Medicalising Psychedelics: Alternative approaches to mental health care in Australia

Antidepressants, psychedelics and the neoliberal infiltration of mental health

Three artworks, one is of half a hollow human head with a tab of LSD on top of it exploding into rainbow coloured patterns. On either side of this are smaller but similar patterns of rainbow colour. Artwork by Lauren Moore

The wind extinguishes the 42 degree, Wollombi morning, leaving silver streaks like a mesh frame. It shrouds me in wispy exo-skeleton. The grass only grows in tufts but the drought-stricken bush glows yellow and green under the acid glare. The endless horizon fizzes blue.

 Chatter bubbles from within the shed-cum-living space behind me. A bee settles on my pinkie. I allow it to explore the grooves in my hand. The grass feels like curly hair beneath my fingers. Red gums and wattles rustle where the afternoon breeze caresses them.

 (My insides tingle and my throat begins to fill with pressure.)

I know I can move inside and I’ll have internet connection. I know I can move inside and talk to my friends.

(My cheeks are wet.)

I roll another Champion Ruby cigarette. I lean into the earth, splashing beer across myself. The bottle lolls at a precious angle, leaking. I don’t care.

(The wind whips across my face and scatters my tears like a farmer throwing seeds.) 

I don’t know how long I sit there crying but it must be a while because, by the time Henry and Caleb join me on the grass, the sun is setting already. They have also taken acid. They don’t say a word. They have heard snippets.

(I float in a pool of tears.)

 They pass me a cigarette. Someone plays Smoko by The Chats. The kitsch song draws a twisted, masochistic smile on my face.

More friends sit down around us. I don’t feel ashamed for one moment, despite my puffy eyes. Someone suggests a walk before the world goes dark on us. Maybe it’s me. I’m both there and not there, leading the conversation and following it.

 We set off so eagerly I don’t find time to put on a shirt.

When darkness begins to engulf the land, the others are keen to return to the shed. 

I linger behind them. Hunter Valley hills unfold in the twilight. In the dust and the heat, my mind expands to fill the space around me, bending and rolling into itself. I feel like I am the sole inhabitant of the planet. What if, what if, what if… 

*  *  *

In recent years there has been talk – not in hushed voices but in loud, confident shouts – of a “psychedelic renaissance.” In June, a panel on psychedelic research forged a space within the very walls of NSW Parliament for the inaugural Science in the House.

Psychedelic drugs (read: medicines) such as LSD and psilocybin, the active ingredient in magic mushrooms, have significantly helped people with treatment-resistant disorders including depression, addiction and end-of-life anxiety. 

Scientists theorise that these medicines have therapeutic effects for psychiatric disorders because they “reset” or “rewire” brain networks, allowing the brain to return to a predisease state. When taken in significant enough quantities, they can induce ego dissolution and mystical or transcendent experiences. They also present us with radically new ways to tackle mental health issues. 

So often we are told that, when we are down, the problem exists within us. Perhaps our suffering is due to a chemical imbalance in the brain and to feel better we need only swallow a pill. Perhaps we need to practice mindfulness – to keep our mind centred in the present and non-judgemental. Both are necessary for short-term stabilisation. But they are only band aid solutions. 

Last year, like one in eight Australians, I was given an antidepressant prescription. Along with the prescription came diagnoses – a passport that allowed me to jump over a threshold of acknowledgment into, I anticipated, a new realm of recovery and self-awareness.

Antidepressants took me away from the edge of a cliff but then left me stranded in no man’s land without adequate supplies. They provided some stability but they also numbed my senses, interfered with my sleep pattern and left my body playing catch up as I adjusted to the medication. For a long time I felt more ghost than human, and I was only on a low dosage. Only after many psychologist sessions, cognitive behavioural therapy (CBT) and several acid trips did I begin to perceive a more familiar landscape. 

I am not alone in my awareness of the limits of antidepressants. A raft of studies show that antidepressants have almost no more meaningful impact on improving mental health than a placebo except, some argue, in cases of very severe depression. Unlike placebos, antidepressants present numerous worrying side-effects, withdrawal symptoms and vicious dependency cycles. 

A growing movement of disparate voices are calling for medical practitioners, researchers and policy-makers to focus on the root causes of depression – environment and disconnection – rather than a chemical imbalance in the brain. Johann Hari and Irving Kirsch, in Lost Connections and The Emperor’s New Drugs respectively, foreground their own conversion from antidepressant believers to antidepressant heretics, speaking to a profound sense of betrayal among those who have taken antidepressants for many years (Hari) and those who have prescribed them (Irving).

