Stop me if you’ve heard this one before: People are sad. Not just normally so—they’re depressed. But a drug is coming, and it’s going to make us happier, more resilient, more attuned to those around us, help us relocate our real selves underneath all this horror. It’ll be swift and simple.
This was the plug for Prozac when it first came on the market in 1988. But take a look around and you’ll have to concede that when it comes to our psyches, lions have yet to lay down with lambs. No matter: A new therapeutic savior has arrived in the form of psychedelics.
MDMA, LSD, psilocybin (the psychoactive substance in mushrooms), and ketamine—which has traditionally been used as an anesthetic but because it causes hallucinations at lower doses is often classified as a psychedelic—have all shown promise in treating severe depression, post-traumatic stress disorder, and other mental illnesses in clinical trials. The concept has become so mainstream that you can’t toss a fungus without hitting an article on “the psychedelic revolution in psychiatry,” even though these drugs (save ketamine) are still illegal under federal law and their legal use is largely contained to trials approved by the US Food and Drug Administration.
Many of these drugs have been used for thousands of years in Indigenous cultures to heal physical pain, mark life transitions, or as part of religious rituals. At the helm of this new pharmaceutical “revolution,” however, is an alliance between traditional psychiatry—including at prestigious research facilities like the Multidisciplinary Association for Psychedelic Studies (MAPS), New York University, and the Johns Hopkins Center for Psychedelic and Consciousness Research— and their financial backers, many of whom come from the world of startups, venture capital, and Big Tech.
Research into the medicinal uses of psychedelics is imperative, and those advancing it (and using its findings to advance broad access) should be praised. But in addition to funding academic research, the businesspeople involved—who tend to be white and male, like most in venture capital—have also started private treatment clinics where clients take a controlled dose of ketamine and (at some) work with an onsite mental health professional to “process” what they experienced while under the influence. Insurance very rarely covers this treatment, so people pay anywhere from $350 to $1,000 out-of-pocket for a session. And more is coming. Companies like MindMed and Compass Pathways are conducting research into other psychedelics in hopes that when those drugs are approved for clinical use, it will be possible to reproduce this model.
If you think it’s a little strange that Big Tech—currently best known for breaking democracy, enabling the spread of medical misinformation, and knowingly endangering the mental health of children—would suddenly be concerned with our well-being, you aren’t alone, and you’re right to be suspicious. A generous take on their involvement would be yes, and: They are generally interested in both healing people and making money, which is how it works in a free market economy. A more cynical read would be that this is purely opportunistic. They helped create the disease, and now they want to hoard the cure.
For Western psychiatry, the psychedelic revolution is coming at the perfect moment. There hasn’t been a blockbuster pharmaceutical since the SSRIs debuted more than 30 years ago, and while many credit Prozac and its ilk with alleviating distressing symptoms, there has been widespread disagreement over the effectiveness of SSRIs since their debut.
Psychedelics are supposed to be the antidote to all that. Contrary to conservative fears, doctors broadly agree that psychedelics aren’t physically addictive. In some studies, participants taking psychedelics experienced a greater reduction in depressive symptoms than those taking SSRIs. Best of all, they’re supposed to be effective after just a few doses, although how long their effects last remains up for debate.
When touting the potential benefits of these drugs, clinicians who work in this sphere tend to favor medical terminology. They talk about “targeted,” “evidence-based” treatment regimens that act on specific neurotransmitters. And they like to cite “neuroplasticity,” the idea that the brain can change its structure in response to input or experience. Doctors maintain that psychedelics must go through clinical trials and gain FDA approval because ingesting them carries some (rare) risks and the substances don’t interact well with certain medications. At the same time, companies looking to market them stress that these drugs are low-risk to calm anyone who has preconceived notions about psychedelics.
Problem is, it’s deeply naive to expect that individuals who run for-profit businesses—and the projected profits are huge—will be satisfied keeping their customer base limited to those with specific, diagnosable mental health conditions. Given that they’ve doubled down on the “medical usage only” party line, the main path forward for these companies is to convince more and more people that they, too, suffer from these conditions, essentially mirroring past tactics of traditional pharmaceutical companies.
