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The psychedelic renaissance is at risk of missing the bigger picture

What we lose when psychedelics are medicalized.

Oshan Jarow is a staff writer with Vox's Future Perfect, where he focuses on the frontiers of political economy and consciousness studies. He covers topics ranging from guaranteed income and shorter workweeks to meditation and psychedelics.

It’s been quite the journey for psychedelics, and it’s just getting started. First, they were sacred and ceremonial plant medicines for millennia. In the 1960s era, they traversed an American culture of mind expansion, which used them as wild tools for transcending ordinary states of consciousness. Then came the backlash in the 1970s when they were outlawed by a nervous Nixon administration. Now, psychedelics are emerging from the underground as a new generation of researchers amasses evidence that mind-altering drugs offer new and effective therapies to help stem the rising tides of mental illness.

Funding for research and legalization efforts on psychedelics are ramping up across the US. In January alone, seven states introduced new psychedelic legislation that ranges from decriminalization to supervised adult use to psychiatric treatment. Abroad, Australia became the first country to legalize psilocybin — psychedelic mushrooms — and MDMA as prescribable medicines by psychiatrists. The US looks poised to follow, with the FDA potentially set to approve MDMA for therapy later this year.

These tectonic changes in drug policy are taking place against the backdrop of a US mental health crisis, one where existing treatments have fallen short: The World Health Organization’s (WHO) largest mental health report this century has termed current interventions “insufficient and inadequate.” Turning to psychoactive fungi for treatment-resistant mental illness is a sharp pivot, a sign of both the impoverishment of current approaches and the excitement around a genuinely novel remedy.

But as important as anything that can turn the tide on mental health is, the frenzy over transforming psychedelics into new treatments for illness obscures — and may even interfere with — their further potential to expand our understanding of what healthy minds could be. The deep history of psychedelics shows they have far more to offer than simply the next generation of psychiatric treatment.

Conventional psychiatry looks at mental disorders: clinically significant disturbances in areas that are important for day-to-day functioning, like emotional regulation, behavior, and thinking. But psychedelics, when used carefully, can do more than heal disturbances. The WHO’s founding constitution defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” Psychedelics can help shift attention toward reconfiguring the baseline of ordinary, non-impaired experience in ways that enrich what we call “normal.”

But fully harnessing these drugs may require a very different set of research and regulatory approaches than current conventional efforts focused on turning psychedelics into the next generation of therapeutic medicines. To make the most of what psychedelics can offer to the more expansive project of human flourishing, medicalizing isn’t enough. Regulators should consider allowing access outside a doctor’s office.

“The problem with the current biomedical vision is that it’s very much based on an individualistic understanding of mental health and human flourishing,” said Claudia Schwarz-Plaschg, a social scientist and visiting scholar at the University of Edinburgh’s Usher Institute who spent three years studying attitudes toward psychedelics in the US. “Medical interventions are geared towards making the individual fit better into society through therapeutic and substance-based interventions, but other approaches are more open towards a broader vision of how mental health issues and societal structures are producing each other,” she said.

Leaving psychedelics in the hands of the biomedical industry and state-regulated facilities can undermine their potential by excluding more diverse “sets and settings” (a term describing how psychological, social, and cultural factors all profoundly shape the kinds of trips one might experience) while leaving inequalities across race, culture, and class unaddressed.

But there is little consensus among researchers and policymakers on questions of access — from who gets access to where and how — in ways that could make the most of psychedelics’ benefits while balancing the potential risks.

Given the extent of the mental health crisis, policymakers should embrace new treatments to help those who suffer from mental illness. But in that embrace, we shouldn’t lose sight of what psychedelics can offer beyond psychiatry. Used holistically, these drugs can help expand our understanding of what healthier, richer, more flourishing states of consciousness might be like. The smothered dream of those hippies and former Harvard psychology professors who called on Americans to expand their minds with psychedelics could be revived in more prudent, diverse, and informed ways — provided we don’t box them in.

Why the psychedelic renaissance is focused on mental illness

In 1943, the Swiss chemist Albert Hofmann first discovered the effects of LSD, which is part of the family known as “classical” psychedelics. These also include psilocybin (magic mushrooms), mescaline (from the peyote cactus), and DMT. Classical psychedelics are non-addictive and bind to the brain’s serotonin receptors. That makes them unlike “non-classical” psychedelics such as ketamine and MDMA, which have different mechanisms of action in the brain and higher risks of side effects and abuse. (For example, in warm environments coupled with dehydration, MDMA can cause death via heatstroke, while ketamine could exacerbate existing heart conditions).

