Abstract
Background and Aims
Advocates of psychedelic medicine have positioned psychedelics as a novel therapeutic intervention that will solve the mental health crisis by liberating individuals from their entrenched habits and limiting beliefs. Despite claims for novelty, the psychedelics industry is engaging in the same profit-oriented approaches that contributed to poor clinical outcomes with SSRIs and other earlier pharmaceuticals, which threatens to undermine their purported clinical benefits.
Methods
We present evidence that the liberatory rhetoric of psychedelic medicalization promotes neoliberal, individualised treatments for distress, which distracts from collective efforts to address root causes of suffering through systemic change. Drawing examples from the psychedelics industry, we illustrate how the discourse of psychedelic medicalisation subjects socially-determined distress to psychotropic intervention through the mechanisms of depoliticisation, productivisation, pathologisation, commodification, and de-collectivisation.
Results
Rather than disrupting or subverting the psychopharmaceutical status quo, the psychedelic industry's current instantiation aligns with and upholds key facets of neoliberal ideology by adhering to the same facilitative mechanisms that scholars identified in the antidepressant industry. We identify these common mechanisms in examples unique to the psychedelics industry, including the search for psychedelic analogues and political lobbying to reschedule psychedelics.
Conclusion
We demonstrate how a neoliberal mental health paradigm that individualises and interiorizes mental distress cannot meaningfully resolve suffering with ubiquitous origins in the current sociopolitical environment, which is characterised by inequality, precarity, exploitation, and ecological collapse. As a result, psychedelics must decouple from neoliberal incentives, and demonstrate efficacy, if they are to facilitate durable improvements in well-being and prosocial outcomes.
Introduction
Over the last decade, a growing body of research has traced the interface between mental health ideas/systems/interventions and wider neoliberal practice1 and ideology (Davies, 2022; Esposito & Perez, 2014; Fisher, 2009; Han, 2017; Roberts, 2015). Scholars have argued that this neoliberalization of mental health treatments and services has undermined their efficacy (Davies, 2022; Esposito & Perez, 2014). Although many commentators have claimed that psychedelic medicine represents a novel approach that will overcome the limitations of conventional mental health treatments, recent scholarship has explored how the project of psychedelic medicalisation is engaging in similar neoliberal practices (Devenot, Conner, & Doyle, 2022; Gearin & Devenot, 2021; Pace & Devenot, 2021; Plesa & Petranker, 2022; Tvorun-Dunn, 2022). Despite extravagant claims that psychedelics may approach a transdiagnostic cure (Moliner et al., 2023; Vollenweider & Kometer, 2010), the standardisation of psychedelic intervention for healing purposes into a model that requires these interventions to maximise profits and productivity above all else is likely to undermine whatever therapeutic potential they may have. On a societal level, this drive to maximise profits has itself become yet another social determinant of widespread mental distress. Interventions that bypass addressing the social drivers of harm amount to—at best—a form of maintenance or adjustment therapy, while the creation of psychedelics as a new extractive industry risks, once again, masking and so helping perpetuate the inequalities that contribute to poor mental health (Hausfeld, 2023a). If psychedelics are to facilitate useful clinical outcomes (which remains an open question), the field needs to identify how these depoliticising trends operate within its own sphere. This paper therefore articulates the core mechanisms by which conventional mental health treatments have aligned with neoliberal objectives in order to raise awareness of how the psychedelic movement, as currently instantiated, threatens to replicate the very mechanisms that have weakened the outcomes of conventional mental health interventions.
Mental health scholars have worked to identify several key mechanisms by which medicalized thought, symbolism and practice within the sector have come to dominate healthcare provision and public health discourse despite presiding over—or helping facilitate—decades of poor clinical outcomes (Davies, 2022; Esposito & Perez, 2014). This mutually supportive confluence between neoliberal and clinical directives has become a key site for socio-cultural analysis (Zeira, 2022). Areas of particular interest have included how the dominance of medicalized interventions and ideas have sidelined viable therapeutic alternatives—not by way of possessing superior efficacy, but via their capacity to align fluidly with and uphold key facets of neoliberal ideology (Davies, 2022; Esposito & Perez, 2014); how existing interventions are transfigured in both their aims and implementation to meet neoliberal policy and funding directives (Binnie, 2015; Frayne, 2015); and how judgements of clinical value are increasingly defined in terms of economic and productivity metrics that centre an abstract economic health over more concrete individual or community well-being (Davies, 2022; Friedli & Stearn, 2015). This current paper contends that psychedelics are now being framed by key financial and political actors as harbingers of a meaningful (and often utopian) clinical and social revolution, despite every indication that they will be operationalized in ways that discourage material change (Read, 2023). On the contrary, we assert that at a structural level, their rise threatens to leverage—and so be enabled by—the very mechanisms that have facilitated the dominance of medicalized meanings and psycho-pharmaceutical interventions over the past four decades. In this sense, we are interested in the vectors of collusion between neoliberalism and the mental health sector as they play out in the rise of the psychedelic movement. To gain salience in late capitalism,2 what dominant socio-political discourses is the psychedelic movement embracing, and what ideological realignment is being manufactured to legitimise and normalise the ascendency of psychedelic medicine? Given that psychedelics are described as sensitive to contextual factors,3 these questions are particularly pertinent in an era of individualism, productivity metrics, high consumerism, aggressive marketization, austerity, excessive social mobility and community atomisation (Davies, 2016; Mattei, 2022, pp. 271–273). Within the status quo of profit and productivity, these factors may optimise psychedelics for revenue generation at the expense of patient outcomes.
