Good Trip? How Psychiatrists Got Serious About Using Psychedelics to Treat Mental Health
How did magic mushrooms, ketamine and other hallucinogens become credible treatments for depression, PTSD or even substance abuse?
Illustration by Yimiao Liu
Last summer, Gaetano, a 35-year-old financial adviser from New Jersey, traveled with his wife to the rainforest outside Sayulita, Mexico, near Puerto Vallarta, where they stayed in a well-appointed villa overlooking the Pacific Ocean. For five days they did what any couple might do on a wellness retreat. They practiced yoga with the handful of other guests and tried a sound bath, lying on the floor and feeling vibrations produced by a local healer. They watched the sunset from their balcony every evening and dined on five-star cuisine.
But twice on their trip they also consumed something else: psilocybin, the hallucinogen more commonly known as magic mushrooms. No longer just a recreational drug favored by club kids and Grateful Dead fans, psilocybin and similar psychedelics are increasingly gaining acceptance by psychiatrists and other mental-health professionals as genuine treatments for all manner of ills. Any skeptics need only consider the spate of respected academic institutions that have recently founded research centers to study their efficacy, including Johns Hopkins University, New York University and Harvard University’s Massachusetts General Hospital.
“Human beings, for thousands of years, have intentionally changed their brain chemistry to think about things a little differently,” reasons Gaetano, who asked Robb Report not to publish his last name to protect his privacy.
He was on a mission for self-improvement. Specifically, he wasn’t happy with his tendency to anger quickly. “I could be combative, and I kind of recognized myself as an angry person. I never really ran from confrontation, and in my mid-30s this started not serving me.”
In 2019 he had picked up the No. 1 New York Times best seller How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence by Michael Pollan. He couldn’t put it down and after finishing it read another half dozen books on psychedelics. “Some of them were mainstream books like Terence McKenna,” Gaetano says, referring to the late ethnobotanist who advocated the use of plant-based hallucinogens. “Others were more under the radar. I was fascinated by it.”
In May 2021 he and his wife were celebrating their fifth wedding anniversary. She had been suffering from anxiety and depression, brought on partly by unsuccessful efforts to have a baby. “It was a very emotional time, so we were thinking about doing something different that wasn’t going to be the normal go away and just drink,” he says. “It was actually my wife’s idea to go on a retreat, but it was sort of a long time coming, because we had both been fascinated by this.”
On the second day of the retreat, at 8 pm, just as the sun was setting, Gaetano and his wife lay on mattresses on the ground next to the infinity pool with eye masks on to block out any distractions. Retreat leaders—people trained in yoga, hypnotherapy, nutrition and spirituality—stationed themselves close by in case anyone needed help. As Gaetano listened to native Spanish songs and the shruti box, an Indian instrument that makes a droning sound, the mushrooms kicked in, setting off a series of visions.
He observed himself revisiting events from his childhood. Some were bright moments spent with his family, times he felt really loved. Others, however, were dark. “I saw kids bullying me in school, being embarrassed by rejection as a child,” he says.
During a trip, some hallucinate and see themselves flying through the universe, swimming the ocean’s depths or riding a shooting star. Others revisit actual memories that they’ve buried.
To get something particular out of a journey—in Gaetano’s case, pinpointing the sources of his anger—it’s possible to guide the mind by setting intentions or asking clear questions ahead of time. Gaetano had journaled before leaving for Mexico and discussed his goals with some of the retreat leaders once he arrived. His work led him to uncover memories, such as the ones of being bullied, that shed light on the root of his feelings.
When the drugs wore off, he found himself crying hysterically before finally being able to articulate what had happened to him. “That changed everything for me,” he says. He felt closer to his wife after sharing the humiliating experiences he’d had as a kid. Immediately after he returned home, he started seeing a traditional therapist, at first weekly and now monthly. His blood pressure dropped so much his doctor reduced his medicine’s dosage. “I had this feeling of tightness in my chest that used to be so worrying,” he says. “I haven’t felt it since the retreat.”
“The thing about these mushrooms is, they get rid of your ego,” he explains. “Sometimes you have to push that aside and let your guard down so you can really evaluate what is going on.”
And the experience he had on the retreat is not the same as doing drugs at a party, he adds. “If your eyes are open, and you are living outside your body, you might have a fun time and experience cool things,” he says. “But that is not the same as doing work within yourself.”
Experiencing hallucinogens in nature the way first-wavers did may hold a certain primal allure.
One reason Gaetano traveled to Mexico to try psilocybin is that most psychedelics remain illegal in the United States. Ketamine has been legalized nationally if prescribed medically, but only Oregon has approved psilocybin for medical and wellness use, beginning by year’s end. MDMA has also shown promising results, though it, too, remains illicit except in approved studies. Advocates say all three have the power to help people overcome trauma.
Jennifer Mitchell is a professor of neurology and psychiatry at the University of California, San Francisco, where she has spent the past four years studying potential psychedelic therapeutics for a wide range of psychiatric disorders. “These [psychedelics] reopen critical times” in a patient’s memory, says Mitchell, who is also affiliated with the UC Berkeley Center for the Science of Psychedelics. “They help you to see all the stuff inside of you that you might not know is there or you might not feel comfortable sharing.”
Psychedelics work by changing a user’s perspective. People report emerging from their trips feeling at one with nature or having newfound empathy. Sometimes, as they did for Gaetano, hallucinogens resurface buried memories, allowing users to see the roots of their problems and address them head on.
