Beyond Medicalization: Psychedelic Therapy and the Promise of Community-Based Healing

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Author’s note: For transparency, I am the co-founder of Elemental Psychedelics, a state-approved training center for psilocybin mushroom practitioners in Colorado. While my experience informs my perspective, this article is not intended to promote our organization but rather to critically examine the psychedelic movement through the lens of someone deeply involved in both research and practice.

I get it. Many readers might have a bad taste in their mouth for “throwing more drugs” at people. I myself have written at length about people’s lived experiences with the realities of antidepressant and antipsychotic drugs, the need for truth-telling about psychiatric medications, bias in clinical trial reporting of the harms of psychiatric medications, and the possibilities of peer-to-peer alternatives as pockets of hope and resistance to the mainstream psychiatric machinery.

Over the past 15 years, I have also closely observed the re-emergence of psychedelics in psychiatric, communal, and spiritual spaces, which I’ve found is often characterized by hype around psychedelics as a fast track to changing your mind. Taking all of this into consideration, the question for me has become: Do psychedelics represent something meaningfully different here? And the answer I have arrived at is yes, I sincerely hope that something meaningfully different is afoot. And at the same time no, nothing will be different if we don’t allow ourselves to also be changed by the possibilities psychedelics present.

Psychedelics can radically disrupt psychiatric practice as usual and rethink healing, connection, and relationality in the world. I believe the outcomes of psychedelic healing are what many MIA readers also want, but anti-drug sentiment and a very real history of psychiatric harms are big roadblocks to move through.

In November 2022, Colorado voters passed Proposition 122, the Natural Medicine Health Act, creating a first-of-its-kind framework for accessing certain psychedelic fungi and plants for healing purposes. Unlike other state models that narrowly medicalize access, Colorado established a broader community-based approach that honors multiple types of facilitation over strict clinical protocols and embraces ecological wisdom alongside scientific knowledge.

As implementation unfolds, we stand at a crossroads: Will this emerging field truly disrupt the problematic paradigms of conventional psychiatry, or will we replicate the same systems that have pathologized human suffering and reduced healing to a standardized consumer product?

Colorado’s Unique Approach to Psychedelic Policy

Colorado’s Natural Medicine Health Act creates a framework that fundamentally differs from the clinical trial models being pursued at the federal level with patentable, synthetic psilocybin molecules. While Oregon pioneered state-level psilocybin services for non-therapeutic uses and New Mexico’s legislature recently approved medicalized uses, Colorado’s approach goes further than any of these models. Colorado’s approach importantly emphasizes natural medicines in their fungal and plant forms rather than synthetic compounds and allows for multiple pathways for legal use. These distinctions matter deeply for reasons I’ll explore.

The framework centers on several key elements:

  1. It emphasizes facilitation over medicalization. Rather than creating a strictly clinical model where only doctors or therapists can provide services, the Colorado model creates pathways for diverse facilitators trained in various traditions and backgrounds. This allows for ceremonial, spiritual, and community-based contexts rather than solely clinical ones.
  2. It prioritizes decentralized access. Instead of consolidating services in medical institutions, the model allows for healing centers with different approaches and philosophies, creating a more pluralistic ecosystem where various cultural, spiritual, and therapeutic lineages can coexist.
  3. It respects both scientific and traditional wisdom. While honoring evidence-based approaches, the framework acknowledges that indigenous and traditional knowledge about these medicines predates modern science and is equally valid.

Early implementation of the Natural Medicine Advisory Board has shown promising signs of embracing these principles, with stakeholder engagement from diverse communities and a commitment to equitable access. But powerful commercial interests are already pushing to reshape this model.

Commercial Interests and the Push for Synthetic Alternatives

As Colorado’s natural medicine framework takes shape, legislative efforts have emerged advancing synthetic alternatives to natural psilocybin mushrooms. House Bill 25-1063, approved in April 2025, represents one such effort, revealing the intersection of commercial interests, intellectual property concerns, and the pharmaceutical model’s influence on psychedelic policy.

I have concerns about the bill’s focus on isolated crystalline polymorph psilocybin, which follows a troubling pattern we’ve seen with cannabis, tobacco, and coca plants where extraction has led to unintended harms. While I understand the need for FDA approval processes and recognize that extracted forms of psilocybin may benefit those with specific physical health conditions, research indicates that isolated compounds may lack the full therapeutic potential found in whole mushrooms, which contain numerous beneficial compounds beyond psilocybin alone.