Like the psychedelic experience itself, there is no single narrative that fits the midcentury American trips that followed LSD’s introduction. It was a blooming, buzzing, revelatory confusion. LSD psychotherapy leaped into the Hollywood elite, the CIA experimented with the drug for mind control, and Jimi Hendrix front-manned a culture of Black psychedelia. But that experimentation largely came to an end in 1971 when President Richard Nixon’s Controlled Substances Act banned psychedelics (among other drugs) and stifled psychedelic research.

A black-and-white photo of Timothy Leary smiling, his arms behind him in handcuffs, as two men in ties on either side of him lead him.
Timothy Leary, the Harvard psychologist turned “high priest of LSD,” escorted by federal officers after his 1973 arrest.
Bettmann Archive/Getty Images

While the legislation forced those interested in psychedelics underground, they didn’t stay there long. By the 1990s, a mostly new generation of researchers had begun revisiting studies from the 1950s, while attitudes toward psychedelics within the FDA and DEA were softening. Regulators no longer saw them as exotic substances with unknown long-term consequences, but increasingly, just another potentially dangerous drug. By 1991, a series of legal challenges, together with the perseverance of researchers who believed psychedelics were worth studying, led to the first approval for human psychedelic research since the 1970s.

Regulatory hurdles to obtaining approval remained steep, and young scientists still risked their reputations by working with psychedelics. But a landmark paper published in the journal Psychopharmacology in 2006 on mushrooms and mystical experiences — where recipients reported mystical experiences with high personal significance that endured for months afterward — signaled the above-ground renaissance in scientific research was professionally viable, institutionally acceptable, and already underway.

This time, however, the focus was not directed toward expanding the mind, Timothy Leary-style, but alleviating mental illness. In part, this shift was a strategic response to the 1960s moral panic and 1970s legal action against psychedelics. By reintroducing psychedelics through the most accepted and controlled channels — medical research — scientists aimed to minimize the risk of another backlash.

The shift toward psychiatry was also a response to a clear need. By 2019–2020, approximately a fifth of all adults — over 50 million Americans, up from 39.8 million in 2008 — were reporting some kind of mental illness. The growing body of psychedelic research suggested significant promise in treating precisely the illnesses that were most widespread: depression, anxiety, and addiction. That list may continue to expand as research fans out into new areas, like eating disorders.

No single group of chemicals can solve the complexities of mental health, which extend beyond the individual mind to include social and political elements. But if recent research holds course, psychedelics may well provide much-needed relief while inspiring entirely new approaches to psychiatry. That’s especially vital given the lack of innovation in mental health treatments since SSRI antidepressants like Prozac were approved in the 1980s.

Still, a singular focus on making psychedelics into pharmaceutical medicines carries its own drawbacks, in part by isolating the psychoactive molecules themselves from the wider cultural practices that have traditionally been inseparable from the experience.

“Mainstream culture hears about psychedelics primarily through a medicalized or therapeutic lens,” said Ariel Clark, an Odawa Anishinaabe regulatory attorney based in California and a founding board member of the Psychedelic Bar Association. “But the use of sacred medicines in Indigenous paradigms of access really eclipse the medical use by far.”

As the Harvard theologian Rachael Peterson put it: “Important wisdom is lost when technologies of transcendence are stripped from their spiritual and religious contexts and presented as psychological treatments.” Now, a new generation of researchers is seeking to return a wider spiritual lens to targeted questions of therapy and neuroscience.

How psychedelics can enrich your mind

Until recently, there was little funding for psychedelic research on volunteers without diagnosed mental illness, what researchers sometimes call “healthy normals.” That’s why Roland Griffiths, director of the Johns Hopkins Center for Psychedelic and Consciousness Research, recently launched the Griffiths Fund. The fund supports research and a professorship at Hopkins to study the effects of psychedelics on well-being and secular spirituality in healthy volunteers. Griffiths, whose research has been pivotal in advancing the field since his 2006 paper helped launch the psychedelic renaissance, has called this “the most consequential direction for future psychedelic research.”

Roland R. Griffiths sitting on a white couch, half in yellow light and half in purple.
Roland Griffiths is the director of the Johns Hopkins Center for Psychedelic and Consciousness Research.
Andre Chung/Washington Post via Getty Images

The first recipient is David Yaden, an assistant professor at Johns Hopkins who works in the Center for Psychedelic and Consciousness Research. Prior to studying psychedelics at Hopkins, Yaden’s work focused on “self-transcendent experiences,” or altered states of consciousness achieved through drugs or other means, ranging from meditation and brain stimulation to simple walks in nature. While most research on psychedelics and spirituality has treated elements like mystical experiences as secondary to therapeutic outcomes, Yaden told me he plans to “confront the issue of spirituality” head-on, rather than as a side quest.