In what follows, we will enumerate the various mechanisms4 being enacted within the psychedelic movement to enable its ideological collusion with key neoliberal directives. These include the mechanisms of medicalization, productivisation, pathologization, depoliticization, commodification, and de-collectivization—mechanisms that normalise the profitable treatment of individuals in isolation from community, while side-lining organised confrontation with social predictors of mental distress.
These mechanisms, while operating within the medical domain, are not restricted to this domain, as their enactment can be espied in multiple arenas of social life, where—for example—manifold human discontents can be depoliticised, complaints de-collectivised, natural resources commodified, forms of legitimate dissent pathologized, and labour productivised. For the purposes of clarity, however, we have chosen to exemplify each mechanism in turn as it is instantiated within the psychedelic movement, choosing examples from this movement to show how each particular mechanism operates—often in clandestine ways—in the public relations of psychedelic ideology.
The rise of medicalisation
To now begin the project of enumerating the central mechanisms by which the psychedelic movement is enabled to successfully collude with key neoliberal ideological directives, we will open with medicalization—namely, the process by which emotional, behavioural, physical and mental phenomena are reconfigured under the conceptual and clinical jurisdiction of medicine (Rapley, Moncrieff, & Dillon, 2012). In the arena of mental health, medicalization has seen increasing domains of adverse human experience being psychiatrically pathologized, framed and treated; a process which, since the 1980s, has been facilitated by the expansion of psychiatric diagnostics (Conrad & Slodden, 2013; Greenberg, Stiglin, Finkelstein, & Berndt, 1993). Manuals like Diagnostic and Statistical Manual of Mental Disorders (DSM), for instance, have inflated the number of diagnostic categories (from 106 in the early 1970s to around 365 today) while progressively lowering the bar for receiving a diagnosis, making it easier to be classed as “mentally ill” (Frances, 2013). By expanding the definition of mental illness to encompass ever more domains of human experience, over-medicalization has not only reconfigured how we respond to distress in health care settings, but also how we respond to distress in wider social domains, whether considering behavioural difficulties at school, underperformance at work, grief at a significant loss, the effects of unemployment, discrimination, abuse, trauma, poverty or social justice and exclusion (Davies, 2022). In short, since the 1980s, socially determined distress has become increasingly liable to psychiatric framing and—in turn—psychotropic intervention. While medicalization constitutes the central mechanism for transitioning adverse experience onto the ground of medical heuristics and management, it has also enabled the operation of germane and somewhat intersecting mechanisms such as depoliticization, productivisation, pathologization, commodification, and de-collectivization. These—on the one hand—gain impetus and credibility from their association with medical symbolism and practice, and—on the other—further render medicalizing practice and discourse consistent with the key aims and values of late capitalism.
Proponents of psychedelic medicalisation are explicit that appealing to medical authority is a crucial component of a mainstreaming project that seeks to leverage trust in medical expertise to achieve psychedelic destigmatisation, cultural legitimacy, and eventually, broad legalisation (Entheogenesis Australis, 2018). Yet medicalisation will necessarily result in outcomes that depart from those associated with the extant, diverse Indigenous and countercultural community models for psychedelic use (Celidwen et al., 2023; Devenot et al., 2022; K. Williams, Romero, Braunstein, & Brant, 2022; K. Williams & Brant, 2023). Further, the institutionalisation required to manufacture a professionalised Psychedelic-Assisted Therapy (P-AT) requires that it be standardised, profitable, and scalable above other considerations, and its equation of responsible use with medical monitoring may restigmatise and diminish non-pharmaceutical use, including among the very traditions that developed core knowledges and practices (Gerber et al., 2021; Noorani, 2019). As the psychedelic movement verges on the medicalisation of what is also a deeply human activity—the induction of altered states of consciousness in pursuit of meaning and relief from suffering—it is necessary to clarify how sociopolitical processes can recruit any behaviour towards extractivist ends that counteract the aims of healing.