The bill’s narrow specification of crystalline polymorph psilocybin rather than psilocybin generally suggests specific commercial interests are at play and is reminiscent of how we once over-simplified THC’s role in cannabis. Using these medicines in an isolated, extractive way divorced from cultural and communal context risks creating unnecessary harms where therapeutic benefits could otherwise flourish.

This is how the same problematic paradigms get recreated. In order to sell psychiatric drugs, companies have to create markets and demand for drugs. So it’s not just over-prescription; it’s also the focus on individual pathology that makes drugs sellable. The difference with psychedelics—if we get it right—is greater attention to ecological and cultural context.

The push for synthetic compounds isn’t just about standardization or safety—it’s about ownership. Natural mushrooms cannot be patented, but synthetic compounds and delivery methods can be. This concentration of ownership contradicts the ethos of community access and shared knowledge that has characterized historical psychedelic use.

The Problems with Industrial-Scale Psychedelic Therapy

The current mainstream healthcare system operates on an industrial scale, treating human suffering as a technical problem to be fixed efficiently. When applied to psychedelic therapy, this approach threatens to strip these experiences of their transformative potential.

Several concerning trends have emerged:

  • Clinical protocols increasingly standardize dosing, setting, and therapeutic frameworks, often ignoring the deeply personal and culturally-embedded nature of psychedelic experiences. This one-size-fits-all approach reflects the reductionist tendencies of conventional psychiatry.
  • Like conventional psychiatric models, industrial-scale psychedelic therapy often locates problems within individuals rather than recognizing the social, cultural, and ecological contexts that contribute to suffering. This reinforces the narrative that “something is wrong with you” rather than acknowledging that many struggles are natural responses to unhealthy systems. Within the former narrative, drugs are designed to fix or force conformity. Under the latter, drugs can be used as tools to catalyze both individual and collective change.
  • As investor capital pours into psychedelic companies, pressure mounts to scale services for maximum profitability. This creates incentives to efficiently administer preparation and integration sessions—the aspects most practitioners consider essential—while guaranteeing potential clients a fixed number of dosing sessions, which generate more revenue. This approach ignores the often slow pace of embodied healing that mushroom work can catalyze, treating psilocybin mushrooms as another targeted treatment technology that will repair your brain networks for you after just a few sessions. Within this, there is a failure to practice honest informed consent about what exactly therapeutic mushroom work entails for true and sustained change.
  • Institutional and patriarchal models of power represent traditional psychiatry. We wrote a blog about women’s leadership in the psychedelic space as an essential part of doing power differently. Psychedelics move us to sharing power with our communities, holding humility for what remains unknown, and honoring the wisdom that is distributed across people and groups.

When psychedelic medicines enter these systems unchanged, they risk becoming tools that reinforce existing power structures rather than catalysts for genuine transformation. The true potential of psychedelic healing lies not just in new compounds but in new paradigms of healing.

Beyond the Psychiatric Paradigm

The conventional psychiatric paradigm has serious limitations that psychedelic approaches might help us transcend—but only if we’re willing to fundamentally reimagine mental health support.

Traditional psychiatry often:

  • Reduces complex human experiences to diagnostic categories
  • Treats symptoms while overlooking root causes
  • Minimizes the importance of relationship and community
  • Privileges narrowly defined expert knowledge over lived experience
  • Separates the Western mind from body, spirit, and environment

These limitations have caused real harm. The overreliance on medication, lack of true informed consent in psychiatric practice, pathologization of trauma responses, gaslighting of people’s lived/living experiences, and enforcement of normative behavior have left many feeling dehumanized rather than healed. The stories shared on platforms like Mad in America attest to these harms.

Psychedelic experiences, when properly supported, offer different possibilities:

  • Rather than diagnosing deficits, psychedelic experiences often foster reconnection—to self, others, nature, and a sense of meaning. This shift from pathology to connection is fundamental.
  • Psychedelics can help us honor both scientific understanding and other ways of knowing—intuitive, somatic, spiritual, and ancestral. This integration challenges the supremacy of rational materialist approaches that dominate psychiatry.
  • Many psychedelic experiences foster a deep sense of connection to the natural world, helping us recognize that human health cannot be separated from ecological health. Integrating such psychedelic experiences can move people toward truly altering their relationship to the natural world. This challenges the individualistic focus of conventional approaches.
  • Rather than isolating treatment to the individual patient, community-based psychedelic frameworks recognize that healing happens in relationship. The container of community support becomes as important as the medicine itself. Psychedelics are not meant to be used indefinitely. With proper support and good integration, at some point we become the medicine through our actions and relationships in the world.

