First they ignore you, then they laugh at you, then if they can’t kill you, they co-opt you.
Co-optation here refers to the process by which a powerful institution attempts to preserve its control by incorporating a popular element of a radical movement while burying the radical ideology of that movement.
Once again, the institution of psychiatry is in crisis and desperately seeking to excite a general public that is increasingly disenchanted by psychiatry’s repeated failures. As I document in A Profession Without Reason (2022), psychiatry’s treatment outcomes were acknowledged in 2011 by former National Institute of Mental Health (NIMH) director Thomas Insel as “abysmal” and “bleak.” Since then, in 2021, the New York Times concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direction, even as access to services expanded greatly.”
Has psychiatry contributed anything positive to society? SSRI antidepressants—psychiatry’s last heralded “miracle drug”—are now known to create a far higher percentage of sexual dysfunction than to positively affect depression, with success rates no different or even lower than placebo rates. Psychiatry’s serotonin imbalance theory of depression, discarded by researchers three decades ago, is now finally known to the world to have no merit; and psychiatry’s attempt to gaslight the general public into believing that it is blameless for this theory’s perpetuation has made it vulnerable to a potential class-action lawsuit. Psychiatry’s DSM diagnostic manual has now been acknowledged even by high-ranking members of the psychiatry establishment to be invalid and even “bullshit.” The Open Payments database reveals 75% of psychiatrists are on the take from drug companies. And research shows psychiatry’s idea that “serious mental illness” is a brain disease has resulted in a perception of greater dangerousness and a desire for social distance—in other words, increased stigmatization.
The history of psychiatry is one of consistent scientific failure, but it is also one of remarkable political success through a variety of tactics, which include partnering with financially powerful drug companies so as to control the mainstream media—and co-opting attractive radical movements. Thanks to well-meaning psychedelic advocates, including Michael Pollan (bestselling author of How to Change Your Mind, 2018), psychedelics today have a mainstream respectability and a popular allure. Politically astute establishment psychiatrists recognize that psychiatry desperately needs to excite the general public, but that with no new Big Pharma “magic bullet” on the horizon, psychiatry has no choice but to attempt to co-opt psychedelics from an underground radical subculture.
Before detailing the current co-optation of the psychedelic underground, first some history of the co-optation of peer-to-peer support and Alcoholics Anonymous (A.A.). Then, some thoughts on why such co-optation is not only critical for the self-preservation and expansion of psychiatry, the medical establishment, and drug companies, but why this is also welcomed by those atop the societal hierarchy, who know full well that successful and attractive anti-authoritarian, non-hierarchical mutual-aid models threaten its control.
Darby Penney (1952-2021) was a longtime activist in the human rights movement for people with psychiatric histories. She was not only a leading force in the implementation of the type of peer support that is peer-developed and peer-run, but she was also a historian of this movement’s development and its co-optation. Some years ago, I had a lengthy conversation with her, one in which she was deeply troubled about how the creation of something so empowering was being co-opted to be disempowering.
Peer-developed peer support, as Penney defined it in 2018:
“is a non-hierarchical approach with origins in informal self-help and consciousness-raising groups organized in the 1970s by people in the ex-patients’ movement. It arose in reaction to negative experiences with mental health treatment and dissatisfaction with the limits of the mental patient role. Peer support among people with psychiatric histories is closely intertwined with experiences of powerlessness within the mental health system and with activism promoting human rights and alternatives to the medical model.”
In 2019, Darby Penney, together with dissident psychiatrist Peter Stastny, authored “Peer Specialists in the Mental Health Workforce: A Critical Reassessment.” They document how peer-developed peer support has increasingly been co-opted and bastardized since the growth of “peer specialist” employees in traditional mental health settings. While providing paid employment for ex-psychiatric patients, it has come with a serious cost.