To wit, few of these investors have neglected, during their media blitzes, to cite the “increased need” for mental health treatment post-pandemic, despite disagreement among researchers about whether mental illness has actually risen globally since the onset of the coronavirus. And it’s similarly irrational to believe these companies when they market their treatments as being for one-time use only, which makes no sense from a financial standpoint. Their raison d’être is making products that you have to return to again and again, like social media platforms.
One way of creating repeat customers is to broaden the list of conditions psychedelics might help, thus increasing the potential number of consumers. A recent press release for Nushama, a New York City-based ketamine clinic founded by two men with backgrounds in finance and law, listed a dizzying array of conditions ketamine could potentially treat, including depression, anxiety, chronic pain, addiction, “trauma-induced mood disorders,” “trauma-related OCD,” eating disorders, and IBS.
Nushama medical director Elena Ocher, whose background is in medical pain management, said the list of conditions the drug treats is based on data from clinical trials, "combined with studied applications, our clinical practice, and empirical medical experience.” The clinic provided a list of studies conducted on ketamine’s application in the treatment of PTSD, anorexia, OCD, and substance use disorders, though it stipulated that all were “small in scale.” Will Siu, a Harvard- and Oxford-trained psychiatrist who uses ketamine in his private practice and independently reviewed Nushama’s press release, says, “It’s complete baloney. The only thing that there is evidence for with ketamine—strong—is treatment-resistant depression.”
Another way to make more money is to keep moving the goalposts for what “better” means. Fine? Content? Euphoric? What the companies have to do, essentially, is make any bad feeling, no matter how appropriate or logical in context, into a symptom of a mental illness that needs to be cured. Look at the websites of many of these clinics, and you’ll see this insidious kind of paternalism at work. Cute infographics suggest you might be a potential patient if you have an opioid dependency or are depressed, but also if you “feel blocked,” are “lacking purpose,” or struggle with “stress,” as if they’re all stars in the same constellation of disease, when in reality, many are natural, unavoidable parts of life, that cannot, and likely should not, be medicated away.
Finally, they can lean on, but not directly utilize, the idea that psychedelics facilitate good old-fashioned self-improvement. Because psychedelic usage has long had a sheen of the spiritual (something no one could ever say of a product made by Eli Lilly), there’s always been the parallel narrative of psychedelics as natural healing tools, utilized by shamans or secret facilitators, which means they have long appealed to seekers and others who might not view their struggles through a medical lens.
So although the companies filling their coffers insist that psychedelics are specialized treatments for specific mental health disorders and should only be consumed in medical settings, they undercut their own message by borrowing heavily from the wellness vernacular. An appointment becomes a “journey” or a “guided experience.” Ketamine clinics like Field Trip Health look like they were decorated by Instagram algorithms—neutral palettes, the occasional Buddha statue, abundant plant life—and are stocked with the kinds of products beloved by woo aficionados, like weighted blankets and zero gravity armchairs. (On occasion, there is merchandise for purchase.) There are also lots of ancillary pleasantries, like sound baths and journaling. Lovely to have, sure, but certainly extra-medical.
At these places, the accompanying therapy isn’t a means of turning hysterical misery into common unhappiness, as Freud once wrote; it is a way of “expand[ing] your human potential” or “a catalyst … to access your healing or breakthrough.” There is the oft-repeated promise that individual change can usher in the utopian era. The word “optimization,” that ominous, ubiquitous term that brings to mind Jack Dorsey’s one-meal-a-day regimen, is particularly overused.
