Psychedelic Therapy is Wretched Psychology

Medicalized psychedelics are a shoe that does not fit.

The term neurosis, as generally applied, is not accurate or helpful. In fact, one of the most negative influences on mental health is the ‘sick’ concept itself, which tightens and distorts, keeping us from a natural unfolding and realignment.”
— Neal M. Goldsmith (2010), psychotherapist

Lincoln Stoller, PhD, 2021. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license (CC BY-NC-ND 4.0)

Where is the Common Ground?

Psychedelic-assisted therapy consists of psychedelics without therapy, combined with therapy without psychedelics. Lacking a theory, practice, or paradigm to combine the two, they separate like oil and water.

Psychedelics create unusual hyperactive or hypoactive emotional states: dissociated, manic, depressed, pacified, sedated, terrified, angry, amorous, empathic, anxious, or contemplative. They even create normal states but, in that case, we say they’re not working.

All the extreme states that psychedelics create are states that psychotherapy aims to remove. As currently practiced, there is no common framework for psychotherapy and psychedelics to work together.

Psychotherapy views psychedelics ‌as a tool to facilitate the social paradigm that psychotherapy is designed to preserve:

  • When psychedelics make abnormal people normal, we say they’re working.
  • When they make abnormal people differently abnormal, we say they’re not working
  • When they make psychopaths more effective in achieving their psychopathic goals, we say they’re not working.
  • When psychedelically assisted clients are distressed, we say they need to be sedated.
  • When therapists deviate from behavior expected of normal-state experience, we say they should be disciplined.

As “happy medicine,” psychotherapy is biased against a broader state experience. Psychedelics, on the other hand, will not be constrained in this way.

The problem is that psychology exists in a domain of rational normalcy, while psychedelics release a person from this. Therapy aims to return a person to a world of reason while psychedelics illuminate the unreasonableness of the world. There is a fundamental mismatch.

Not Here to Fix a Problem

Psychedelic’s positive cultural role was developed in traditional societies. In these contexts, psychedelics did not play a remedial role in a diagnosed illness, as psychotherapy suggests they should be applied. Traditional cultures will recognize those who do not fit their paradigm, but they don’t ‌purport to cure them of it. These traditions did not reduce personal, family, and social problems to separate issues of mental health, moral precedent, and political attitude.

Psychotherapy has little tradition. It was invented by Freud and others as a psychological adjunct to the scientific enterprise of the 19th-century. It broke from religious, spiritual, naturalist, shamanist, and spiritist traditions to claim dominion over mental health. Psychotherapy has since struggled to resolve its conflicting categories and medicalize what are seen as processes in more integrated world views.

We’ve seen psychotherapy pathologize such concepts as violence, war, homosexuality, stress, alienation, and political extremism. Just about anything that a person in a psychedelic state might ‌begin to understand, psychotherapy cannot.

Psychedelics are ‌shamanic in the sense that they connect disparate worlds. They can open paths to insight or confusion, and resolve or exacerbate existing conflicts and old injuries. They do this, it seems, by creating room in which your mind can expand to find consonance in places where only dissonance existed before. This could mean many things, but one thing it does not mean is an understanding built on the your old framework.

Contrast a shaman with a psychotherapist. A shaman is socially unreliable, emotionally opaque, operates according to supernatural directive, disregards material values, appears to act in contradictory ways, and operates independently. Despite this, the shaman is respected as a visionary who provides social guidance, moral insight, and personal healing but they are not considered normal people. A shaman is the quintessence of the dictum, “Do as I say, not as I do.”

A psychotherapist is an agent of government, corporate interests, professional colleges, and the legal system. He or she is required to be reliable, transparent, obedient, respectful of material values, and operates within a circumscribed field subservient to authorities who are unfamiliar with and indifferent to his or her practice, methods, and clientele.

Not a Side-Kick to Therapy

Implicit in the program we call Psychedelic-assisted therapy is the notion that psychedelics will do something and then go away, leaving our client more amenable to the therapeutic means that didn’t work before. Some say that psychedelics increase one’s psychological lability or neuroplasticity. A chemical version of electro-convulsive therapy that will break the obstacles to the success of normal talk therapy.