The essence of true peer-to-peer support is non-hierarchical empowerment, but in these traditional mental health settings, Penny and Stastny document research showing (1) peer specialists “are often used to carry out paraprofessional and even menial tasks within traditional mental health programs, rather than provide genuine peer support”; (2) in contradiction to the horizontal relationships of grassroots survivor-developed peer support, relationships between peers and patients in these traditional mental health settings are routinely hierarchical; (3) peer specialists are increasingly being “employed in situations where people are being coerced into ‘treatment,’ secluded and restrained, and forcibly medicated”; and (4) peer specialists are performing tasks “such as pressuring clients for medication compliance, reporting clients’ behavior to clinicians, and enforcing adherence to outpatient commitment orders.”
In our conversation, Darby Penney made clear that while empowering peer-developed and peer-run peer support continues to exist, she was worried. What she detailed reminded me of how the Nazis in their concentration camps used Jewish “prisoner functionaries,” commonly called kapos, to control other Jewish prisoners, and I asked Darby if that analogy sounded hyperbolic. With a pained expression, she responded, “I think about exactly that all the time.”
Alcoholics Anonymous (A.A.)
What psychiatric survivor activists today call “peer-to-peer support” has a longer history of being termed by anarchists as “mutual aid.” In mutual-aid groups, joining and participation is voluntary and an absence of coercion is a central value. Mutual-aid groups are non-hierarchical and egalitarian, distinguished by consensus decision making and participatory democracy, all of which is the essence of the political philosophy of anarchism.
The term mutual aid was popularized in the early twentieth century by the Russian anarchist Prince Peter Kropotkin (1842–1921) with his 1902 book Mutual Aid. A.A. co-founder Bill Wilson (1895-1971), referred to in A.A. circles as “Bill W.,” greatly esteemed Kropotkin and nonviolent anarchism. In Alcoholics Anonymous Comes of Age, Wilson pointed out how attractive the noncoercive nature and freedom of A.A. is for anti-authoritarian newcomers:
“We cannot be compelled to do anything. In that sense this society is a benign anarchy. The word ‘anarchy’ has a bad meaning to most of us. . . . . But I think that the gentle Russian prince who so strongly advocated the idea felt that if men were granted absolute liberty and were compelled to obey no one in person, they would then voluntarily associate themselves in a common interest. Alcoholics Anonymous is an association of the benign sort the prince envisioned.”
Wilson, prior to his co-founding A.A., had been repeatedly failed by the medical establishment. His multiple 1930s commitments at Charles B. Towns Hospital for Drug and Alcohol Addictions had no effect on his alcohol abuse—a habit which only was broken following a deep spiritual experience. In the 1950s, Wilson experimented with LSD, and he was enthusiastic about its potential for quieting the ego and allowing for the kind of spiritual experience that he believed was necessary to exit from the drinking life.
Anarchist writer Logan Marie Glitterbomb points out that A.A.’s Twelve Traditions are replete with anti-authoritarian anarchist principles that stress mutual aid, self-support, non-hierarchical organization, and autonomous groups. Wilson knew that these elements were attractive to anti-authoritarian alcoholics such as himself, and while he believed that it is a spiritual conversion that opens one up to a new way of life, he was concerned that an authoritarian interpretation of God would turn off many anti-authoritarian problem drinkers. So, Alcoholics Anonymous Comes of Age recounts A.A. founders’ consideration of not using the word God in A.A.’s “Twelve Traditions” and their “Twelve Steps.” They ultimately chose to use God but to make clear that the term was open to individual interpretation.
A.A. founders attempted to preempt A.A.’s co-optation and bastardization by hierarchical capitalistic institutions via A.A.’s “Twelve Traditions.” Specifically, Tradition #6 states: “An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.” This tradition has been subverted by the for-profit rehab industry which uses A.A. groups and Twelve Steps as part of a money-making enterprise. Furthermore, when court systems coerce people to attend A.A. meetings, the non-coercive mutual-aid A.A. culture is destroyed.