By blurring the lines between mental illness and the stressors of everyday life, and between medical treatment and spiritual healing, these financial backers are able to market their products to the widest number of people, including those with documented mental health issues (although some of the most pressing cases, like people with a history of psychosis or severe suicidal ideation, are often ineligible), the “worried well,” and spiritual seekers. But framing the stressors of everyday life as symptoms of mental illness is a philosophically perilous and surely futile pursuit. As critics of the wellness industry have pointed out, even though the language used by its proponents is often centered around self love, its unmistakable subtext is that we are fundamentally broken, that we could be better, and that we need to be fixed. The apex of health and happiness, marketed to us as something attainable, is kept tantalizing out of reach by design so that we’ll suffer through that next cleanse, buy that next brand of supplements, or take that next drug on our journey to health Xanadu. And this endless striving is exactly what companies want because it brings you right back to them.
There are rumblings of concern from physicians about the potential impact of this commercialization, which borrows from the professional lens of some (doctors) and the caretaking of others (Indigenous elders, therapists) to gain legitimacy for these trend- and profit-driven endeavors. “It is critically important that the medical and scientific communities be vigilant in opposing the conflation of science with larger cultural agendas, as occurred in the 1970s with the blending of psychedelics into the antiwar and other anti-establishment movements,” three psychiatrists, two of whom are affiliated with Johns Hopkins, wrote in a December 2020 JAMA op-ed.
But with all due respect to the worried doctors, we’ve already crossed the Rubicon. The latest indication that psychedelics are not solely medical was when Mark Haden of MAPS Canada appeared on Netflix’s the goop lab and nodded sympathetically as (now-former) chief content officer Elise Loehnen talked about goop staffers taking mushrooms in Jamaica in order to “feel more creative” or “have a psycho-spiritual experience.” Doctors allow this mission creep every time they let their COOs serve as their mouthpieces and spout corporate rot on their behalf.
Though their profits depend on convincing you that you need a professional—the professionals they hire—it turns out that most of these entrepreneurs believe themselves to have been healed without such detailed and expensive protocols.
In interview after interview, the bigwigs behind these clinics and research companies talk about taking psychedelics in non-medical settings and/or for reasons that amount to personal growth—and they reaped the benefits anyway. Joe Green, an entrepreneur who helped raise $30 million for MAPS, told the The Wall Street Journal his experience with psychedelics helped him “rediscover wonder.” Dylan Beynon, who founded the ketamine clinic Mindbloom, told the blog EightSleep that he became interested in psychedelic medicine after a friend recommended he try MDMA. Similarly, an investor recommended psilocybin to Lars Wilde, a serial entrepreneur who cofounded Compass Pathways with George Goldsmith. (Major funders of Compass include Peter Thiel and investor Christian Angermayer, whose first trip was with friends on a beach in the Caribbean.) Presumably, none of these investor-friends was moonlighting as an MD.
So if these men safely enjoyed the benefits of psychedelics in a wellness context, why pursue the medical route at all? Why not go full goop? First, the underground psychedelic market already exists, and dyed-in-the-wool spiritual seekers are unlikely to care much about whether the FDA has approved a drug, so they don’t represent an untapped source of profit. But crucially, it’s unlikely that all but a few states will legalize psychedelics for broad consumption anytime soon, so using medicine as a back door allows tech companies to take advantage of a burgeoning market before anyone else is able to.
By keeping these drugs behind gates to which they hold the keys, they ensure a certain kind of clientele will be best positioned to gain entry—people with disposable income or really good insurance, given that ketamine infusions plus medical oversight plus hours of “processing” with a therapist cost much more than a pill on the street—while populations who’ve been historically less able to access good health care or have been disproportionately penalized for drug use (namely, the poor) will be locked out. This way, they can court potential customers who might be afraid of the risks, or who associate drug-taking with degeneracy and dependency, and whose hesitancy will be lessened by a medical imprimatur.
Sure, various parties make occasional mention of “democratizing” their services, but that’s part of their big utopian long con. Given time, their monopolistic hungers inevitably surface. For example, David Bronner, a supporter of the Oregon bill to make psilocybin legal in therapeutic settings, recently accused Compass Pathways of trying to “mobilize opposition” to legalization so Compass could have greater control of the market by being the only one offering the service. (Compass’ CEO told Vice that he “just wanted to have a conversation” about the bill.)
