its bloodlust for consumption and profit, that is already doggedly pursuing the commoditisation of the psychedelic experience. The international psychedelic research company Compass Pathways, for example, has been attempting to patent aspects of psychedelic assisted therapy for a number of years already. While Compass will see this as a necessary means of ensuring progress and ultimately access, is the type of progress we need?
A major difference between psychedelic therapy and other psychopharmacological treatments is that psychedelics do not require ongoing, daily dosing. It is easy to see why antidepressants have proliferated as the main line of treatment for a range of mental health conditions, despite a relatively low demonstratable efficacy: they are taken daily, often for the rest of someone’s life, which maintains a high demand and thus huge profits for the pharmaceutical industry. Conversely, psychedelic treatments typically involve only one or two doses that might not need to be repeated for months, if at all. This does not fit into the current pharmaceutical paradigm. A more cynical person than myself might suggest that there is a conflict of interest in a profit-driven industry providing mental health treatments. After all, were we to have treatments that worked, rather than merely managed symptoms, people wouldn’t need their repeat prescriptions and the market would shrink. I acknowledge that, to a degree, this tension also exists in my work as a counsellor in private practice whereby my ability to do the job is predicated on the availability of clients able to pay.
Another challenge is that psychedelic treatments are more expensive, given the length of a psychedelic journey and the cost of the team needed to deliver it. While there are no actual figures yet, some people are estimating the cost of accessing psychedelic therapy in Australia will be in the region of $10,000 to $20,000 (£5,500 - £11,000), placing this out of reach for most individuals. From a social justice perspective, it is imperative that psychedelic treatments do not become available solely to the rich.
But we don’t have another system yet; currently the only way for psychedelics to become accessible legally in the West is through the evidence-based medical model, which requires the backing of the pharmaceutical industry, which necessitates a race for patents and IP ownership. Despite what is evident to almost anyone who has tried them therapeutically - that psychedelics can help us change, heal and grow - only a continuous flow of evidence within the existing scientific paradigm will lead to the policy change needed to create access.
There is also the issue of how the commoditisation of psychedelics in the West can be seen as a form of contemporary colonialism, given that the history of psychedelics is rooted in indigenous cultures around the world. The Naut sa mawt Centre for Psychedelic Research at Vancouver Island University, BC, seeks to further psychedelic science while at the same time benefiting First Nations communities. In their own words:
“We aim to pave the way for research-informed programming that promotes reconciliation with ourselves; with one another; with the natural and spiritual world.”
In conclusion..
Psychedelics are powerful agents of change, with the capacity to revolutionise our approach to mental health treatment globally. And of course the cure we really need isn’t another drug, but a radical shift in human behaviour and society that addresses not the individual ailment but the systemic factors underpinning and exacerbating much of our modern forms of distress. We live with increasing existential anxiety: the fallout from the Covid pandemic, the fastest fall in living standards since records began, extreme wealth inequality, the rampant, febrile consumption and the cataclysmic climate collapse haunting our collective psyche. None of this is going to be changed by a trip or two in a clinic.
However, given that psychedelics are essentially non-harmful and offer individuals who are seeking change a reasonable possibility of insight, deep-feeling and growth, I believe they should be legal and accessible to anyone who makes an informed decision to momentarily expand their consciousness.
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