For these alternative approaches to flourish, we need frameworks that honor personal sovereignty, community wisdom, and traditional knowledge alongside scientific evidence. Colorado’s natural medicine model, despite its imperfections, creates space for these possibilities—if we can preserve its integrity as implementation proceeds.

Emerging Signs of Hope

Despite the significant challenges facing the psychedelic movement, I see promising developments that give me hope for truly transformative approaches to mental health and well-being.

Across Colorado, communities are organizing to create healing circles, peer support networks, and educational initiatives centered around psychedelic medicines. These grassroots efforts often emphasize reciprocity, accessibility, and genuine community engagement.

I’ve witnessed practitioners who prioritize deep preparation and integration work, creating containers for healing that respect the profound nature of these experiences. Many emphasize relationship-building, careful attention to set and setting, and ongoing community support that extends far beyond the acute psychedelic experience.

Indigenous leaders continue to advocate for recognition of their ancestral relationships with these medicines and for approaches that honor their knowledge and sovereignty. Their persistence reminds us that these substances have been used within cultural frameworks for millennia, not as isolated interventions but as elements of complex knowledge and healing traditions.

And within more conventional treatment settings, pioneering practitioners are finding ways to bring the insights of psychedelic work into their practice—emphasizing connection, somatic awareness, and trauma integration even when working within existing healthcare systems.

For Colorado’s natural medicine framework to fulfill its promise, we must maintain vigilance against co-optation by commercial interests while nurturing these emerging community-based approaches. This requires ongoing engagement from diverse stakeholders committed to preserving the spiritual and communal essence of psychedelic healing.

A Final Reflection

This journey requires holding a lot of paradox and sitting with both hope and despair as we witness the complex meeting of psychedelics and entheogens with the fullness of our humanity—the light and the dark of ourselves and the social and economic systems we have built. I try to hold it all, and when it gets to be too much, I choose hope, connection, and creation as my guiding lights forward.

The question remains open: Will psychedelics represent something meaningfully different from conventional psychiatric drugs, or will we recreate the same problematic paradigms and harm? The answer depends on our collective capacity to be changed by these medicines—to allow them to transform not just individual minds but our systems, relationships, and our ways of being in the world.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

11 COMMENTS

  1. Psychedelic treatments will be never be accessible to people of lower SES, who likely could benefit the most, and thus will be yet another wellbeing intervention for the wealthy.

    Psychedelics are non-specific amplifiers, and if there was inherent benefit in their application, then please explain Elon Musk to me.

    Finally, can facilitators ever stop touching people on psychedelics nonconsensually? The whole history of underground psychedelic “therapy” is replete with sexual assault. What happened to the MAPS MDMA trials? Hmm?

    Decriminalization, not medicalization – or facilitation.

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  2. I am surprised and truly disappointed that some of the response responses to this article article are so negative.
    For I am so relieved and even exuberant as I take in the reality and potential of this article. I am a psychiatric survivor who was deeply embedded and deeply harmed by the dehumanizing medicalizing psychiatric system. And because of my experience, I actually don’t qualify for most, if not all, therapeutic uses within clinics and retreat centers. And yet it is people like me that can benefit the most, yes, the most, from careful, communal, relational, individual and sacred uses of earth medicines, a.k.a. psychedelics. I found colleagues, professionally trained Therapists, to be my guides two at a time for three major journeys. One journey was guided by two trained facilitators who are not Therapists. My first words coming out of my first journey was “my experiences of deep altered states, psychosis, were attempts to heal through my trauma.“ Some conventionally, trained and anally focussed will think me reckless and even dangerous. Yet that is the issue behind the controversy of psychedelics. Communal and sacred uses of psychedelics is dangerous to psychiatry and to the institutions of power that are fed by the dependence on psychiatric drugs.
    And maybe most importantly, one thing that my experiences with psychedelics have done for me and so many I have read about and heard from is that psychedelics bring out the activist in me as I reconnect with deeper levels of inner Authority and personal power.
    Another beautiful learning from my experiences with psychedelics and sacred healing is the distinction between a person‘s experience of mental health crisis in a set and setting that is a medical psychiatric clinical cold setting, and a setting that is communal, trauma informed, relational and not led by any psychiatric drug intervention. I had an experience of a community who chose not to take me to the hospital when I was deep in a psychosis and sat with me in twos of four hour shifts for the weekend, which allowed me to do trauma healing in a way I never experienced before. It changed my life forever and yes, without any exaggeration, it saved my life! I’m indebted to that community for the rest of my life. And my experience of a psychiatric setting was not only not healing. It was harmful in many ways, which took me many years to heal from. I was fortunate before I was introduced to psychedelics to experience the healing power of nature which I experienced as none other than a miracle that helped me escape the mediocrity and dysfunction of psychiatric drug dependence. Not to mention it helped me get out of a psychiatric hospital where I was committed and completely powerless.
    Bravo Shannon for all your work and this very well constructed and clear article. You speak from the voice of science and from the voice of healing and maybe even from the voice of the Earth that psychedelics is gently nudging us towards. That connection with nature has certainly deepened my experiences with Psychedelics. Thank you and blessings.