And of all the groups to define mental well-being and tell you how to achieve it, you’d be hard-pressed to find a worse one than white tech dudes with money. Their obsession with global connectivity has made many of us more emotionally distant from each other (ironically convenient, as they can cite “disconnection” as a symptom of depression, making them the mental health equivalent of firefighter arsonists). The omnipresence of social media has shown us the dark side of self-optimization, and how cavalierly platforms treat the data of individual users. Finally, their prioritization of growth over stewardship means companies tend to balloon before being hollowed out, leaving behind a trail of burned-out, disenfranchised employees and disgruntled users, which bodes poorly when you’re working with vulnerable populations. Many previous forays into mental health care have been marred by scandal and inefficiency, with companies like Talkspace being accused of opacity and unethical conduct, and others like BetterHelp with the more benign sin of overpromising—an amazing therapist, on call 24/7!—and under-delivering with a bot that doesn’t always respond.
Psychedelics haven’t captured our attention for brute capitalist reasons alone. Many people are suffering, and psychedelics can radically shift people’s mindsets and lead to meaningful personal growth, sometimes after only a single use—I count myself among those who have had positive experiences. It’s important that we let those who feel they would benefit from psychedelics have the option of trying them.
But instead of handing over the reins to a group with a long track record of corroding our collective mental and spiritual health, what if we listened to those with experience using psychedelics to heal people? If we want to honor the way psychedelics have been conceived of for thousands of years in Indigenous communities—which there is some attempt to do, to be fair, but it's often tokenizing—then we will turn to the psychedelic practitioners, doulas, and other guides, many of whom have operated underground for years due to fear of prosecution.
Ideally, we’d work toward federally decriminalizing, regulating, and legalizing recreational use of psychedelics at people’s discretion and educate individuals about how to set themselves up to have a safe, enjoyable trip. Enacting this kind of policy change would be the real revolution we need.
If psychedelics are as low-risk as many nascent startups are telling us, then we have no more to fear from psychedelics than we do from alcohol, which is habit-forming and can be very harmful to consumers’ health. In fact, the psychiatrists I spoke to were broadly in favor of this approach and defined situations that might require scientific or medical oversight very narrowly, mainly for users with long histories of intractable mental illness, or to run trials on conditions that have not yet been treated with psychedelics, like fibromyalgia.
Joanna Moncrieff, a psychiatrist at University College London who has written skeptically about psychedelics before, says she is “a bit of a libertarian on this. I really think drugs should be legalized, but not medicalized. I think psychedelics might help in personal development, same as all drugs, but I don’t think that’s a medical process. Climbing up a mountain helps us with our personal development. That’s not a medical process.” Siu told me he gained his knowledge of psychedelics mostly by “trial and error,” taking them alone in his dorm room during med school, and he feels comfortable with others experimenting the same way. “It would be a tragedy if [psychedelics were] only available to people through prescriptions. People should be free to explore their consciousness.”
The psychedelic companies often say they are scaling best practices and putting safeguards in place for the sake of both consumers and doctors, though that hasn’t always kept people from being harmed. But the information about how to take psychedelics safely is simple enough to understand, and easy enough to disseminate, that if we regulate the market and provide ample testing to ensure product quality, we don’t really need the services of these companies. Those with the wisdom of experience could soft-train lay people in harm reduction methods or a psychedelic equivalent of Mental Health First Aid, which teaches bystanders to recognize psychological crisis, a grassroots version of which was practiced at the height of psychedelic use in the 1960s and today. The Zendo Project, an initiative of MAPS, provides such harm reduction at events like Burning Man. We could widely educate potential users about the notion of “set and setting," a concept coined by the pioneering psychedelic researchers to stress the importance of mindset and environment, so they could choose the right environment and select trusted loved ones to be with them while they tripped.
Don’t believe Big Tech when they tell you you need their weightless bean bag chairs and offices filled with shrubbery and medical validation. You deserve to take drugs on the beach with your friends, just like they did.