Dr Stephen Bright, a psychologist and academic at Edith Cowan University, explained to me on the phone, “An antidepressant is like putting training wheels on your bike. It’s going to help you learn how to ride the bike but eventually you need to learn how to ride it on your own. You need to make lifestyle changes so you can eventually take the training wheels off, go off the antidepressants and not relapse into anxiety or depression.”

More sinisterly, popular tools for combating depression – antidepressants and mindfulness – reinforce the neo-liberal doctrine of self-control, boundless agency and free-market logic because they fail to address the societal causes of personal distress. 

In his polemical tome McMindfulness, Ronald Purser coins the term “mindful capitalists” to emphasise that the recent commodification of mindfulness by companies such as Google and Apple has depoliticised the practice and unmoored mindfulness from its ethical and Buddhist origins. Used in this way, mindfulness becomes a tool to make us accepting of power imbalances and resilient within precarious, uncertain economies. This privatisation of depression and anxiety threatens to support the status quo. 

When antidepressants are effective – sometimes this involves changing dosages and medicines multiple times – they can make us thriving members of society. However, they can also bulldoze motivation and emotions – both positive and negative – leaving us flat and potentially more susceptible to accepting business as usual. 

I’m not saying we should toss antidepressant bottles into landfill or abandon mindfulness. Many antidepressant sceptics believe the drugs should be used (in the short-term) alongside therapies that treat the social causes of depression. But are there other options? 

*  *  *

While the stigma attached to psychedelic drugs is dissipating, Dr Bright suggests academics and health professionals often remain less supportive of psychedelic research and drug law reform than the average Australian. “Even people who are really conservative in Australian culture are open to the idea of the medical use of illegal drugs,” said Dr Bright. “Alan Jones, for example, supports medicinal cannabis. They can see that A: there is a difference [between medical and recreational use] and B: there is a need.” 

Dr Bright and Dr Martin Williams, co-founders of the non-profit organisation Psychedelic Research in Science & Medicine (PRISM) have written and publicly spoken about entrenched conservatism and risk-aversion in Australian research communities and universities. 

According to Dr Bright, Australia is “conservative” regarding psychedelic research because individual disciplines are “so insulated” here. “The best way to fast track a career in academia in Australia is to jump on board what everyone else in your lab is doing and get on those papers. The most difficult way to work your way up is to do something different, to challenge the paradigm. This is also not very Australian because you become a tall poppy and people want to cut you down. Up until very recently, no senior academics in Australia would stand up in support of these [psychedelic] treatments. ” 

Dr Bright laments Australia’s history as a disinterested follower, rather than a leader, in psychedelic research. Since Australia is “so far behind … clinicians and patients are becoming increasingly frustrated by the lack of movement in the research space. There have been a number of media reports – one by Jenny Valentish for the ABC, and another by Jesse Noakes for Meanjin – on the underground, psychedelic therapy scene where people are accessing psychedelic therapy in an unregulated environment because they’re sick of waiting for trials to happen in Australia.” 

Besides the obvious risks of tapping into an unregulated drug market, Dr Brights warns, “if you’re working in an unregulated environment and something goes wrong with the patient, the threshold before you bring in paramedical services is probably going to be a lot higher than it would be in a regulated, sanctioned environment.” 

Similarly to the NSW government’s draconian stance on drug use and pill-testing at music festivals, excessive legal and bureaucratic obstacles to psychedelic use and research may harm Australian adults intent on making their own decisions more than it helps them.

Government regulation is not the only potential obstacle to the fair distribution and use of psychedelic medicines.

The possibility that multinational corporations and profit-driven venture capitalists could co-opt and misuse psychedelic research exacerbates its already precarious position in society. Concerns have arisen surrounding the funding for Compass Pathways, a for-profit corporation that has undertaken psychedelic research, and recently made a patent application for the psilocybin production process. Intellectual property rights have long been a weapon in the arsenal of ‘Big Pharma’, attracting criticism from experts such as Nobel Prize winning economist Joseph Stiglitz. Since psychedelic drug treatments centre on consumption within clinical settings with trained professionals, market monopolisation may make an already expensive treatment inaccessible. 

 By framing the micro-dosing of psychedelics in terms of productivity and innovation for tech entrepreneurs, rather than in terms of the therapeutic effects, media coverage meanwhile has cemented the phenomenon as a Parthenon in the Silicon Valley landscape, resplendent in marble. Micro-dosing — taking small doses of a drug for cognitive benefits — does not slide smoothly into a medicalisation mould but it has received widespread support where it supports the capitalist model. 