Depoliticisation
[Psychedelics are] so powerful that if misaligned with cultural institutions, they can result in cultural kickback. In the 1960s they became aligned with the antiwar movement and radicalised-youth movement that was terrifying to existing political structures and institutions, and as a consequence, legislation was put up against them, funding dried up, they were considered a third rail in academic research. We need to proceed cautiously. It’s going to be critically important not to threaten existing cultural institutions. So I’ve been a proponent of medicalization, because with medicalization, we already have regulatory structures in place. (Marchese, 2023)
Griffiths clearly states his belief that P-AT should not address systemic drivers of mental distress, meaning those drivers that could be addressed by policy shift, institutional change, or restructuring of social relations. To the contrary, Griffiths argues that the re-association of psychedelics with medical authority will help ensure that institutions invested in maintaining the current hegemonic order are not challenged. This is a strategy of ‘depoliticisation’—namely, the process by which suffering is conceptualised in ways that protect current economies from criticism (i.e., reframing suffering as rooted in individual rather than social causes, thereby favouring self over social reform). The abundant examples of depoliticisation in contemporary society include, for instance, the rapid proliferation of mental health workplace consultancies over the last 10 years, which have deployed mental health tropes to reframe growing population-level worker dissatisfaction and under-productivity as requiring specialist mental health framing and intervention (Davies, 2022; Frayne, 2015, 2019). By depoliticising work dissatisfaction as a mental health issue, these consultancies exonerate working conditions and meaningless work as causal factors while distracting from the wider structural economic conditions that undermine the health of the working population, such as flat-lining wages, rising wage inequality, increased short-termism in the employment market, the erosion of unionised working protections, longer working hours, growing pressure (Berry, Mirabito, & Baun, 2010) for dual-working households, lower job security, higher job precarity, and the rapid expansion of the service sector (Davies, 2022). Some firms have already incorporated P-AT into their workplace as a part of benefits packages or to navigate workplace disputes (Huet, 2023; Plus Three, 2020), yet the primary purpose of workplace wellness programs is to benefit the bottom line of employers by reducing absenteeism and insurance costs (Berry et al., 2010). In this vein, P-AT is set to be instrumentalized in cost-cutting efforts at the Pentagon, with research well underway to treat PTSD in veterans and eventually, active-duty military (Hoener, Wolfgang, Nissan, & Howe, 2023; Marseille, Mitchell, & Kahn, 2022; Miller, 2013; Nickles, 2020).
Depoliticisation can be further elaborated by looking at the rise of undergraduate anxiety and depression since 2010 (Thorley, 2017). Despite the obvious social determinants of higher despondency in present-day undergraduates (diminishing economic prospects, increasing debt, lower likelihood of owning a home, flat-lining wages, careers for life disappearing), the narrative around worsening student mental health is still mostly depoliticised: commentators call for “more psych-services” in the sense of better access to general practitioners (GPs) and mental health consultancies, while avoiding serious reflection on—and reform of—the policies weighing on student life (Davies, 2022; Lindgren, Tristao, & Neighbors, 2023).
Corporate actors are phrasing the psychedelic movement in similarly depoliticising terms that are compatible with neoliberal heuristics. Although clinical trials of psychedelic medicines are still preliminary,5 proponents of psychedelic medicalisation frequently invoke the mental health crisis and climbing rates of mental health diagnoses to argue for a moral necessity to develop P-AT as quickly as possible (W. Williams, 2020). As with the preceding trends involving psycho-pharmaceuticals, their rhetoric often focuses on brain-based models of distress that deflect from political causes (and hence solutions) to widespread suffering. In May 2023, similar urgency was reflected in the UK's House of Commons as Charlotte Nichols—an elected Member of Parliament—referred to the government's slow adoption of psilocybin as medicine as amounting to “institutional cruelty” (Morton, 2023). Referring to her PTSD diagnosis, Nichols described the government's inaction as “condemn[ing] us to our misery when there are proven, safe, and effective treatment options if the government would only let us access them.” In the midst of these urgent calls for psychedelic medicalization, socio-economic determinants of mental health (when mentioned at all) tend to be framed either as barriers to accessing treatment or as reasons why novel mental health interventions are necessary (COMPASS Pathways, 2021). This emphasis on access is a form of hype that builds anticipation for experimental treatments and contributes to the perceived value of P-AT as a novel intervention.