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  3. I found this to be an interesting but somewhat troubling article.

    My understanding is that Australia was the first country in the world to legalise the controlled therapeutic use of psilocybin. The decision was announced in February 2023 by the Therapeutic Goods Administration (TGA), and it came into effect on 1 July 2023.

    This authorisation provided for a strictly clinical model where only authorised psychiatrists could provide these services. Clinics quickly popped up (like mushrooms), offering a couple of synthetic psilocybin trips and a bit of psychotherapy for $AU30,000 dollars. For many years there has also been a substantial underground movement operating in Australia that authorities turned a blind eye to except for commercial scale cultivation which could earn you a substantial jail sentence.

    You can obtain much the same thing as the $AU30,000 professional clinical offering from the underground market for well under $AU1000.

    I am an elderly survivor of the mental health system who has had life long problems with psychosis. The standard medical/psychiatric advice for anyone like me who might be contemplating the use of psychedelics is to not even think about it.

    While I strongly endorse this advice, I was, for many years intrigued by psychedelics and the claims that people make for them.

    Some years ago I hung out with a group of transpersonal psychologists. Some of these people were regular users of psychedelics, mostly mescaline, obtained from San Pedro cactus. They claimed that it provided them with great spiritual insights but I never saw anything in their outward behaviour or attitude to suggest that the psychedelics had any significant transformational affects on them.

    I have since known some others who have used psychedelics and also claimed that they were using them as part of some spiritual or shamanic practice. Again I was unimpressed.

    After the new Australian legalisation I started doing a lot of reading and making enquires with a very cautious view to the possibility of some personal experiments in order to find out for myself what it was all about.

    I didn’t have $30,000 to spare and because of my psychiatric background I wouldn’t have been eligible anyhow unless I did a lot of lying so I looked to the underground market as a source of both supply and expert guidance. What I mostly found there was frightening. Some of these people were genuine enough while others were obviously just in it for the money but there was no way I felt confident to risk getting involved with any of those people.

    I did eventually find someone who appeared to have considerable personal experience with psychedelics and the right attitude. This person initially tried to discourage me from experimenting with them but I am a rather determined person. With over 12 months of quite intense preparation and some home cultivated psilocybin mushrooms I undertook two trips a few weeks apart. This was done completely under my own direction with full personal responsibility. The dosage of each trip was measured with reasonably accuracy using a test kit imported from Germany

    What I discovered was not too different from what I had anticipated based on all my prior research.

    My psychedelic trip was very similar to a psychotic episode with the exception that the psychedelic trip tapers off after several hours whereas a “triggered” psychotic episode may last for a few days with a much longer taper period.

    I have only ever used psychedelics on these two occasions and did not experience a bad trip but I have spoken to enough people who have had bad trips to know that they do happen and can be quite horrific. Again I draw a parallel between a bad trip and a bad psychotic episode.

    According to my research “set and setting” play a significant part in whether a psychedelic trip turns out to be a good or bad experience.

    When I took my psilocybin trips I made sure that I was in a good mental space before hand, i.e. I was not depressed, anxious or angry etc.

    Will I ever use psychedelics again? Probably not. There is no point. I can step into this altered state of mind associated with psychosis or psychedelics pretty much at will so why bother with drugs?