“I think it’s essential that the study of well-being is not lost in this emphasis on therapeutics,” Yaden told me. He calls this focus on whether and how psychedelics can improve well-being (even for those who aren’t mentally ill) the “positive program” of psychedelic research.

Although the Griffiths Fund is the first effort specifically dedicated to these questions in healthy volunteers, there already exists a small foundation of academic research on the subject. Most of it can be divided into two buckets: the observable effects of psychedelics on the brain and their subjective effects on the mind. This blurry relationship between the brain and the mind is one of the many mysteries psychedelics may help clarify.

We can record objective data on how LSD changes patterns of electrical activity in the brain with neuroimaging technologies like EEG and fMRI. But to capture the feeling of the psychedelic dissolution of the boundary between yourself and the world, we can only rely indirectly on people’s recollections. Mainstream psychedelic research leans toward what you can directly measure, but Yaden told me that the subjective experiences are a necessary part of any full explanation of the lasting benefits on well-being some psychedelic users report.

In the brain, psychedelics are associated with at least three groups of observable effects. They boost neuroplasticity, which supports the rewiring of existing neurons. They promote neurogenesis, which supports the creation of new brain cells. And they increase brain “entropy,” or the diversity, randomness, and unpredictability of electrical activity across brain regions.

Neuroplasticity likely plays a key role in addressing mental illness by enhancing the brain’s ability to rewire patterns of thought. Especially when paired with psychotherapy, psychedelic-induced neuroplasticity can help reshape harmful habits — from mental patterns of self-criticism to forms of addiction — into more beneficial ones.

While anyone can benefit from a little more neuroplasticity, which tends to decline with age, increasing brain entropy offers another explanation for the spectrum of benefits beyond treating illness. In 2014, Robin Carhart-Harris, a neuroscientist who was then the head of the Centre for Psychedelic Research at Imperial College London, published a landmark work on what he called “the entropic brain.” The basic idea is that what any state of consciousness feels like — and in particular, what he calls the “richness” of its feeling — depends on the amount of entropy in the associated brain activity. Brain entropy is low in reduced states of consciousness, like when you’re under general anesthesia. During altered states, from psychedelic trips to deep meditation, entropy is higher. In ordinary waking consciousness, it rests somewhere in the middle.

Carhart-Harris argues that the brain evolved an ability to strike a useful balance of entropy levels. In particular, he believes that the collection of regions known as the default-mode network (DMN) is primarily responsible for suppressing entropy in the ordinary brain. Doing so favors forms of cognition that help us make sense of our environments in ways that are useful for survival. “Equally however,” he writes in the paper, “it could be seen as exerting a limiting or narrowing influence on consciousness.”

Psychedelics reduce activity within the DMN, loosening its hold over entropy levels. The resulting high-entropy states may not have been the most beneficial for our ancestors on the savannah. (Predators would welcome blissed-out prey, marveling at their surroundings rather than scanning for threats). But for a species where basic survival can now mostly be taken for granted, these states may have much to offer. Beyond mere vacations into “richer” states of consciousness, entropic states can cast new light on the ordinary ones we return to when a trip subsides. Sometimes it’s tough to imagine how different something that’s grown so familiar can be — like the habitual ways we experience ourselves, those close to us, and the world — until we’ve had the direct experience of it being otherwise.

But Yaden emphasized that entropy, neuroplasticity, and all the other factors that we can observe with brain-imaging technologies are only part of the story. He calls these “lower-level neurobiological processes,” and adds that higher-level ones, like the subjective content of the experiences themselves, play a key role in explaining the benefits of psychedelics.

These fall into the hazier category of effects on the mind, where scientific tools awkwardly grasp for measurements that don’t come easy. To describe these parts of a trip, you must rely on imperfect language: mystical experience, ego death or dissolution, unselfing, oceanic boundlessness. They can run the spectrum from blissful to terrifying, and the quality and intensity of these experiences shape the long-term effects.

For example, one study found that higher scores of oceanic boundlessness during a trip (a term reaching all the way back to the 17th-century philosopher Baruch Spinoza, describing the sense of separation between self and world melting away, like a water droplet losing its separateness as it rejoins the ocean) were more predictive of long-term clinical benefits than basic hallucinatory effects (like seeing undulating geometric patterns). The interpretation was that when it comes to psychedelics, the ordinary and predictable relationship between dose and outcome isn’t as simple as with other drugs. Sometimes, the kind of experience someone has — and the set and setting in which that experience takes place — is more important than the dose of psychedelics they take.