There have been many therapies, similar to psychedelic therapy, that made little or no use of chemicals and worked in ways similar to psychedelics. There are various ways to bring a person to an extreme emotional state without using a chemical. These have involved taking a person to physical or emotional extremes and into altered states.

In traditional societies, many states in which people function are altered states: hunting, fighting, journeying, mentoring, and so forth. In our society, there is almost no recognition of state and no place for altered states. Giving birth is a rare exception, and even that is largely medicalized.

Psychotherapy has never trod in the psychedelic space because the psychedelic space is manifestly irrational and ‌nonverbal. The reason that psychotherapy is increasingly split off from coaching, personal growth, business, and transpersonal psychology is that it cannot incorporate transcendence into its multi-allegiance, diagnostic framework.

Psychotherapy is becoming involved in trance work against its will because trance work can achieve what therapy cannot. Psychedelic-assisted therapy is entering the psychedelic space in true colonialist tradition: claiming the territory for its own and appropriating control along with whatever treasures it can find. The clinical, government, academic, and institutional approach to psychedelics entirely disrespects not only indigenous tradition, but all traditions that preceded the industry.

At the same time that clinicians see opportunity, government organizations are reluctant to upset protocol, and academic institutions feel entitled to appropriate the field to revise knowledge as usual. We have seen this behavior time and again in every industry, from health care to natural resources to transportation. It is our tradition of imperialism.

Western culture changes through crisis. It is poor at evolving itself through any means other than chaos. In order to retain as much structure as possible, chaos is sent off shore. If that’s not possible, then new ideas are tested on expendable populations: the young, the old, the poor, or available minorities.

For a Lack of Inner Vision

Psychedelic-assisted psychotherapy is headed for chaos. Experiments are already being performed on the sick, the young, and the disenfranchised. People coming forward to report injuries are being disregarded. The problems that are being recognized are those that threaten the institutions or the institutional role, not the patients. Patients are again being considered pawns for profit.

The media is happy to report anything sensational. Standards of truth and accuracy are hardly possible in a system where no one understands what’s going on, and information is routinely mismanaged. We’d like to say that the media could be held to a higher standard, but there is no unbiased higher standard. We’d like to say there was a scientific standard, but the Covid-19 experience has shown that scientific standards are neither understood nor enforced.

Only doctors can doctor effectively in an uncertain and changing environment. The media, celebrities, agencies, politicians, academics, bureaucrats, and their foot soldiers cannot. The only positive future I see for psychedelics is a return to social and therapeutic values that support altered state experiences, these being shamanic, indigenous, holistic, non-institutional, and personal.

In psychedelic-assisted therapy, there are no doctors. No one in the above-ground, Western culture has experience, and no one with experience has authority. Only those who are officially considered unqualified are qualified, and it’s these people—operating in the underground or from other cultures— who will ultimately provide the guidance we need.

Psychedelic therapy can play a positive role if it can develop trusted, trustworthy, and experienced guides who can operate within the context of a supportive cultural, communal, familial, and medical system. We don’t have this. It needs to be built and, in many regards, it is being obstructed.

We need actual training and experience, not the continued ignorance that’s now passing as psychedelic training. If you have not experienced shamanic dismemberment and altered state dissociation, then you have no business leading another person into those situations. You have no authority without these basic experiences.

We need to develop collaborations between counselors, provisioners, wisdom keepers, community support networks, and those who can guide our culture to accept and support the altered state experience.

Psychedelics are not medicines, and they never were. They do not heal; they change. They do not restore normal health; they expand the mind. If you are not ready for radical change, don’t take the psychedelic path. If our culture cannot support unconstrained changes in clients, and the intuitive, personal, and unconventional behavior of practitioners, then our culture is not ready for psychedelics.


Goldsmith, N. M. (2010). Psychedelic Healing: The Promise of Entheogens for Psychotherapy and Spiritual Development, Healing Arts Press.

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