A.A. founders envisioned A.A. to be fellowship, not a medical technology. Owing to its co-optation, A.A. has lost its anti-authoritarian underground subculture allure, and many people today are surprised when they hear about its co-founder Bill Wilson’s affection for anarchism.
There is an increasingly loud drumbeat today for the use of psychedelic drugs such as LSD and psilocybin in psychiatric treatment of depression, anxiety, post-traumatic stress disorder (PTSD), drug addiction, and despair over terminal illness.
While European-American culture became excited by synthetic psychedelics such as LSD in the twentieth century, plant-based psychedelics such as mescaline and psilocybin have long been a spiritual component of indigenous cultures. In the United States, psychedelics were legal until Richard Nixon’s “War on Drugs” in the late 1960s. One major political reason for Nixon’s war was to criminalize and eliminate a large anti-authoritarian subculture who were generally no fans of the authoritarian Nixon. The psychedelic subculture was comprised of individuals with varying ideologies and philosophies, but was an anti-authoritarian subculture.
Anti-authoritarians reject an unquestioning obedience to authority, and they believe in challenging and resisting illegitimate authority. “Turn on, tune in, and drop out”—the catchphrase of psychedelic advocate Timothy Leary (1920-1996)—was much about rejecting the conformist and oppressive nature of society. A control-freak culture perpetuates a control-freak ego, and psychedelics were seen as a vehicle to quiet that ego and allow for a connection with the universe—and an experience of the joy of being alive.
Ken Kesey (1935-2001), author of the anti-authoritarian 1962 novel One Flew Over the Cuckoo’s Nest, along with his “merry pranksters,” championed LSD parties (or “acid tests”), and this anti-authoritarian subculture is visible today in Grateful Dead and Phish scenes. Within this psychedelic subculture, there are libertarian-socialist-anarchist anti-authoritarians, fuck-government-libertarian anti-authoritarians, and anti-authoritarians who eschew any political identity.
Today, the Drug Enforcement Administration (DEA), terming psychedelics as “hallucinogens,” continues to remind Americans that these drugs are classified as “Schedule I under the Controlled Substances Act, meaning that they have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.” In contrast to Schedule I drugs, Schedule II drugs (such as the ADHD amphetamine drugs including Adderall), while also seen as having a high potential for abuse, are considered by the DEA to have medical use and so can be prescribed by physicians. Thus, an increasing number of members of the medical establishment want psychedelics to be classified as Schedule II drugs so these too can be legally prescribed by them, and of course several drug companies see high-profit potential in such a re-classification.
How can psychiatry co-opt the psychedelic underground subculture, discard its radical anti-authoritarian message of rejecting a dehumanizing society, retake psychiatry’s lost power and authority, and make both drug companies and the ruling elite happy?
A key insight to begin to unravel how this is being orchestrated is provided by Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, in her 2021 essay, “Psychedelics—The New Psychiatric Craze!”:
“The rationale behind this trend is confusing and contradictory. On the one hand, psychedelics are promoted as assisting the process of psychotherapy through the insights that the ‘trip’ or drug-induced experience can generate—on the other they are claimed to represent a targeted medical treatment for various disorders, through correcting underlying brain deficiencies.”
The use of psychedelics to quiet the ego and open oneself up to liberating insights is a very different use than psychedelic microdosing three to five times per week with a standardized “subthreshold” dosage to adjust to society with less emotional suffering.
People certainly do have breakthrough ego-quieting experiences while using psychedelics. On such a trip, they may for the first time in their life take seriously previously discarded insights about their depression being caused by self-absorption and a lack of love in their life. “But,” as Moncrieff points out, “these benefits are not medical or health effects. They are akin to the personal development that people achieve through other sorts of activities.” People have achieved similar breakthrough benefits through near-death experiences, through authentic sweat lodge ceremonies, through fasting, or through a variety of extraordinary altered states that quiet ego controls and enable liberating insights to be taken seriously.
