In April 2021, a widely anticipated paper in the field of psychedelics dropped. The study, a small trial run at Imperial College London and published in The New England Journal of Medicine, investigated the use of psilocybin, the active ingredient in magic mushrooms, to treat depression. Led by Robin Carhart-Harris, who now directs the Neuroscape Psychedelics Division at the University of California, San Francisco, the research compared psilocybin with a standard antidepressant. The findings were somewhat lackluster: it found that the psychedelic was only marginally better than traditional treatments at relieving depression.
Back in 2017, Rosalind Watts, an author on that paper and a former clinical lead for the trial at Imperial, had given a TEDx talk on the power of psilocybin to treat depression, prompted by the time she had spent working on the study. In the talk, she shared her belief that psilocybin could “revolutionize mental health care.” But in February of this year, Watts published a Medium piece in which she expressed regret at her initial unbridled enthusiasm. “I can’t help but feel as if I unknowingly contributed to a simplistic and potentially dangerous narrative around psychedelics; a narrative I’m trying to correct,” she wrote.
“I just reflected on how I myself had got caught up in the black and white of like, ‘This is wonderful,’” she says today. “Now having been through that trial … I’m much more neutral and agnostic.”
We’re firmly in the midst of a psychedelic renaissance, with substances long regarded simply as recreational drugs—such as psilocybin, LSD, and MDMA—being reappraised as potential treatments for a number of mental health conditions. At the same time, legislation and stigma surrounding psychedelics has slowly begun to loosen in recent years, and it increasingly looks like it might shake loose altogether. “Now all of a sudden, within the past year or so, the pendulum has swung all the other way,” says David Yaden, an assistant professor at the Johns Hopkins University School of Medicine who studies the subjective effects of psychedelics.
But Yaden thinks the field is in danger of overcorrecting. In a new opinion piece published in the Journal of the American Medical Association, Yaden—with his coauthors Roland Griffiths and James Potash, two experts in psychedelics and psychiatry, respectively—argues that if we don’t tread carefully, psychedelic research could end up back where it started: treated with deep suspicion, if not completely outlawed. “I don’t want to be a wet blanket,” Yaden says. “I think there’s a real reason for excitement. But I think it’s a really important message to get out.”
To trace psychedelics’ potential future, Yaden, Griffiths, and Potash looked to a model called the Gartner Hype Cycle, which can be used to characterize the trend cycle of new technologies, like virtual reality or 4D printing. The pattern has gone something like this: Forbidden for decades, psychedelics began to reemerge in recent years out of fringe underground communities and into labs as potential revolutionary treatments for mental illnesses. Then in 2018, the US Food and Drug Administration granted psilocybin “breakthrough therapy” status for depression, which gives a treatment the fastest possible route to approval. The media leapt at it and startups sprung up, followed by obsessive patenting of psychedelic compounds.
But what began as a welcome glimmer of hope for new ways to treat mental illness (which psychedelics irrefutably are, even if trial results so far have been modest) has morphed into actual misinformation, Yaden argues. Claims began to crop up ranging from the unsubstantiated to the outlandish: that psychedelics can “cure” mental illness, solve massive social problems, and create a “psychedelic utopia.” We’re in the midst of what Yaden and his coauthors call the psychedelic hype bubble. And they argue that scientists should be the ones to burst it.
Psychedelic research, for all its promise, is still at the embryonic stage. Trials so far have been small, and while results such as those from Imperial suggest that certain substances could be useful, findings don’t support any claims of these drugs being able to cure mental health conditions.
The more time she has spent working with patients, the more Watts has come to believe that the drugs themselves are not the key; the real value lies, she says, in the therapeutic experience—the “assisted therapy” part of psychedelic-assisted therapy. This is where a person sits with a guide for hours after having taken a psychedelic, in what should be a safe and compassionate context, with the space to untangle deeply buried feelings and trauma. The effects of the psychedelic help to create this space.
“The drug was a catalyst to the therapeutic process, not the therapeutic process itself,” she wrote in her Medium piece when describing her involvement in the Imperial trial. Afterward, participants received aftercare, known as “integration,” in which they process everything that happened during the trip. Therefore, new startups offering psychedelic treatment without the assisted therapy component could stand to actually do harm, Watts worries. “Some people will have this big burst of openness, and they won’t have the support to deal with it,” she says. Plus, the actual therapeutic effect of these drugs in these scenarios could end up being pretty muted. “There will be lots of companies, I think, who have invested in the drug without therapeutic support, who will find that their results are very, very disappointing for their shareholders.” When you see a headline extolling the virtues of “resetting your brain,” what’s missing is the “visceral, sometimes hellish experience” of actually doing that, Watts says.
