Disenchantment and Repair: Psychedelic Therapy as an Epistemic Intervention in Contemporary Psychiatry
- Topaz Manneh
- Jun 16
- 10 min read
By Topaz Manneh
Introduction
The modern biomedical model of psychiatry, rooted primarily in neurochemical explanations, has long dominated both clinical practice and research paradigms. Since the mid-twentieth century, conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD) have been predominantly framed as neurobiological dysfunctions treatable with pharmacological agents such as selective serotonin reuptake inhibitors (SSRIs). However, the recent resurgence of psychedelic therapies, which demonstrate rapid and durable efficacy, poses a fundamental challenge to this reductionist framework. By centering subjective experience, spiritual insight, and narrative meaning-making, psychedelic therapy unsettles dominant psychiatric epistemologies, compelling a re-evaluation of mental health that is existentially grounded, relationally situated, and attentive to sociohistorical complexity.
This essay critically examines how psychedelic therapy challenges the dominant neurochemical paradigm, highlights the epistemic injustices embedded in current psychiatric practice, and argues for a pluralistic and decolonial approach to mental health that integrates diverse knowledge systems, cultural traditions, and lived experiences.
Neurochemical Reductionism and the Biomedicalisation of Mental Health
Since the mid-twentieth century, psychiatry has been dominated by a biomedical model that conceptualises mental illness primarily as a dysfunction of brain chemistry. This paradigm gained momentum with the advent of psychotropic medications, particularly selective serotonin reuptake inhibitors introduced in the 1980s, which were widely promoted as correcting a “chemical imbalance” in the brain (Healy, 2004). However, the serotonin hypothesis of depression has faced increasing empirical scrutiny. For instance, a comprehensive umbrella review by Moncrieff et al. (2022) found no consistent evidence supporting the claim that depression results from low serotonin levels.
Despite such critiques, the neurochemical model remains deeply entrenched in psychiatric practice. Its endurance is partly attributable to alignment with pharmaceutical industry interests and its appeal as an ostensibly objective, measurable framework (Whitaker, 2010). Scholars such as Lacasse and Leo (2005) have documented how public narratives about SSRIs have often outpaced the underlying evidence, highlighting the role of commercial imperatives in shaping psychiatric knowledge.
Crucially, this reductionist framework marginalises the complex social, psychological, and existential dimensions of mental distress. As Rose (2007) and Double (2006) argue, the biomedicalisation of psychiatry mirrors broader cultural trends towards technological rationalism and commodification of healthcare. It privileges quantifiable neurobiological data over subjective experience, frequently sidelining trauma histories, socioeconomic determinants, and cultural contexts. Moreover, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which underpins pharmacological treatment decisions, has been criticised for its rigid categorical diagnoses that obscure the fluid and context-dependent nature of psychological suffering (Frances, 2013; Horwitz and Wakefield, 2007). Consequently, psychiatry risks becoming a discipline that manages symptoms rather than addressing the roots of distress.
Psychedelic Interventions as Epistemological Disruptions
In stark contrast, psychedelic therapy presents a profound challenge to the epistemological foundations of biomedical psychiatry. Unlike SSRIs, which primarily aim to stabilise mood through chronic neurochemical modulation, psychedelics such as psilocybin, MDMA, and ayahuasca induce acute, often transformative experiences that catalyse emotional insight, spiritual connection, and narrative reprocessing.
One of the most compelling findings in psychedelic research is the robust correlation between therapeutic outcomes and the intensity of the “mystical experience,” characterised by ego dissolution, unity, and transcendence (Griffiths et al., 2006; 2016). These subjective states resist reduction to serotonin receptor activity or brain imaging metrics, thereby challenging the assumption that healing can be fully explained by neurobiology alone.