While the majority of clinical psychedelic experiences are positive, this is likely because researchers have a great degree of control over risk factors. But the very measures of control that help ensure more positive experiences can also suppress the wider range of possibilities, just like the default-mode network’s regulation of entropy levels. The clinically controlled environments employed in research trials and regulated psychiatric contexts have their own set and setting that will tend to reproduce particular kinds of experiences while discouraging others. Many within the psychedelic community believe that greater freedoms in where, how, and in what company we take psychedelics are crucial for maximizing their benefits, especially in already healthy users.

States across the US are introducing varieties of psychedelic legislation that will lay the groundwork for what psychedelic access may come to look like domestically while also informing global strategies. “From a global perspective,” Schwarz-Plaschg writes in her ethnographic study, “the US can be understood as a test bed from which lessons might be drawn for how to best build a post-prohibitionist world for psychedelics.”

The debate over how to expand access to psychedelics

There’s an unavoidable tension in legislative efforts to shape this post-prohibitionist world. Supporting wider uses and benefits of psychedelics by making them easier to access means raising the risks for individuals, as well as the chances of another legal backlash. As states continue introducing new bills, there is no settled blueprint. Each approach explores different ways of balancing benefits and risks.

One approach gaining traction is the “adult-use” model pioneered in Oregon, which took effect at the start of 2023. Anyone over the age of 21 who can afford the cost (early estimates suggest as much as $1,000 per session, which would keep out all but the well-off) can sign up for a psychedelic service session. These can only take place at a service center approved by the Oregon Health Authority (OHA) under the supervision of facilitators who have completed one of the training programs vetted by the Oregon Psilocybin Services division of the OHA.

A comfortable chair with warm lighting in a room used for psychedelic therapy. Cole Burston/AFP via Getty Images

By eliminating the need for a medical diagnosis or referral, the adult-use model does expand access. But requiring the trip to occur inside a government-sanctioned room, under the supervision of a facilitator one may have very little relationship with, and without the company of others joining in the experience, can all run counter to the variety of social and nature-immersed ways Indigenous cultures have used psychedelics for generations.

Colorado recently went a step further, including a decriminalization component alongside adult-use legislation. This would allow citizens to possess, grow, and share psychedelics for personal use in whatever forms they see fit. But psychedelic researchers and practitioners disagree on permitting such unregulated access. Beyond concerns over the risks of psychedelic use in unregulated environments, there are further worries that decriminalization could undermine researchers’ ability to carry out rigorous clinical trials, or that an absence of restrictions on the quantity of psychedelics that can be grown for personal use will lead to a large black market supply for the drugs.

Beyond “where” and “how,” there is also the question of “when.” As Rick Doblin, director of the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit specializing in psychedelic research and education, told GQ in 2021, “medicalization precedes legalization.” But for how long?

There are two broad camps here. One (including Doblin) sees medicalization as the necessary path toward broader acceptance, arguing that mounting evidence of medical benefits will gradually turn public opinion in favor of wider access to psychedelics. The other camp sees medicalization as a sort of waiting room that will slow legalization efforts.

Clark echoed the idea that careful regulatory policy is essential, but rejected that medicalization is the best approach in the meantime. As she pointed out to me, holding psychedelics in an exclusively medicalized waiting room could worsen the existing diversity problem. “You want to talk about the history of Black people or Native people with the medical establishment?” Clark said. “Who’s driving the conversation around the medical and therapeutic being the safest and only way?”

There is also the uncomfortable matter of psychedelic capitalism. The reservation of early access to psychedelics for pharmaceutical companies, medical researchers, and opportunistic investors is transforming the psychedelic industry — including the drugs themselves — before it even reaches the public. Broadly, the concern is that capitalism’s profit motive won’t necessarily support the prudent research, rollout, and harm reduction measures that can help ensure a smooth and equitable reintroduction.

Schwarz-Plaschg said that a complementary non-biomedical focus (like decriminalization) would help maximize the benefits. “The broader the spectrum of psychedelic services and legal uses in society, the more people will be reached who can benefit in their own flourishing, and that will enable society to flourish more in the long term.”