And in an attempt to protect the field, it also seems that some criminal actions are being glossed over and going unchecked. In recent years, cases of sexual abuse during psychedelic therapy have come to light. Earlier this year, New York Magazine, in collaboration with psychedelic watchdog nonprofit Psymposia, explored sexual abuse taking place in psychedelic clinical trials in an investigative podcast called Cover Story: Power Trip. A notable example was the story of Meaghan Buisson, who in 2015 took part in a trial testing MDMA as a treatment for post-traumatic stress disorder, as part of a clinical trial hosted by the Multidisciplinary Association for Psychedelic Studies, a psychedelic research nonprofit. During this trial she was sexually assaulted.
Psychedelics induce a specific kind of vulnerability, as they are known to enhance suggestibility and sexual feelings. That means addressing the risk of sexual abuse in psychedelic research and therapy should be prioritized as highly as the risks of hype, says Neşe Devenot, a postdoctoral associate at the Institute for Research in Sensing at the University of Cincinnati and a team member of Psymposia. “Historically, some of the scientists working in the field have really dismissed, discounted, and even ostracized the people who have spoken up about risk,” she says. Psychedelic researchers themselves haven’t spoken up much about this specific risk set, and Devenot says they need to.
It’s also not just the mass media and industry that’s behind the hype—scientists themselves are guilty of promoting it, says Philip Corlett, an associate professor of psychiatry at the Yale School of Medicine. Corlett compares it to the movie Scream: The call is coming from inside the house. “Some scientists really court this type of attention and don’t take responsibility at all for how their work is portrayed in the popular press,” he says.
Some researchers aren’t particularly receptive to criticism from fellow scientists. In April, another paper led by Robin Carhart-Harris looked at how psilocybin works to treat depression. Carhart-Harris and his coauthors posited that perhaps the effect was the result of boosting connections between different parts of the brain. But a few other academics began to pick holes in the paper. One of those was Corlett.
He and two other concerned scientists—Fred Barrett and Manoj Doss—submitted a letter to the editor to the journal, in which they pointed out some worrying red flags: outcome inconsistencies, odd omissions, statistical flimsiness—all in the scientific weeds, but important nonetheless for research to be rigorous. The letter was rejected, so they instead uploaded their response to a preprint server. (The letter has now gone through peer review and was recently published in a journal.) In response, Carhart-Harris and two other coauthors published their rebuttal to the rebuttal, in which they questioned whether the response had been fueled by the personal motivations of its authors, kicking off an even bigger firestorm of back-and-forths on social media. (So much so that Carhart-Harris has blocked Corlett on Twitter.)
Scientists’ unwillingness to accept criticism makes Corlett pessimistic about the future of psychedelic research. “Science is meant to be somewhat adversarial. It’s not meant to be presided over by a single group of people,” he says. “I’m still open and excited about the possibilities, but I think this kind of breathless rush to translation and to a conclusion is really dangerous.”
And in an ethically murky turn, for those in the field who have begun to dabble in the corporate side of psychedelics, hyping up findings has become of obvious interest. Declaring conflicts of interest is standard practice in academia, and for good reason: Would you trust a paper that declared that spending more time on Instagram makes you happy if the lead author was receiving money from Meta? But that happens on a regular basis in psychedelic research; many in the field have accepted board positions or consulting fees for the ever-expanding number of psychedelic companies. That means “it’s literally a financial incentive to hype the results,” says Yaden. Watts agrees: “I think for research to be truly solid and not hyping things, it needs to be separated out from the interests of the companies who have stuff to gain.”
Against this backdrop, it needs to be remembered that while generally safe, psychedelics are not totally risk-free. Though it happens rarely, psychedelics can trigger psychotic episodes. Yaden says it’s a matter of when—not if—a high-profile adverse event occurs during psychedelic treatment. “I think preparing people for that is also important.”
If, as Yaden and his coauthors predict, the psychedelic hype bubble does burst, backlash will follow. But alongside the smugness there will be darker repercussions, and those for whom psychedelics represent a last-ditch effort to treat severe mental illness will be some of those who stand to suffer the most. If they have extraordinarily hyped-up expectations, future rigorous studies that temper and provide a more realistic view of these substances’ capabilities are going to be disappointing, says Yaden. “They’re going to feel, I think, cheated.”
If this bubble-bursting moment does come, Yaden and his coauthors hope that the psychedelics field will settle down again, with less public and corporate interest and more time for the boring—but necessary—rigorous research. “The idea is not to squelch research,” says Yaden. “The idea is to be in it for the long run in a sustainable, responsible way.”
Updated 9-1-2022 5:20 am ET: The misspelling of Meaghan Buisson’s name was corrected.