If—as we are arguing—P-AT becomes yet another neoliberal treatment option, then increasing access to these “novel” treatments will still evade the root sources of distress. For example, calls for increased access to mental healthcare rose with the COVID-19 pandemic, which claimed millions of lives and counting (Moreno et al., 2020; WHO, 2023). Advocates have proposed the utility of P-AT for COVID-19-related mental health distress, including among frontline healthcare workers for whom such distress has contributed to acute labour shortages (ASPE, 2022; Chutiyami et al., 2022). These discussions tend to overlook the concrete socioeconomic factors that have impacted this labour sector, including systemic failures to reduce the spread of the disease coupled with long hours and inadequate access to personal protective equipment (PPE), all of which contributed to worsening symptoms of mental distress for healthcare workers worldwide (ASPE, 2022). A real solution to these issues would build a more responsive and resilient healthcare system that better serves both patients and healthcare workers by making bold investments in public health in the wake of a glaring and ongoing failure to adequately manage a global pandemic.
Since the investments required to accomplish this are at odds with both profit-seeking and austerity in healthcare, corporations are proposing superficial fixes to profit from the problems that capitalism is creating. For instance, ongoing clinical trials of P-AT for “Frontline Clinicians Experiencing COVID-Related Distress” reveal how corporations are seeking to monetize the deleterious impacts of systemic workplace neglect and mismanagement (Cybin, 2021). Alongside pandemic-related symptoms of mental suffering, the trial explicitly addresses burnout, which—according to the World Health Organization—is not a disease but an “occupational phenomenon” that may be “conceptualised as resulting from chronic workplace stress that has not been successfully managed” (2019). P-ATs mobilised in this manner, without improving the material conditions of healthcare workers (e.g., increased leave and staffing, more robust PPE reserves, expanded healthcare infrastructure), serve as novel strategies to staunch workplace attrition while avoiding the systemic factors that are motivating so many workers to flee. Similarly, we see P-AT floated as an ideal treatment for individuals experiencing system-wide, pandemic-related depression, anxiety, PTSD, and substance use disorders while both government and industry push for an end to work-from-home and other safety measures that have been shown to mitigate COVID impacts (Argento, Christie, Mackay, Callon, & Walsh, 2021). This manner of deploying P-ATs serves the interests of powerful institutions rather than supporting the sorts of systemic changes that could prevent harm and improve mental health.
Productivisation & pathologization
Moving now from inspecting the dynamics of depoliticisation in the psychedelic space, the next mechanism for discussion is “productivisation,” which denotes—in this context—the process by which individual mental health is redefined in terms consistent with the goals of the economy, where ‘health’ is characterised as comprising those feelings, values and behaviours (e.g., personal ambition, industriousness, and positivity) deemed to serve economic growth, personal productivity, and cultural conformity, irrespective of whether they are actually good for the individual and the community. Productivisation is legitimated by way of pathologization—that is, the process by which here is discussed as behaviours and feelings deemed inconvenient from the standpoint of certain authorities (i.e., those that perturb and disrupt the established order) are transfigured into pathologies that require medical framing and intervention. The DSM's reclassification of underperformance at work, or what it called “occupational dysfunction,” as a key symptom of mental disorder (Aas, 2011) illustrates such productivisation at work. If you experience fractious working relationships, lack workplace motivation, or work at a level deemed “below expected,” you may score high on its mental illness assessment scale—called the Global Assessment of Functioning scale (GAF)—which increases the likelihood of your being to be referred for psychiatric diagnosis and treatment (American Psychiatric Association, 1994, pp. 25–35).
From the 1980s onward, neoliberal social policy has facilitated the over-medicalization of worker underperformance within psychiatry, as the discipline more closely aligned with a central pillar of neoliberal social policy—namely, to increase “labour productivity” (i.e., the output of each worker per hour of their labour). While neoliberal governments would aspire to improve worker productivity via new social policies (e.g. privatisation, de-unionization and the dissolution of labour and welfare protections), psychiatry would promise to improve worker productivity by altering the very dynamics of a person's subjective and mental life—tackling the low moods and poor motivation deemed to threaten the economic order (Crott & Gilis, 1998; Davies, 2022; Greenberg et al., 1993).
This pathologization of many economically unproductive emotional states saw drug companies and government agencies marketing pills and therapy as economic correctives. The United Kingdom's Improved Access to Psychological Therapies programme, for instance, was established in 2004 to reduce mental health disability payments, unemployment and workplace absenteeism/presenteeism, making “return to work” a key measure of “recovery,” despite the nature of work returned to (e.g., low paid, insecure, low-satisfaction) (Jackson & Rizq, 2019). Similarly, the World Health Organisation's early Global Mental Health Programme argued that poor mental health in developing economies constituted a heavy economic burden, which wider dissemination of psychiatric drugs would remedy (Ecks & Basu, 2009; Jenkins, 2010). In both cases, psycho-interventions are framed as economic correctives, by way of their alleged capacity to better realign straying individuals with neoliberal norms of productivity.
