The world of psychedelics is painted with neon colors and smiling, white hippies with long hair who use hallucinogenic substances for wild, recreational trips. But psychedelics like LSD, MDMA (also known as molly or ecstasy) and psilocybin (also known as magic mushrooms) have a much richer history in their use as therapeutic medicines, which existed in Indigenous communities long before Western culture and medicine discovered them.
In recent years, clinical trials have identified multiple psychedelics as treatments for mental health disorders ranging from depression and anxiety to obsessive-compulsive disorder. In 2017, the U.S. Food and Drug Administration granted “Breakthrough Therapy Designation” to MDMA-assisted psychotherapy for PTSD. The FDA gives this status to treatments that may have significant benefits over existing therapy. In 2018 and 2019, the organization granted the designation to two different treatments using psilocybin - one for treatment-resistant depression and one for major depressive disorder.
Host Anita Rao talks with Ismail Ali, policy and advocacy counsel for the Multidisciplinary Association for Psychedelic Studies, about how psychedelic medicine came to be stigmatized and criminalized, the turn toward medicalization and what culturally responsible regulation and policy reform may look like in the future. Rao also speaks with psychiatrist Dr. Hani Elwafi and marriage and family therapist Leticia Brown about how they incorporate psychedelics into their therapeutic practices. And Dana Saxon joins to talk about her personal experience microdosing psilocybin to treat her depression.
The Healing Trip
Dana Saxon was diagnosed with depression in 2002. She tried Prozac. She tried therapy. For 15 years, nothing seemed to work.
Finally, after living in the Netherlands for a few years, she decided to try an alternative therapy: magic mushrooms.
She planned to microdose — taking one-twentieth to one-tenth the amount of a recreational dose, or just enough to feel benefits in the mind and body without taking a full trip. But the research she did recommended taking a full dosage to prepare for the microdosing sessions.
It was an eye-opening experience.
Saxon recorded herself over video, and as she did, she saw another person looking back at her. That person looked like a panicked monster. But as she continued to talk to herself about what she was seeing, she became more aware of issues that had been plaguing her mind below the surface.
By the time the trip ended, Saxon said she felt like she “had been through at least a couple of years of therapy.”
Psychedelics, which translates from Greek to mean “mind-manifesting,” are a category of natural and synthetic substances that trigger altered states of consciousness.
Psychedelics work for healing purposes by making the mind more able to process troublesome subjects that may be harming a person’s wellbeing, said Dr. Hani Elwafi, a psychiatrist in Chapel Hill.
Elwafi works with an FDA-approved medication and hallucinogen called ketamine to practice psychedelic-assisted therapy.
“Instead of taking a daily medication that reduces symptoms — much like Tylenol might reduce a fever but not necessarily get to the source of an infection — molecules of ketamine can help someone to relax in conditions ... and to feel safe in confronting sources of anxiety, sources of fear,” he said.
Psychedelic-assisted therapy is not the best form of treatment for everyone, and the substances should be used in a responsible and educated way.
How the Mushroom Got Its Bad Spots
For centuries, psychedelic substances have been used by Indigenous communities for community and therapeutic purposes — purposes that continue in the present day.
“They've often been used in community intergenerationally as rites of passage, or as initiations, or as containers in which various kinds of political, social, personal, healing and community work can be done,” said Ismail Ali.
But when colonizers reached the North and South American continents, they demonized the use of plant medicines.
“The strategy and tactics of European colonizers ... was based on the rupturing of cultural contexts and knowledge-holding containers,” said Ali. “Which included places like ceremonies where some of these substances were utilized.”
This messaging that discouraged psychedelic substances continued centuries later, making an appearance during the war on drugs. In 1970, President Richard Nixon signed the Controlled Substances Act and listed MDMA, LSD and other substances as the most dangerous drugs with high rates of addiction and low medical benefit.
“One of the things that we know that happened with the war on drugs is that in addition to Black and brown folks being penalized at rates … very different from their white counterparts, we also received these messages about drugs being bad,” said Leticia Brown, marriage and family therapist at Doorway Therapeutic Services in Oakland. “It makes complete sense that you think this isn't for you.”
Despite the growing interest in psychedelics among medical communities in the present day, limited access to psychedelic-assisted therapy in communities of color has continued to reinforce their stereotype as “white people drugs.” In a review of 18 psychedelic studies from 1993 to 2017, researchers found that over 80% of study participants were white.
“What we have seen over the years is that demonization has, over time, shifted into appropriation,” Brown said.