Further complicating the biomedical model is the centrality of “set and setting” the psychological, social, and cultural context in which psychedelics are administered. Hartogsohn (2016) and Carhart-Harris et al. (2018) emphasise that therapeutic outcomes depend as much on context and intention as on pharmacology itself. This emphasis on relationality and context stands in marked contrast to the standardised protocols and decontextualised frameworks that characterise contemporary psychopharmacological practice.
Moreover, psychedelic therapy reopens long-sidelined questions: What role does consciousness play in healing? How do meaning, memory, and spirituality shape recovery? Scholars such as Letheby (2021) and Grof (1980) argue that psychedelics create space for integrating existential and transpersonal dimensions into mental health care.
These epistemic expansions are not merely theoretical. Clinical trials demonstrate that psychedelics can produce rapid, sustained improvements in treatment-resistant depression, PTSD, and end-of-life anxiety (Carhart-Harris et al., 2021; Mitchell et al., 2023; Ross et al., 2016). Such outcomes challenge the modest, often marginal efficacy of SSRIs and suggest that healing requires more than neurotransmitter regulation; it demands a reorientation of selfhood, meaning-making, and relationality.
In this way, psychedelic therapy acts as an epistemic disruptor, questioning the hegemony of reductionist science and opening the door to pluralistic, integrative models of mental health that honour subjective experience, cultural context, and the transformative potential of altered states of consciousness.
Historicising Psychedelic Practice: Clinical Erasure and Indigenous Continuities
The contemporary resurgence of psychedelics often overlooks the rich and complex history of their use in both Western clinical research and Indigenous ceremonial contexts. In the 1950s and 1960s, pioneers such as Humphry Osmond and Stanislav Grof explored the therapeutic potential of LSD and psilocybin for treating alcoholism, anxiety, and depression, with promising results. However, this early wave of psychedelic science was abruptly halted by the Controlled Substances Act of 1970, legislation driven more by political and racial anxieties than by scientific evidence (Dyck, 2008; Hart, 2020).
Today’s psychedelic renaissance risks repeating this erasure if it fails to critically engage with the lessons of its disrupted legacy. As Langlitz (2013) observes, the institutional memory of psychedelic science is fragmented, and the field frequently reinvents itself without fully grappling with its own history.
Equally significant is the millennia-long use of psychedelics by Indigenous communities for spiritual, communal, and medicinal purposes. In the Amazon basin, ayahuasca has been central to healing rituals that intricately weave cosmology, ecology, and social cohesion (Labate and Cavnar, 2014). In North America, peyote ceremonies remain vital within the Native American Church, blending Indigenous and Christian traditions in a syncretic form of spiritual healing (Calabrese, 2013).
Such practices must not be reduced to cultural curiosities; rather, they reflect sophisticated epistemologies that offer alternative ontologies of health, embodiment, and care. As Fotiou (2020) and McCleave et al. (2024) argue, Indigenous knowledge systems offer holistic frameworks that fundamentally challenge the individualistic and medicalised orientation of Western psychedelic science. Ignoring these traditions perpetuates epistemic injustice and forecloses opportunities for culturally resonant and expansive models of care.
Epistemic Injustice and the Politics of Psychedelic Knowledge
Psychedelic research remains overwhelmingly Western, white, and male dominated, despite marginalised communities bearing disproportionate burdens of trauma and mental illness (George et al., 2020). This exclusion exemplifies what philosopher Miranda Fricker (2007) terms “epistemic injustice,” the systematic devaluation of certain groups as credible knowers.
Black and Indigenous perspectives are often relegated to symbolic or supplementary roles rather than recognised as central contributors to knowledge production. Community-based healing practices are frequently dismissed as anecdotal or unscientific, while randomised controlled trials are valorised as the gold standard. Yet randomised controlled trials often fail to capture the relational, spiritual, and contextual dimensions of healing integral to many non-Western traditions (Walsh and Thiessen, 2018).