Particularly among youth experiencing mental or emotional anguish, accommodation and support is often defined by and contingent upon first having that anguish pathologized, even when community intervention and social support may have better and more lasting results (Fergusson, Reed-Purvis, & Foulkes, 2023). Similar quandaries on a much larger scale have been replicated by P-AT advocates, with author and psychedelics media spokesman Michael Pollan highlighting the potential to use P-AT in addressing “climate grief” when far more comprehensive collective action is likelier to make progress on the issue (Hertsgaard, 2020; Petersen, 2020). Earlier precedents for the use of P-AT therapy to intervene in pathologized mental states or behaviours may be found in the first round of psychedelic medicalisation in the mid-20th century, where early P-AT practitioners like Richard Alpert (Alpert, McDonald, Nemeroff, & Rodriguez, 2022) (later Ram Dass) attempted psychedelic-assisted gay conversion6 “therapy” to treat distress that would be better served by reducing bigotry towards those who do not conform to cis heterosexual norm (Ens, 2019). As for the future, patent filings from industry front-runner COMPASS Pathways—covering hundreds of mental health conditions for which clinical data supporting efficacy for P-AT to treat is presently absent—telegraphs clear intent to market P-AT to wide sections of the public (Hausfeld & Nickles, 2021).
Similar research has also examined the possibilities of drugs in assisting capital accumulation, such as examining psychedelic microdosing effects on labor-relevant traits…and the role recreational drugs can play in improving entrepreneurial abilities
While enthusiasts have associated microdosing with the cultivation of flow states and peak productivity (Denton, 2017), larger doses of the classic psychedelics are incompatible with the focused attention required of workplace use.
Efforts to produce psychedelic-inspired drugs with the “trip” excised, modified, or truncated are instances of how productivisation dovetails with the pathologization of less profitable timescales and stigmatised states of consciousness. These trends appear to be motivating several groups who are developing drugs that bear structural similarity to classic psychedelics to address a variety of mental health issues (Cameron et al., 2021). Srinivas Rao, Chief Scientific Officer of atai Life Sciences, has said that efforts to reduce the trip “can also get away from some of the emotional baggage of these compounds” (Halford, 2022). These purported next-generation psychedelic pharmaceuticals promise to better conform to a productivist paradigm while simultaneously benefitting from hype emphasising positive accounts of classic psychedelics in clinical and recreational environments. Moreover, unlike classic psychedelics, which have long been described by science, these psychedelic derivatives would be patentable, thus making them far more profitable if approved. While it is currently unknown whether these novel drugs will result in genuine improvements or ersatz therapeutics, what is clear is that the logic which drives their development is one incentivized by objectives other than patient outcomes.
Commodification
A further facilitative mechanism is commodification: the process by which suffering is reconfigured into a vibrant market opportunity. Commodification makes distress highly lucrative to big business as it manufactures alleged solutions from which increased tax revenues, profits, and higher share value can be extracted. For instance, we now know that most of the compilers of the DSM had financial ties to the industry, including its three previous chairs (Cosgrove & Krimsky, 2012), while the industry itself has promoted DSM's over-medicalisation of everyday life, often in clandestine ways. It has achieved this through funding the dissemination of DSM diagnostic tools throughout primary care and distributing the manual to healthcare providers (Davies, 2022). As DSM-III Chair, Dr Robert Spitzer, acknowledged: “[t]he pharmaceuticals were delighted with the DSM,” presumably because it created a vast and highly lucrative market for their products (Cosgrove & Shaughnessy, 2020, p. 63).
In other words, once widespread suffering has been medicalised and pathologized, large swathes of the population must now be treated, and the treatments generally preferred in the neoliberal era have been psycho-pharmaceutical. The spread of medicalisation, therefore, opened the door to the unrestrained commodification of distress, creating a vast global market for psychopharmaceuticals now worth over $25 billion each year globally (GlobalData, 2020). The main beneficiaries of this market have been the drug companies, their shareholders, some of their political allies, and those psychiatrists and mental health organisations who have been in wide receipt of industry money in the form of consultancy fees, speakers fees, sponsorship, donations, research funding, and other contributions and honoraria (Davies, 2022)—all types of remuneration that research has demonstrated bias recipients in favour of industry products (Goldacre, 2013; Hengartner, 2022). And so while the commodification of human distress has proven very profitable to sections of the psychiatric, corporate, and political communities, successfully monetising the management of human distress—the consumers themselves, from whom all this profit is derived—may well be cause for complaint, given the poor efficacy of most psychiatric drugs when compared to placebo (Hengartner, 2022), the lack of declared conflicts of interest with industry (Whitaker & Cosgrove, 2015), the corruption within the evidence base (Jureidini & McHenry, 2020), the wholescale underplaying of harms (Davies & Read, 2019), and the strong association between long-term psychiatric drug use, which is proliferating in society and worsening outcomes (Whitaker, 2015).