Psychedelic culture has also become synonymous with whiteness and findings suggest white people use psychedelic drugs, like many other drugs, more than any other race. It is hard to discard the images of (predominantly white) Silicon Valley techies micro-dosing, obscene wealth and comfort at faux-hippy festivals such as Burning Man, a war on drugs that has targeted racial minorities and the racialisation of schizophrenia as a black disease from the 1950s. Perhaps this explains why over 80% of participants in research-related, psychedelic-assisted psychotherapy are white.

Arguably, psychedelic research has been conducted by white people for white people, although the American organisation Multidisciplinary Association for Psychedelic Studies (MAPS) has very recently taken steps to address race within psychedelic debates and fund studies on trauma within minority communities

Dr Bright suggests that the paucity of people of colour in psychedelic research is a direct result of the society within which we all live. “When you’re accessing research therapy, there is no cost associated with it… You’re the guinea pig… The reason minority groups have been somewhat excluded thus far is not about cost. It’s about how you access a clinical trial. You need to [already] be accessing a well-connected psychiatrist or psychologist who can refer you into it.” 

“With the St Vincent’s [psilocybin] trial in Australia, for example, there is nothing that would lead to minority groups being excluded in any way other than the people they’re seeing prior, who would need to refer them in. These professionals may not be as well connected as others. Better connected professionals are difficult to access in the first place unless you have private health insurance.”

As the all-pervading force of neoliberalism surreptitiously scouts mental health as a new frontier, research suggests there are empirical barriers to the capitalist exploitation of psychedelics.

A recent preliminary study on micro-dosing by staff at Macquarie University, has shown that the actual effects of micro-dosing differ from the expected effects. According to Dr Vince Polito, one of the study’s authors, they began the research precisely because “the claims that people were making [about micro-dosing in the media] were pretty wild considering the doses that were being reported… It seemed like there was at least the potential that some of these effects may be exaggerated or that they could be explained in terms of expectations from people reading the media.”  

Unlike media reports and research on high-dose psychedelics, this study found no significant change in creativity and open-mindedness among the 98 participants over a six week period and a small increase in neuroticism. But micro-dosing did increase feelings of personal well-being, reduce stress, anxiety and depression and improve absorption in activities. The investigation suggests a note of caution due to the capacity of the experience to create unease. The authors assert that regarding its “potential as a business tool… micro-dosing may not be universally beneficial.”

Furthermore, the benefit of psychedelic drug treatments – and the reason Big Pharma has generally steered clear – is that their administration bumps up against our current reality of prescribing antidepressants indefinitely. Research suggests that participants only need one intense spiritual experience to feel continued benefits for months afterwards. 

In a randomised, placebo-controlled study with patients with life-threatening cancer at Johns Hopkins University in 2016, 80% of participants stated, six months after their psilocybin experience, that the experience increased well-being or life satisfaction moderately or very much. While there is little effective pharmacotherapy for drug dependency, another recent study on psilocybin-assisted psychotherapy for tobacco addiction has shown that, one year after taking psilocybin, 10 of 15 participants were abstinent from smoking tobacco. 13 ranked their participation as one of the five most meaningful events in their lives. 

If psychedelic drug production is indeed a playground for profit-seeking venture capitalists – this is highly questionable – it will likely be culpable for many broken bones and a scarcity of thrills.

Dr Bright understands the scepticism of Compass among psychonauts: “The psychedelic experience is one of unity with the cosmos and connection with Mother Nature – things that are quite inconsistent with the capitalist model.” But Compass’ recent emergence in psychedelic spaces does not alarm him. Rather, he sees this progression as a reflection of the need to work within the dominant capitalist model. In his eyes, Compass simply offers something different from non-profit organisations like MAPS and PRISM. 

*  *  *

In many ways, psychedelics offer a promising alternative for treating depression and anxiety. While I am ambivalent about micro-dosing – something I have never tried, mind you – my own experiences with higher dose psychedelics align with the research. Taking acid while I was on antidepressants and after I stopped taking them helped me to engage my pain in empowering and progressive ways, and to reconnect with friends, nature and a meaningful future. 

Our current approach to depression, which centres on the neat checklists of psychiatrists, prescription antidepressants and self-help, encourages individual disconnection from the world and, sometimes, from the pain necessary to growth and future happiness.

I genuinely believe my trips (and CBT) helped me more than any antidepressant. But this is my story, and my story alone. 

I told this belief to my psychiatrist when I explained to her why I wasn’t taking Zoloft anymore. She shifted into a condescending tone and scribbled down a list of drug counsellors, shooing me out to the door. I don’t expect everyone to understand.

If this article has raised any personal issues, the following services may be of use to you:

Beyond Blue: 1300 22 4636

Lifeline Australia: 13 11 14

USyd counseling and mental health support: +61 2 8627 8433