But the sometimes strained move from biomedical to recreational legalization in cannabis suggests the need for prudence. Businesses that deal with a substance legalized by the state but still outlawed by the federal government face a variety of elevated costs (for example, they can’t deduct business expenses from their federal taxes and struggle to find willing insurers). The odds of success in the industry are stacked toward large corporate entities with money to blow. “We have to go slow to go fast,” Clark told me. “That is a huge lesson from cannabis, and with psychedelics, there’s even more reason to go slow at the beginning. It’s the foundational stages that matter the most because of these huge, important, intersectional issues.”

The current moment presents an opportunity to engage deep representation and participation from all stakeholders of psychedelic drugs and sacred plant medicines alike. Colonial tensions are baked into the psychedelic renaissance, but movements to decolonize the industry can elevate a commitment to equity while helping to expand the conversation around different models of access.

These Indigenous approaches vary by culture and place, but generally share a few themes. First, as Clark explained, psychedelics are not seen as substances you “take,” like an aspirin or an antidepressant, but as entities that you enter into relationship with. “It’s a deep and sacred relationship, grounded in veneration and relationality.” Second, many Indigenous models could not be carried out on a solo trip inside a cozy doctor’s office, isolated from larger communities of practice.

Finally, many Indigenous models do not recognize a distinction between therapeutic and spiritual. Illness and one’s existential relationship to the self and the world go hand in hand. The idea that you could extract the therapeutic mechanism from the spiritual context is seen as a peculiarly Western conceit.

Next stop on the trip

President Biden’s administration expects the Food and Drug Administration to approve MDMA and psilocybin for treating PTSD and depression, respectively, within the next year or two. This would increase pressure on the DEA to reschedule the drugs, which are currently categorized as Schedule I substances “with no currently accepted medical use and a high potential for abuse.” This status — widely considered out of touch with current research — restricts access to the substances, creating a major barrier to further studies and to those who could benefit from their use.

With or without rescheduling, the flurry of state bills for psychedelic access is likely to continue. One study based on cannabis legalization trends predicts that a majority of states will legalize psychedelics in the next 14 years. Whether these legal models will open up access for a wider range of potential benefits (and risks) or reinforce the conditions to explore only a narrow, more manageable band of their potential is still up for grabs.

So what could legalization efforts that extend access beyond psychiatry look like? It would require a diversity of sets and settings, not just clinical trials or government-approved cozy rooms. It requires a diversity of participants, beyond privileged subgroups who can afford access to expensive services. And it needs an equal investment in harm reduction alongside benefit maximization.

Doblin has sketched one idea: licensed legalization. Think of it like getting your driver’s license but for buying psychedelics. Once you are a certain age, you would become eligible for a supervised psychedelic experience at a licensed facility — a sort of initiation ritual where you learn the ropes. Perhaps there’s a written portion to ensure basic knowledge. Afterward, you receive a license that allows you to purchase psychedelics for use however you see fit. The license could be revoked for any number of infractions, just as we do for drunk drivers.

Advocates for this sort of regulated legalization still lack answers for how to keep purchasing costs down — one reason that some support decriminalization, where personal cultivation could afford cheaper access. The cannabis legalization experience shows how dealing in Schedule I substances entails regulatory compliances and tax burdens that drive up the price.

Costs aside, there’s still a bumpy road to licensed legalization. There is no getting around the fact that lowering barriers to access can raise the risk of harm, and safety measures in clinical settings are better developed than those for communities new to the drugs. Nor are there established business models for psychedelics that ensure benefit sharing with Indigenous communities.

Experiments are underway, though, like Journey Colab’s “Reciprocity Trust,” where they designate 10 percent of their founding equity to cycle back into Indigenous communities and other stakeholders working on equitable access. Finally, rising demand from widespread access would deepen exploitative pressures on the ecosystems where psychedelics grow. Synthetic alternatives developed in the spirit of open science could help. But whether synthetic alternatives are as effective as their naturally occurring counterparts remains under-studied.

Whatever rationale — or concern — one leans toward, a broader approach to psychedelics offers something that’s otherwise hard to come by. Disturbances in ordinary experience are easy to spot, like measuring the brain’s electrical activity. But how much richer ordinary experience itself can be is a camouflaged question that seldom arises unprovoked.

Psychedelics are one way of bringing the construction of ordinary consciousness into view, wherever one falls on a diagnostic rating scale of mental disorders. But regulatory environments and models of access are part of the wider set and setting that shapes or constrains psychedelic experiences. Hopefully, the burgeoning post-prohibition world for psychedelics won’t remain boxed in by lab coats and psychiatry alone, and we won’t deprive ourselves of the strange, fascinating, sometimes risky, and meaningful views a wider approach to psychedelics can offer.

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