Psychedelic advocates such as Pollan conclude that the psychedelic renaissance requires a trustworthy cultural “container,” and psychiatry and organized medicine desperately would like to convince society that they are the safest and most effective container. Pollan is a critical thinker with an anti-authoritarian sensibility and a reverence for indigenous cultures’ use of psychedelics, and he understands the concerns of psychedelic underground guides who fear marginalization from medicalization. However, there is a political trap that even well-meaning psychedelic advocates get caught in when they embrace “brain evidence” as a major way of legitimizing the ego-quieting capacity of psychedelics.
Pollan, in “The Big Think” and other presentations viewed by millions of people on the Internet, routinely highlights Robin Carhart-Harris’s 2012 study “Neural Correlates of the Psychedelic State as Determined by fMRI Studies with Psilocybin,” which concludes that functional magnetic resonance images (fMRI) show that psychedelics quiet one particular part of the brain—the “default mode network” (DMN), which is active when one is self-critical and ego driven; and so for Pollan, psychedelics can induce an “uprising” by the rest of the brain against the now quieted “dictator” DMN—a revolt against one’s own tyrannical ego. However, while fMRI colorful pictures are visually quite compelling, such a faith in fMRI research with respect to psychological functioning needs be critically examined—both scientifically and politically.
First, scientifically. A 2022 Neuron review co-authored by Raymond Dolan (considered one of the most influential neuroscientists in the world) of more than 16,000 neuroimaging articles published during the last 30 years, concluded, “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition.” Detecting brain activity and its absence with respect to psychological states via fMRI research is replete with methodological problems. A 2016 study, published in the Proceedings of the National Academy of Sciences, reported that the methods used in fMRI research can create the illusion of brain activity where there is none up to 70% of the time. Perhaps the most famous example is when Dartmouth researchers placed a dead salmon into an fMRI machine and “showed” it photographs depicting humans in social situations, and the resulting fMRI data made it appear as though the dead salmon was thinking about the pictures that it had been shown.
Second, politically. Of course, psychedelic use has biochemical correlates, but is the psychedelic trip to be seen as primarily a medical procedure or a spiritual activity? That is a political question, with ramifications for who are considered by society as psychedelic authorities. Whether or not neuroscientists can overcome the historic methodological problem that make scientists skeptical about fMRI announcements with respect to psychological states, and whether or not neuroscientists have in fact located the biological site for “ego quieting,” the idea that this is true has political consequences. A societal “brain focus” for ego quieting helps facilitate its medicalization by psychiatry—enabling it to seize the top tier of the psychedelic hierarchy; and this enables psychiatry and its drug company partners to control both the narrative and use of psychedelic chemicals.
Enter microdosing, which has exploded in popularity in the last decade and which drug companies and their investors are betting on, but which is being slated for use in a very different way than ego quieting so as to allow for a greater connection with the universe.
What exactly is microdosing? The webzine Psychedelic Spotlight reports in 2022: “The common definition is that it is a ‘subthreshold’ dose of a psychedelic substance that has no noticeable effects. . . . For typical psychedelics it might be as little as 1/10th to 1/20th the normal dose, which would be around 10-20 micrograms of LSD or 0.25-0.3 grams of psilocybin mushrooms.” Drug companies will be able to guarantee to doctors standard and reliable dosages. Psychedelic Spotlight continues, “Advocates and anecdotal reports claim that microdosing increases energy, increases focus, decreases anxiety, relieves depression, helps sleep, reduces alcohol or drug craving, reduces food craving, and promotes a positive attitude. However, clinical research has not come anywhere near to demonstrating any of these benefits.” Specifically, a 2022 Psychopharmacology study, “Psilocybin Microdosing Does Not Affect Emotion-Related Symptoms and Processing,” used a double-blind, placebo-controlled, within-subject crossover design, and the authors reported:
“Our confirmatory analyses revealed that psilocybin microdosing did not affect emotion processing or symptoms of anxiety and depression compared with placebo. . . . Our finding that psilocybin microdosing does not affect symptoms of anxiety and depression contradicts previous survey studies which reported marked reductions in negative emotionality following the repeated microdosing of psychedelic substances.”