In the case of psychedelics, enthusiastic testimonies from clinical trial participants are overshadowing issues with the evidence base, including small sample sizes and widespread financial conflicts. As in the wider psychopharmaceutical industry, many psychedelic companies have paid board members, science advisors, and consultants conducting active research in the field (see Devenot et al., 2022, pp. 483, 499–500; Hausfeld, 2023b). Despite these issues, bullish optimism about the profit potential of psychedelic mental health has grown to such a proportion that the current moment has been dubbed the “Shroom Boom” by commentators (Nutt, Erritzoe, & Carhart-Harris, 2020). Market estimates for psychedelic medicine vary, but a projected $10.75 billion by 2027 is sufficient to incentivize a menagerie of competing startups capable of manifesting the full repertoire of psychopharmaceutical industry tactics, from drug development to clinician education and consumer advertising (Phelps, Shah, & Lieberman, 2022). Researchers have warned that the hype—fueled by media coverage and capital investments8—is likely influencing expectancy and inflating treatment effect sizes while overemphasising the likelihood of benefit and underemphasizing the risks (Aday et al., 2022; Butler, Jelen, & Rucker, 2022; Muthukumaraswamy, Forsyth, & Lumley, 2021).
Impervious to these warnings, corporate actors have instrumentalized the hype to achieve medicalization through political lobbying. In February 2023, Australia's Therapeutic Goods Administration (TGA) decided to down-schedule psilocybin and MDMA, allowing prescriptions by “authorised psychiatrists” for specific indications (PTSD and treatment-resistant depression, respectively) as of July 1, after an “aggressive” lobbying campaign led by Mind Medicine Australia (MMA) (Blau & Thompson, 2023; Therapeutic Goods Administration, 2023). Although the same government authority had determined there was “insufficient evidence” for such down-scheduling in October 2022, the TGA ultimately decided in MMA's favour based on an application that underplayed the risks and overstated the evidence base. Although MMA is a registered charity, its Chairman—Peter Hunt—is a shareholder and director of for-profit clinics that are aspiring to commercialise P-AT, and MMA invested a 25% stake in a new for-profit pharmaceutical company after submitting its applications to the TGA (Blau & Thompson, 2023). The TGA's final decision overrode the recommendations of its own expert panel along with the results of an independent meta-analysis that the TGA commissioned, which found “low or very low” certainty for findings in the evidence base for P-AT (Kisely, 2023; Kisely, Connor, Somogyi, & Siskind, 2023). As a result, TGA's decision commodifies psychedelics in line with political and economic forces in place of the medical and scientific evidence.
As with the creation of the DSM, the psychedelic industry is building systems to optimise the generation profits rather than providing the best care. The two main contenders for psychedelic-assisted therapy, MDMA and psilocybin, are both multi-hour commitments with co-therapist teams—a considerable expense. In pursuit of cost-cutting, explicit efforts are underway to modify psychedelic compounds to have shorter durations of action (Yakowicz, 2021). Multiple “corporadelic” startups have invested in technological prostheses for the human elements of P-AT by introducing AI and machine learning for the prediction of treatment outcomes and patient assessment, pre-recorded or web-based treatment guidance for patients and therapists, app-based post-treatment integration, virtual reality augmented P-AT, and other wearable devices (Dougherty et al., 2022; Fiveson, 2023). Each of these innovations depart from the underground therapeutic practices that preceded the current era of P-AT research and present another revenue stream for firms that adopt them by aggregating and monetizing patient data (Hausfeld, 2020). These cost-cutting, big data tactics are being woven into the source code of P-AT; for instance, COMPASS Pathways has touted an AI continuous data analytics system called ‘Chanterelle’ in their latest pitch deck to investors (COMPASS Pathways, 2023). Dubbed ‘digital psychedelia’ by Noorani (2021), the use and application of highly granular patient data will be foundational to P-AT and portends a milestone in the operationalization of surveillance technology in mental health (Plus Three, 2021).
