Psychedelic drugs have great therapeutic benefit – if understood on their own terms | Ross Ellenhorn and Dimitri Mugianis

Earlier this month, an advisory panel rejected MDMA-assisted therapy for PTSD, possibly dooming US Food and Drug Administration (FDA) approval of the drug commonly called ecstasy. In a public meeting alongside FDA staff, panel members said that the research neither adequately accounted for abuse risks nor proved the drug’s efficacy in combination with psychotherapy.

This decision dealt a major blow to Lykos Therapeutics, the for-profit public benefit corporation of the non-profit Multidisciplinary Association for Psychedelic Studies (Maps), which sponsored the trials. More broadly, the rejection has been described as a drastic setback for the psychedelic movement as a whole. For several years now, it seemed that greater acceptance and new legal spaces for psychedelics were a certainty. Then, scientists appeared at the FDA hearing and everything went dark.

As practitioners and leaders in the realm of human transformation, and in creating and running organizations that serve individuals experiencing complex psychiatric symptoms, we believe in psychedelics as a force for good. Yet, to us, this FDA decision is the natural and expected outcome of a basic and fatal conceptual error that our brothers and sisters in the movement have adopted. By joining larger trends within the behavioral health milieu that focus on the elimination of distinct symptoms by drugs and by expert-driven techniques, today’s psychedelic movement is teetering on the edge of becoming unpsychedelic.

What do we mean by this? Psychedelics free our minds to novelty, liberating us from habitual patterns. The common term for this property is “brain plasticity”, and it may be the core reason these substances can also impact areas of psychological suffering related to habits of the mind – those that experienced psychiatrists label as depression, anxiety, addiction and, yes, PTSD. Psychedelics are pro-imagination, pro-creativity, pro-innovation – qualities that research shows are at the very root of personal growth.

But approaching these remarkable substances as solutions for a specific brain disease, treatable through pharmaceutical and therapeutic approaches that are akin to surgical excision, isn’t plastic at all, but rigidly protocolled, oriented toward human suffering as something impersonal. It’s approaching symptoms like the “check engine” light in a car – something to be figured out and fixed through the right tool for the specific dysfunction.

We think the problem of an anti-psychedelic approach in the psychedelic movement began when organizations like Maps and Lykos grafted psychedelics onto a common rubric where psychiatric diseases pair with therapies that are purported to conclusively treat them.

Research on therapies proves that no specialized approach is more effective than others. What works is not some magically specific approach, but what the psychoanalyst Jon Allen refers to as “plain old therapy”. The most effective medicine is being witnessed and cared for by compassionate others.

Traditional psychotherapy is interested in building a non-formulaic, non-prescriptive, transformative space from which someone experiencing profound insecurity can find new perspectives on and relationships to their discomfort. “Plain old” sound practitioners, ceremonialists and underground “space-holders” in the psychedelic world have practiced within a very similar ethos for decades now. They often deploy elements of sound and subtle imagery as non-formulaic guides through an experience.

Formulation, diagnosis, and the imposition of expert opinion are often seen as impediments to growth and are never the starting or focal point of care. Using a drug and a symptom-reducing technique is anathema to the environment of a good psychedelic “space-holding” or well-held psychotherapy session.

The treatment for symptoms of PTSD and trauma has become a central focus of psychedelic care. But what do we mean by trauma? Often, we mean existential concerns, such as betrayal, disillusionment, helplessness, alienation, that render a loss of meaning. Care that promises a quick cure for PTSD symptoms trades the old-fashioned orientation to these problems of living for an emphasis on bodily responses like cortisol, the vagus nerve, and fight-or-flight.

This “biomania”, as Allen calls it, turns “trauma” into a product in the industry of psychological suffering, subtly labeling vulnerable individuals – who often report feelings of shameful brokenness – as fixable by experts, and thus broken until they receive the expert care. Maps executive director Rick Doblin’s vision of “net-zero trauma by 2070” exemplifies how psychedelics have aligned with this trend, promising a kind of utopia via a drug – until the FDA intervened.

We suspect that the main reason MDMA therapy failed the FDA panel is that plastic, attuned, and ever-changing models of care do not fit with the assumptions of the pharmaceutical industrial complex, whose profitable ideas have captured government regulators alongside elite academics. Forcing the profoundly existential round peg of trauma into the square hole of a compound for symptom elimination just resulted in a lot of questions about efficacy. For psychedelics to return to being psychedelically effective, we should use them to overturn the larger factory orientation in psychological care, not to join it. In other words, researchers and practitioners in the psychedelic space need to get more plastic, not less.

MDMA, like any psychoactive drug, helps someone better receive comfort and care. It’s a means of accessing an experience; it’s not a medication. An adept “space-holder” can facilitate a new lens, a plastic moment, an opportunity for contemplation. They can help someone build a new relationship to their suffering, maybe a less consuming and more generative one. In this way, the facilitation of human transformation can be likened to the treatment of metal: initially subject to a burst of high heat that sends its atoms into a kinetic frenzy, followed by a gradual cooling process during which the metallic atoms settle into a discernible lattice, leaving the metal pliable, softer, less easily broken. It’s an all-consuming process that substantively transforms.

A biomaniac approach does just the opposite. It’s reductive in practice, automated in approach, prescribing a few cures for a vastly complex event that occurs for vastly complex humans. Habitual, totalizing in thought, and always about getting a person from sick to normal, it lacks plasticity.

The philosopher Thomas Kuhn, famous for his study of paradigm shifts, believed such shifts occur when one form of thought accumulates enough anomalies and contradictions. We hope that the FDA’s rejection of MDMA, despite its efficacy, offers such a contradiction, and thus an opportunity for the proponents of psychedelics-as-psychotropics to take a more innovative, less conformist approach. The current crisis in the medical world’s pursuit of a miracle cure for trauma may free their minds to what truly helps people change: an approach that views each individual’s suffering as deserving of a unique response.

It also highlights what doesn’t work: the perspective that suffering is a disease that can be surgically removed from the psyche by experts with the right prescription. If psychedelic refers to creative, flexible approaches that attune with a greater wisdom, nothing could be less psychedelic than this approach.

• Ross Ellenhorn is a sociologist, psychotherapist and the founder and CEO of Ellenhorn, a psychiatric program with offices in Boston, New York and Los Angeles. His has published three books; the latest is Purple Crayons: The Art of Drawing a Life. Dimitri Mugianis is a harm reduction activist, musician, poet, and writer, with over two decades of experience as a psychedelic practitioner. Ellenhorn and Mugianis are the founders of Cardea, a psychedelic program operating in New York City and Treasure Beach, Jamaica