However, with publicly traded companies such as MindMed and Compass Pathways betting heavily on psychedelic microdosing, and with capitalist investors such as Kevin O’Leary (from “Shark Tank”) excited about his investments in these companies, along with psychiatry’s desperation to have the next “miracle drug” replacement for their failed SSRIs, I have little doubt we will hear about new studies showing microdosing is a “safe and effective” treatment for depression, anxiety, and a host of other ills. Furthermore, it would be in the interest of psychiatry and these drug makers that microdosing becomes FDA-approved for a dosing regimen similar to SSRI use (or perhaps with less frequency but with an extremely expensive product and procedure). And following the path of all psychiatric drugs, eventually psychedelic microdosing will be seen as “safe and effective” for children and every other population in which current psychiatric drugs are now failing. No wonder Kevin O’Leary is excited.
But what about those medical treatments that seek to emulate the ego-quieting breakthroughs? What about psychedelic-assisted therapy (PAT), in which a certified therapist replaces an underground guide? PAT will certainly become increasingly more available but, unlike microdosing, there is no big money for drug companies with PAT, and so PAT will likely become a secondary phenomenon. Moreover, stripped from an underground anti-authoritarian subculture—one that recognizes that a control-freak dominant culture incites a control-freak ego—mainstream-medicine PAT will be a component of mainstream society, not a defiance of it. Furthermore, the power of any ego-quieting trip—whether or not it is chemically induced—has a great deal to do with its experience as sacred; and in the mainstream medical environment, what is routinely found is the sterile rather than the sacred.
Using the classic co-opting tactic, a popular element of an underground movement is extracted from its anti-authoritarian subculture. To strip psychedelic use down to its chemicals is to de-radicalize what is most threatening to a control-freak authority structure. While Nixon was able, via criminalization, to drive the anti-authoritarian psychedelic subculture more deeply underground, the current co-optation by the medical establishment of the psychedelic underground subculture will de-radicalize psychedelic use. Politically, one can argue that the medicalization of psychedelics is the only way to decriminalize its use; however, the question for society is this: Given psychiatry’s history of treatment outcome failure and its ethically compromising financial relationships with Big Pharma, is it really a good idea to make psychiatry the societal authority in charge of psychedelic use?
Victory for Those Atop the Societal Hierarchy
To the extent that any anti-authoritarian, non-hierarchical, mutual-aid organization is not only successful but pleasurable for participants, it serves as an attractive model. The greatest fear of those atop the societal hierarchy—the “power elite”—is that once people see this type of attractive model succeed anywhere, increasingly more people will want this elsewhere, including their workplace, which would mean that there would no longer be a ruling class.
The vision of an anti-authoritarian, non-hierarchical, mutual-aid society is intoxicatingly attractive to many people—and this terrifies the ruling elite. An effective and satisfying non-hierarchical mutual-aid model is so threatening for various authoritarians that it can become their common enemy. For example, during the Spanish Civil War in the 1930s, Nazi Germany, fascist Italy, Stalinist Soviet Union, Western capitalist nations, and the Catholic Church all played a role in destroying a successful non-hierarchical, mutual-aid, anarchist society.
Simple logic tells us that those atop a societal hierarchy will provide rewards for professionals who promote an ideology that maintains the status quo of a hierarchical coercive society. If a population believes the roots of its emotional suffering are in an un-quieted DMN and un-activated 5-HT2A receptors that can be medically treated with psychedelics, rather than such suffering being rooted in a control-freak, dehumanizing, frightening culture that incites a control-freak ego that can be spiritually illuminated with psychedelics, this or any biochemical individual-defect belief system can be a more powerful and less expensive way of maintaining the status quo than a heavily armed police force.