De-collectivisation
Having now seen how neoliberal dynamics of commodification are instantiated in the psychedelic space, the final mechanism we will consider is de-collectivisation—namely, the process by which the causes of suffering are rooted in the self, thereby undermining more sociological explanations that may help galvanise social and collective solutions. By treating people in isolation from their community, and by alienating them from the social drivers of their distress, individuals are cut off from identifying where their distress may be shared—a collective experience that anthropologists have defined as “social suffering” (Kleinman, Das, & Lock, 1997, pp. ix–x). Insofar as social suffering is individualised and the communal roots of pain is erased, the individual's impulse for collective action may be subverted (Hsieh, 2014). By dispersing the origins of our distress into individual, internal deficits, our current mental health sector therefore threatens to scatter and diminish collective experience and action, as the collective roots of our pain are individualised.
The proposition that social problems can be solved by treating individualised mental and emotional suffering is pervasive and lionised at the vanguard of the psychedelic medicalisation project. Instead of providing specifics about how this model of change would work in practice, its advocates often rely on mythic allusion to illustrate grandiose predictions. For example, Liana Sananda Gillooly, Strategic Initiatives Officer at MAPS, has commented that the psychedelic medicalisation effort is “rooted in social justice”—a position she clarified while speaking to a documentarian at the pivotal MAPS Psychedelic Science conference in 2017: “We cannot have peace in this world without having peace within ourselves…. I don't think we are going to see mass change in our planet without integrating psychedelic therapy” (Chacruna Institute, 2019; Cinematic Syndicate, 2017). Situating the stakes of self-transformation as necessary for world peace casts the patient in the role of a hero—the quintessential individual who, by means of psychedelics, gains full agency to choose their destiny (Wheal, 2022). Matthew Johnson of Johns Hopkins describes the psilocybin-assisted therapy dose in terms of this heroic myth: “The [psilocybin] dose we now give to patients is from 30 to 40 mg, which Terence McKenna—who's the famous psychedelic bard—would refer to repeatedly as ‘the heroic dose’”9 (Big Think, 2022, 4:59).
A hero ventures forth from the world of common day into a region of supernatural wonder: fabulous forces are there encountered and a decisive victory is won: the hero comes back from this mysterious adventure with the power to bestow boons on his fellow man. (Campbell, 1968)
Don’t blame capitalism, the radical left, or the inequity of your enemies. Don’t reorganize the state until you have ordered your own experience. Have some humility…. Perhaps you will see that if all people did this, in their own lives, the world might stop being an evil place. After that, with continued effort, perhaps it could even stop being a tragic place. (Peterson, 2018)
Here, we again see individual responsibility to improve oneself, which is situated as a catalyst for collective deliverance at a global scale. Peterson is both inspired by and compared to Campbell, and he claims to have had multiple 7-gram psilocybin mushroom experiences (Heer, 2018; D. Marcus, 2021; Peterson, 1999, 2022b). Peterson's interest in psychedelics led major figures in the psychedelic field to contribute lengthy video interviews to his podcast (Peterson, 2021, 2022a, 2022d), despite his public record as a vigorous opponent of the validity of transgender identities, consensus science on climate change, institutional diversity initiatives, and social justice categorically (J. Marcus, 2022; Media Matters, 2023; Peterson, 2022c; The Epoch Times, 2017). In his conversation with Roland Griffiths, Peterson hypothesised a role for psychedelics in revivifying flagging church attendance and faith in Christian religious institutions (Peterson, 2021). While both Peterson and MAPS's Gillooly advocate for the individual's responsibility to fix global problems, Peterson's vision for using psychedelics to preserve and redeem the status quo contradicts Gillooly's own heroic vision of social justice and P-AT as the missing ingredient for “mass change.”
As we have seen, the individualism that permeates medicalisation also infuses psychedelic discourse, rendering sociopolitical and relational drivers as subsidiary. However, as multiple Indigenous-led and anthropological studies have shown, the efficacy of psychedelics—when studied in Indigenous settings—has much to do with the local symbolism that frames, embraces, and integrates these powerful individual experiences within a pre-established set of shared cultural knowledge (Balsera, 2009, pp. 292–293; Fotiou, 2019). As Keith Williams and colleagues have emphasised, this symbolism—which is derived from the particularities of local place—serves to mediate more-than-human power towards the renewal of alliances and social relations (K. Williams et al., 2022). Such cultural framing helps to integrate the individual within the socio-cultural whole by way of healing rituals that simultaneously reaffirm the solidarity of the social group—its beliefs, symbols, traditions, and ways of life. Indigenous relational ontology is at odds with Western interpretations of psychedelic medicine, which promote narratives of healing through abstract, transcendent experiences that dissolve and subsequently reconstitute the individual “ego” (Fotiou, 2019; K. Williams et al., 2022, p. 511). As a result, psychedelic clinical usage in the West is often shorn from any wider and more meaningful community cosmology beyond the pathologizing and individualising ideology of psych-medicine.