    My experience and understanding of this alternative mind state is one where terrifying psychotic experiences may occur if entered into with unresolved trauma and/or conflicts. When most of that trauma and conflict have been resolved and one learns how to safely navigate this space, it becomes a place of respite, deep understanding, creativity and insight. This in turn results in a much more meaningful, purposeful and creative way of being. In other words the transformational effect can be real but in my opinion is very unlikely to take place just by using psychedelics without a lot of additional and well directed work. Because of their biomedical bias, I would surprised if there are many mainstream psychiatrists or even psychologist with the sort of knowledge and experience to affectively direct this sort of work.

    I am not claiming that I never get triggered into this space accidentally or by unanticipated circumstances. When I do accidentally find myself in this space I don’t always manage it as well as possible, but those skills have improved significantly over the years.

    Would I suggest others with mental health problems explore psychedelics? The simple answer is NO!

    Psychedelics will reliably give you a look into this alternative state of consciousness, associated with psychosis but of itself I have seen no evidence that the experience is transformative. If your mind is overwhelmed by trauma or inner conflict there is a pretty good chance that your psychedelic trip will finish up a psychotic episode. Transformation can and does take place but it requires a lot of work usually over an extended period of time. If you can find a good mentor or guide you can do this sort of work without the use of any drugs.

    In my opinion, psychedelics has great potential for studying psychosis and mental heath in a research environment. Before anything can come out of that however, researchers have to be willing to move away from the materialistic biomedical concept of mental health and its related experiences. If that happens, I think big steps forward could be made in the understanding not only of mental health but the entire human condition. Sadly we seem to be a long way from where that sort of mainstream research is likely to even be considered.

    If you talked to the average psychiatrist about these sorts of things you would very likely be diagnosed as severely delusional, locked up and involuntarily drugged etc.

    That really would be a bad trip.

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  4. There is no silver bullet for anything, nor should there be. However, as usual, most people are unable to be nuanced in their thinking and perceptions and either believe that psychedelics are the solution or that psychedelics are snake oil. Both are true depending on how cynical or naive people are. However, unlike Australia which has taken a clinical reductionist and soulless approach, what Colorado has done is far more meaningful and authentic in the psychedelic space which goes far beyond mental health. There is absolutely no mental health without ecological, spiritual and community health, and if psychedelics used in the way the author claims can be one of the many things that move us away from the current sociopolitical-economic system which is literally destroying all life on Earth than it’s time to truly open our minds to alternatives not controlled by propaganda and profiteers. Our disconnection from our true Self, our Community and Nature is the ultimate cause of most mental health issues as well as nearly every problem on Earth from addiction to global warming to war to extinction. We are much too slow in shifting our paradigms and integrating deep change while the world around us is rapidly disintegrating amplifying the need for deep transformation not more reactionary fear and cynicism, the very responses that have led us to the current insanity, cruelty and hypocrisy pervasive in our society.

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    • “… if psychedelics used in the way the author claims can be one of the many things that move us away from the current sociopolitical-economic system which is literally destroying all life on Earth than it’s time to truly open our minds to alternatives not controlled by propaganda and profiteers.”

      Open your own mind. The same thing’s happening right now with psychedelics. Someday it’ll likely be run like the wine industry if it isn’t already. And who knows? Maybe it should be.

      FYI: There’s a world of difference between disillusionment and cynicism: one releases, the other calcifies.

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    • Hi Jeff,
      I agree with most of what you say. Unfortunately I do not see a great deal of interest in this approach. Many if not most people seem to want an instant push button, pop a pill solution to relieve their emotional pain and distress so that they can rush right back to doing the same thing that helped get them into their particular mental health mess in the first place. What they actually get however is often a shortened life span of limited functionality because they think that the road to reconnection is unappealing or two hard. Some that I have come across also seem to see psychedelics as a quick fix or magic solution.

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  5. Using that logic and double standard, ALL medications and treatments for mental health that are not free should also be shunned. Unfortunately we live in a greedy, individualistic, small-minded society where purists usually expend more effort complaining about the current corrupt, failing system while tearing down alternatives and ironically bolstering the staus quo which completely serves the agenda of the big money interests. The author of the article was not advocating for the clinical and profit making approach to psychadelics that you are rightly concerned with, but rather the way that Colorado is striving to do things in a way that is culturally and ecologically respectful and appropriate rather then turning it into what both you and I see as a corporate ploy to control and profit from entheogens. It doesn’t have to be that way, but we need to be more nuanced in our ‘all or nothing thinking’ about alternatives. Basically your approach would shut down consideration of any and all alternatives where someone could get paid to use those approaches to improve the lives of some people.

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