BENJAMIN Y. FONG (Jacobin Magazine)
Pharma companies and shrewd investors are poised to make massive profits off the medical legalization of psychedelics. For now, they’re united with the psychedelic movement’s true believers — an uneasy truce that must break in one party’s favor.
Before he turned his focus to psychedelic medicine, Dr German Ascani felt disenchanted with his psychiatric practice. Since the biological revolution in psychiatry in the ’70s and ’80s, after which most mental disorders came to be seen as chemical imbalances in the brain, psychiatrists have been talking less and prescribing more. The absence of relational therapy and the overreliance on medications like Prozac made Ascani feel “dead inside going to work.”
Exposure to the research of Philip Wolfson, who was experimenting with ketamine-assisted psychotherapy, provided a breath of fresh air. When an opportunity presented itself to work with Wolfson and Julane Andries in 2017, at the Center for Transformational Psychotherapy, Ascani jumped at the chance. “It was a game changer,” Ascani explained to me. “It really infused my practice and [reinvigorated] my curiosity for psychiatry and mental health again.” He now works at Evolve Mind Wellness in Sebastopol, California, where he does ketamine-assisted therapy and “integrative psychiatry,” which incorporates the use of natural substances into psychiatric care. “It’s so much richer and more fulfilling for me than the way I was practicing before,” Ascani concluded.
Ascani is now preparing to add MDMA-assisted psychotherapy to his range of offered services. And like many psychedelic doctors, he’s actively training through the Multidisciplinary Association for Psychedelic Studies, or MAPS, to do so. In Ascani’s view, ketamine laid the “infrastructure, the groundwork for practicing psychedelic medicine in general,” but it will soon be one of many tools — including MDMA, psilocybin, and LSD — in the psychedelic practitioner’s tool belt. MDMA, for instance, is on track for a 2023 FDA approval, and the Biden administration is already preparing for the imminent legalization of MDMA and psilocybin therapies. Psychedelic Bidenism seems to be in our immediate future.
MDMA, psilocybin, and LSD are all currently Schedule I substances, defined as “drugs with no currently accepted medical use and a high potential for abuse.” It’s thus natural to wonder why everyone is now so certain that all of these substances will very soon be legal prescription medications. Even in light of the recent sea change in cultural attitudes toward psychedelics, it seems quite the gamble to be banking on drugs officially regarded as no different from heroin to be rendered acceptable anytime soon. But practitioners and psychedelic investors alike are confident that things will work out in their favor.
Previous iterations of research into psychedelic therapeutics — like that on LSD by psychiatrists Humphry Osmond, Sidney Cohen, and Oscar Janiger in the ’50s and ’60s, and on MDMA by psychologist Leo Zeff in the ’70s — ended in heartbreak for clinicians. Promising findings about their curative potential were ignored as the broader culture took a hard line against psychedelics. Some clinicians and researchers grew bitter toward the countercultural excess that had invited reaction; others were appalled at the ease with which the general public could be worked up into a drug scare. Still others, like Rick Doblin at MAPS, waited patiently for the storm to blow over, believing that psychedelic-assisted psychotherapy’s day would come again.
While that day appears to have arrived, Ascani warns that nothing is guaranteed. “Prohibition [of psychedelics] was a political act. These substances were said to have no medical value and a high potential for addiction, when that’s really not the case.” He added, “A lot of these substances are safer than opiates and benzodiazepines [and other] things I used to prescribe every day.” If the current prohibition does come to an end, Ascani believes that the victory will owe to rigorous and transparent science, particularly the “really good data and the open science that MAPS has pioneered.”
The Broken Paradigm
Today, one in three Americans suffers from anxiety, depression, or both (globally, that number is about one in twenty), and one in six Americans is on a psychiatric medication. These numbers reflect the broader trend that about half of all mental illnesses go untreated.
The sources of the current mental health crisis are numerous and varied, but two causes must be mentioned in any serious account. The first is the current fragile state of American society. In the last fifty or so years, incomes have stagnated, personal debt has skyrocketed, politics and culture have become hyperpolarized, and communal life has collapsed, leaving Americans materially insecure, fearful, and atomized — all feelings exacerbated of late by the COVID-19 pandemic. Naturally, these social conditions take a toll on people’s mental health.
Nigel note, I worked in mental health support and have always thought that the erodion of communal life is at the heart of our problems, capitalism has scattered us to the winds and destroyed families. I believe this is intentional isolated we feel less solidarity with our neighbours, making resistance less likely.
The second is the dysfunctionality of mental health care itself, a component of the broader practical absurdities of the American health care system, but also a problem with its own particular history. In the last half century, Americans have fallen prey to what medical historian Edward Shorter calls “neurotransmitter chatter.” Psychiatrists agree that troubled human beings are, from their professional perspective, no more than broken brains. Patients have adopted this outlook too. As Joseph E. Davis argues in Chemically Imbalanced, many have so thoroughly absorbed the language of the biological revolution that they now explain their own conditions in terms of dopamine and synapses, as though this vocabulary were adequate to the task of describing human interiority. The convenient result for pharmaceutical companies and insurers is that the solution to every psychiatric problem is a pill, typically taken on a regular basis.
This model of care is reductive, callous, and existentially insulting. And to make matters worse, the drugs aren’t even good. This is partially the result of a misguided preference for site-specific drugs (like SSRIs and SNRIs) over so-called “dirty” drugs with less specific actions. It’s also partially the result of the industry’s entire drug development model, which prioritizes chronic (i.e., moneymaking) over curative treatment. The case of Prozac is illustrative: in a majority of double-blind studies, sugar pills equal or outperform Prozac and similar antidepressants. Prozac also causes a small but significant number of people to become violent and suicidal, and users for whom it is effective sometimes get addicted and develop a tolerance to it. The drug that is virtually synonymous in the public imaginary with the profession of psychiatry is about as smart as the whole paradigm that has elevated it as a miracle cure.
The insufficiencies of this model have grown more glaring with each passing decade, and psychiatry no longer enjoys the hegemony it once had. Many Americans know they need help, and they know the prevailing mode of psychiatric care is deeply flawed. This is what distinguishes the psychedelic renaissance from previous moments when America’s dominant regime of “punitive prohibition” was relaxed. Americans like cocaine and marijuana. Today, from the sociological and psychopharmacological perspectives, they seem to need psychedelics.