Conclusion
To avoid replicating the mechanisms that have put economic outcomes above clinical benefit in the neoliberal era, the psychedelic movement must understand its structural accordances with the wider aims of capital and capitalism. The salvationary and utopian rhetoric and logics of psychedelic discourse bury beneath a “liberatory” veneer the same medicalising, pathologising, depoliticizing, commodifying, individualising, and de-collectivising dynamics that enabled psychophramaceuticals to become the governing emotional technology of the neoliberal era. Insofar as psychedelics may merely repeat and reaffirm these very neoliberal dynamics, they may do nothing at all to counter—at a structural level—the central drivers of distress. Instead, they may become—as their forebears—an instrument of neoliberal hegemony, facilitating the conditions of increasing inequality while distracting individuals from attending to the root causes of their distress.
The belief that P-AT represents a paradigm shift in mental health does not make it so. Political violence, structural oppression, workplace exploitation, social isolation, inequality, social injustice, ecological collapse, and climate catastrophe are all significant social and environmental determinants of distress that cannot be fixed with individual solutions. If P-AT is deployed into the existing neoliberal mental health paradigm, mental distress will continue to be framed as a problem of mindset, ineffective coping, and inadequate resilience. While, for some, P-ATs might provide respite from suffering and potentially yield personal insights, those insights are not automatically the catalyst to change in material relations—which impact the lives of everyone—as their most ardent supporters extol psychedelics to be. As has ever been the case, material conditions can be more effectively addressed through collective organisation and co-ordinated action against exploitation and inequality. In the absence of such collective action, psychedelics may only exacerbate the very problems that the field is claiming to solve.
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While definitions of neoliberalism are varied and diverse, there is sufficient consensus to warrant a working definition for this paper. We follow the definition advanced by David Kotz, who describes neoliberalism not only as an ideology or discrete set of ideas, but as a political commitment to reduce the role of non-market institutions—including the state, trade unions and corporate bureaucracies—in the economy (Kotz, 2015, pp. 8–9).
In this paper the descriptors “late capitalism” and “neoliberalism” will be used interchangeably.
Psychedelic drugs are characterised as non-specific amplifiers of “set and setting”: they exaggerate and recombine external and internal influences to create a subjective experience of embodied and narrative meaning (Devenot, Seale-Feldman, et al., 2022; Hartogsohn, 2017; Pace & Devenot, 2021).
The definitions for these mechanisms are drawn from James Davies’ Sedated: How Modern Capitalism Created our Mental Health Crisis (2022), which focused on the role of these mechanisms in the context of earlier psycho-pharmaceuticals including SSRIs. The continuation of these mechanisms in the psychedelic medical industry emphasises limits to the industry’s claims to novelty.
In response to widespread claims about the efficacy of psychedelics as medicines, the American Psychiatric Association released an official “Position Statement on the Use of Psychedelic and Empathogenic Agents for Mental Health Conditions” in 2022, which asserted that there is “inadequate scientific evidence” to support claims about psychedelics as a mental health treatment for any indication (Alpert et al., 2022).
So-called “conversion therapies” are harmful and ineffective practices that attempt to alter the sexual orientation, gender identity, or gender expression of a person to conform to cis heterosexuality. These practices have been widely condemned by national and international medical and mental health organisations, including the American Medical Association and the World Psychiatry Association (American Medical Association, 2007; Bhugra et al., 2016; British Association for Counselling and Psychotherapy, 2021).
Francis Crick allegedly told his friend Dick Kemp that he had been under the influence of LSD when he first visualised the chemical structure of DNA. When asked for confirmation, Crick quipped, “Breathe a word of it and I’ll sue.” Geneticist Kary Mullis was more open about his relationship with psychedelics, writing about his synthesis and use of them in his autobiography (Mullis, 2000). Albert Hofmann—who first synthesised LSD in 1938—shared at his 100th birthday celebration that Mullis had told him “LSD had helped him develop the polymerase chain reaction that helps amplify specific DNA sequences” (WIRED, 2006). As part of a funding pitch for MAPS’s psychedelic clinical trials in a 2007 letter to Steve Jobs, Hofmann cited the mythos that LSD contributed to Jobs’ technological innovations at Apple (MAPS, 2011).
Now that the Multidisciplinary Association for Psychedelic Studies Public Benefit Corporation (MAPS PBC) is offering shares to investors, both P-AT firms closest to US Food and Drug Administration approval (the other being COMPASS Pathways) are incentivized to increase shareholder value (Gunther, 2023; Wirz, 2023). Until this move, MAPS PBC was the wholly owned subsidiary of the nonprofit, MAPS.
Terence McKenna defined the heroic dose in terms of dried psilocybin mushrooms: “Five dried grams in silent darkness will flatten the most resistant ego” (Jacobson, 1992).