Emerging evidence indicates that culturally adapted psychedelic-assisted therapies, such as those developed by Black clinicians to address racial trauma, can be more effective and ethically appropriate for marginalised populations (Williams et al., 2020). Without meaningful inclusion, the psychedelic renaissance risks becoming a site of epistemic colonisation rather than liberation (Tuck and Yang, 2012).
Psychedelic Capitalism and the Political Economy of Access
The rapid commercialisation of psychedelics, propelled by venture capital and biotech firms, threatens to entrench existing inequities. Companies have sought to patent synthetic psilocybin formulations, trademark Indigenous symbols, and monetise sacred practices often without consent or benefit sharing (George et al., 2020; McKenna, 2021). This dynamic exemplifies “psychedelic capitalism,” the extraction of spiritual technologies from oppressed communities for corporate profit (Pellizzon and Gauthier, 2022).
Moreover, the high cost of psychedelic therapy, often exceeding £10,000 per treatment course, renders it inaccessible to most, particularly those from low-income and racialised backgrounds (Reiff et al., 2020). Limited insurance coverage and restrictive legal frameworks further exacerbate disparities in mental health care access.
While concerns about the high cost of psychedelic therapy are valid, emerging evidence suggests that psilocybin-assisted therapy may be cost-effective in the long term. A decision-analytic model found that psilocybin therapy for treatment-resistant depression could be cost-effective within the UK NHS context, particularly when considering quality adjusted life years (QALYs) and reduced long-term healthcare utilisation (McCrone et al., 2023). The model estimated that, despite upfront costs ranging from £6,132 to £7,652, the intervention could lead to net savings by decreasing the need for ongoing pharmacological and psychiatric care. Psilocybin therapy also yielded the highest QALY gains compared to conventional medication and cognitive behavioural therapy. These findings align with broader research suggesting that psychedelics like psilocybin and MDMA can produce rapid and durable therapeutic effects after just one or two sessions (Carhart-Harris et al., 2016; Tullis, 2021; Nichols, 2020). With appropriate regulatory frameworks and public investment, psychedelic therapy could be integrated into national health systems like the NHS in a financially sustainable and equitable manner.
Alternative models, however, do exist. Community-based approaches, including peer-led integration circles, nonprofit clinics, and culturally grounded healing centres, offer more equitable and context-sensitive care (Loizaga-Velder and Verres, 2014).
Frameworks such as EQUIP (Equity-Oriented Health Care Intervention) promote trauma-informed, harm reduction practices that address structural determinants of health and centre marginalised voices (Browne et al., 2015).
Beyond Biomedicine: Toward a Plural and Decolonial Epistemology of Healing
To realise psychedelic therapy’s full potential, we must move beyond the constraints of the biomedical paradigm towards a pluralistic epistemology, one that honours diverse ways of knowing and healing. This necessitates interdisciplinary collaboration and a fundamental rethinking of who holds epistemic authority.
Psychiatrists, neuroscientists, and pharmacologists must work alongside anthropologists, Indigenous healers, spiritual practitioners, and individuals with lived experience of mental illness. Such an approach challenges Cartesian dualisms separating mind from body, individual from community, and science from spirit (Kirmayer and Gómez-Carrillo, 2019).
It also requires reckoning with the colonial and racial histories that continue to shape contemporary mental health systems. As Smith (1999) and Santos (2014) contend, decolonising knowledge involves not only inclusion but also the redistribution of power and validation of alternative epistemologies.
Conclusion: Reclaiming Mental Health through Epistemic Pluralism
The reemergence of psychedelic therapy presents a rare opportunity to reimagine psychiatry’s epistemic foundations. Rather than simply repackaging these substances within a biomedical framework, this moment should prompt critical interrogation of the assumptions underlying dominant models of mental illness and healing.
By embracing a pluralistic, decolonial, and justice-oriented approach, we can begin to build a mental health system that honours the full complexity of human experience and diverse pathways to healing. This is not only a scientific imperative but a profound ethical responsibility.
References
