Therapy Isn't Working. Can Psychedelics Fill the Gap?

We’re in a mental health crisis, and current treatment options aren’t cutting it.

As Dr. Raghu Apasani, an integrative and addiction psychiatrist and psychotherapist, notes, “Only about 43 percent of people got mental health services in the past year who needed it. And that's in the United States. If we think more globally, the treatment gap is more like 75% to 85% of people who are not getting services.”

That’s partly due to a lack of understanding around mental health problems, where, thanks to inaccurate stereotypes and sensationalism, stigmatization runs rife. Compound that with prohibitive costs and the difficulty of finding help that actually, well, helps, and it’s no wonder we have major treatment gaps.

What Kind of Help Do We Need? 

Currently, we have a therapeutic model of care informed by research and hopefully grounded in culturally sensitive values.  It also includes the triumphs and travails of pharmaceuticals. Medication can provide critical low-effort support. When we’re in crisis, sometimes we don’t have the capacity to stretch goals or make big changes.  Medication can give us the scaffolding we need for the next steps.

But as Dorna Parang, a psychedelic clinical research specialist and founder of the Mind Rise Medica LLC, notes, “Of course, we realized over time that the medicines that are available can't be a band-aid for some of the underlying root causes for these issues such as trauma, poverty, other sort of community factors, things like that.”

Appasani agrees, holding the complexity that medication can be a powerful tool as long as it’s not used to wallpaper over what needs to be healed.

He says, “Thinking about things like Prozac and Zoloft and Lexapro and the rise of SSRIs, which, you know, for a subset of people are beneficial and necessary. But the way that it's been prescribed, oftentimes in the Western world, particularly the UK and the United States, again, we use it as a way to numb emotions, right? They take away the depressive symptoms, but they also kind of numb the joy sometimes for many people. And so you lower that window of, ‘Oh, I don't need to deal with this anymore, right?’ And you numb it."

From Me to We: The Importance of Holistic, Community-Oriented Solutions

It’s mission-critical to expand our mental health practices. That means moving beyond notions of “curing” a condition and into developing practices of holistic and integrative care.

Appasani notes, “I try to think about it the same way you do with going to the dentist. You don't just go because your tooth hurts or you have a cavity or you need something acute. You go regularly to get tuned up, and it's for hygiene. If you can think about that the same way from a mental hygiene concept, we have our routines and our rituals and our habits.”

While it’s empowering to attune our individual responsibility to ourselves, we also want to keep in mind there are larger systems outside our control impacting our well-being.

Pourang cautions “I think the sort of stereotype or base of psychotherapy is that everything is just your internal reaction to what's happening outside of you. So if something outside of you happens, that's your thing to work on inside, and then that's your internal process to manage. And that's part of it too, but as we're progressing as a society, I think we're realizing that therapy can only get you so far if you're in poverty, if you're actively experiencing trauma, or relationships, people who are actively experiencing racism. And so it's also the continuous work to deconstruct some of these systems of oppression that are then creating the internal sense of unwellness. So I think it's important not to kind of think of therapy as the blanket solution for all of this in general. And so … how can therapy be elevated? Being in solidarity with these groups and finding ways to support them.”

Moving beyond individualistic solutions to communal care honors our innate knowing that as humans we need social and emotional connections and as Ram Dass says, “We are all just walking each other home.”

Can Psychedelics Help Therapy Be More Effective? 

Speaking of Dass, while discussing complementary and alternative ways to heal our troubled minds we of course need to name psychedelics. Particularly when honored within their traditional healing contexts, they offer a potent pathway for these deeper connections to ourselves, each other, and the planet.

Appasani reminds us that the indigenous communities we get so many of our medicines from aren’t just handing people a pill.

“Think about what besides the plant medicine they're doing that's different than us that is also beneficial, right? They're living in nature, they're providing protection to their own environment and they're living in community," he says. "We've really shifted from that village concept to individualization, right? And so it's not just the plant medicine. Why don't we also learn the other things that are being done that are really helping their community and their society grow and thrive? Because those are tangible things that we can also do at scale.”

But what if you’ve tried it all and nothing seems to work? Appasani has some questions he’d like you to consider.

“How long did you do it? How long did you work with this person? Did you do things in between the sessions that were suggested? It's oftentimes no, right?" asks Appasani. "People kind of show up for the 50 minutes and they leave. And it's really about fully investing in it. It's the same with psychedelic medicine too. You can't just go and do it and then expect it to have this wild healing potential for you, right? We talk so much about this integration … but that's really where I personally think the magic happens. When you have these insights, you have this processing with your therapist, with whoever you're doing this with, and then you start to actually process. You start to discuss in these integration circles, you start to discuss with yourself. And that's where the actual potential of growth and healing can happen.” 

Curious to explore psychedelic-supported therapy? Appasani encourages people to remember it’s not a one-and-done event but rather an ongoing journey of creating what he calls a “mental health toolkit.

“So what I would really encourage people to do is that if they're choosing to go down this path and want to explore it, they recognize that it's not just a one-day or a two-day or a three-day thing," says Appasani. "It's actually a journey. Make sure that you have your sort of mental hygiene toolkit. And your ways of expression.”

Pourang agrees, reminding folks that “This is part of why, when people go into ayahuasca ceremonies, they're asked for several weeks prior to follow specific diets and meditation practices and journaling practices and to abstain from certain substances and activities. And the purpose of that is to really ground you down into a specific mindset so that you arrive in the ceremony a certain way.”

As with pharmaceuticals, Appasani is concerned psychedelics could likewise become a silver bullet excuse to neglect the daily “chop wood, carry water” practices necessary for sustainable change.  He says, “I do have this underlying worry that if we start to medicalize psychedelics outside of their context of healing and community and potential and integration, that it may turn into this path of using it to sort of have kind of escapism and bypassing from dealing with the real stuff. And we all as humans without any external factors, have the potential within us to really heal and to understand ourselves deeply if we choose to do the work.”

All the choices and obstacles combined can make it tough to know the first move to make. Appasant offers some compassionate wisdom.

”There’s a lot of noise and a lot of conversation out there right now. And it's okay to have feelings and emotions. It's natural," he says. Don't run away from them and really think about what helps you because everyone is different and mental health is a mosaic and you need a mosaic of treatment for you as well and support. So explore things in a safe way and don't lose yourself in it.”

Sara is MUD\WTR's Trends w/ Benefits podcast host. Learn more about MUD\WTR advisors Dorna Pourang and Raghu Appasani here.

Photo by Auriane Clément on Unsplash

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