A more scientific explanation is that psychedelics promote neurogenesis, which makes your brain reorganize and grow—meaning the drugs literally wipe away old patterns and launch new ones.
Mitchell, Yehuda and other researchers hold that the science is there to warrant their legalization. What is truly exciting is that “a number of psychedelics can really impact a series of mental-health conditions, and many of them don’t have particularly valuable treatments at present,” Mitchell notes. “We know they can help PTSD, depression, alcohol- and drug-use disorder, end-of-life distress and other conditions.” One dose of ketamine can work for about 10 days to fight depression, she adds, while a session of MDMA or psilocybin might do the trick for years.
“There is clinical data that backs up all this stuff,” says Jonathann Kuo, M.D., medical director at Hudson Medical, a practice in New York City’s West Village that administers IV ketamine for chronic pain and depression. “At this point we know that talk therapy and putting you on Prozac for years at a time doesn’t really work in the vast majority of people, so this is the next frontier.”
Advocates for psychedelics agree that SSRIs, pharmaceuticals (including Prozac) that were hailed as game changers when they were introduced decades ago, have run their course. “There is a mental-health crisis, and we don’t have too many good traditional solutions,” says Yahuda. “This is something that looks like it might work. So the question is not why are we doing this? The bigger question is how could you ignore this?”
Mount Sinai gave the go-ahead for the research center after the FDA declared MDMA a breakthrough therapy for PTSD in 2017, allowing scientists easier access to the drug for study. “There is a lot of hype in the field, a lot of investment and drug development, and it’s very important for academic institutions to get involved and produce scientific data so we can see what is really going on,” she says. “When academic medical centers get involved, they will probably be very rigorous, [and] the research will be done by people who are skeptical, which is very important. It should be done by skeptics and not just people who have become very enamored of psychedelics.”
Advocates believe and anecdotal evidence suggests that the substances can also help some users without full-blown mental illness. Fewer studies have examined psychedelics for what scientists call “the betterment of healthy populations,” but Mitchell predicts such testing is right around the corner. In Oregon, a diagnosis will not be required to access psilocybin. As for the danger of addiction, the experts Robb Report interviewed say that neither psilocybin nor MDMA is chemically addictive. Ketamine may be—research is ongoing—though taking the drug under medical supervision probably lowers the risk.
Ketamine, which requires a patient to have some form of anxiety or depression to obtain a prescription, is currently being administered in clinics, in homes and on retreats across the country. Experts predict the FDA will approve MDMA by next year and psilocybin by 2025, and Senators Cory Booker and Rand Paul, normally on opposite sides of the aisle, cosponsored a bill in July that would give patients with terminal illnesses the right to use MDMA and psilocybin as therapeutics. Startups are already busy setting up centers to treat patients once these drugs get the green light.
In January, Business Insider identified 11 venture-capital firms that have invested around $140 million into the treatment industry. A month later, Mindstate Design Labs, a biotech company that develops psychedelic therapeutics, raised $11.5 million. “The funders know a new drug application is in the works,” says Mitchell. “Everyone now wants to get behind it.”
To be sure, psychedelics have already seeped into mainstream culture. During the pandemic, Netflix released Have a Good Trip: Adventures in Psychedelics, a documentary featuring celebrities from Sting to Sarah Silverman recounting their experiences with hallucinogens. Pollan has developed his seminal book into a four-part docuseries that premiered on Netflix this month. Silicon Valley CEOs are openly discussing their own experiences with microdosing, ingesting just a bit of a drug to get the mental-health benefit without the same level of high. Joe Rogan claimed to be on mushrooms during his podcast with rapper Post Malone.
“I just think a lot more people are more focused on mental health, especially after Covid,” says Kuo.
Before the pandemic, Jay Godfrey owned a namesake fashion line that was sold at Saks and seen on celebrities including Jennifer Lopez and Viola Davis. Then, in May 2019, he journeyed to Mexico, where he did plant-based hallucinogens with a shaman. “My first experience was like five years in [therapy]. It was mind-blowing,” he says. “I felt like this needed to be brought in a legal, medically sound, hospitality-driven way to the United States.”
Godfrey cofounded Nushama, a psychedelic wellness center with three locations in New York City. The flagship is on the 21st floor of a gilded building in midtown Manhattan; the goal is to open 35 in five years. Treatment rooms are decorated with wallpaper hand-painted with cherry blossoms, a symbol of renewal, and decked out with white zero-gravity chairs.
Before opening Nushama, Godfrey studied the history of psychedelics. “The first wave goes back thousands of years, when Indigenous cultures across the world—in the Amazon, in West Africa, in Mexico—were using sacred plants to heal what they called ‘ailments of the spirit,’ ” he recounts. “Medicine likes to use words like ‘mood disorders’ or ‘depression’ or ‘anxiety’ or ‘PTSD,’ or there is a new one, ‘protracted grief syndrome,’ but ultimately they are all the same thing, which is that something has happened—a trauma, a wound—to create a sense of being dispirited.”
The second wave was a 20th-century phenomenon. Harvard’s psychology department became the unlikely epicenter of research into then still-legal hallucinogens in the early 1960s, when a pair of academics, Timothy Leary and Richard Alpert, started studying their effects on human consciousness. After their scholarly colleagues objected to their methodology—Leary and Alpert often went on trips of their own alongside their subjects—the duo were booted from the faculty. Though disgraced in academic circles, the men became counterculture icons. It was Leary who, promoting recreational use of LSD, coined one of the era’s most iconic taglines: “Turn on, tune in, drop out.”
Still, Mitchell says, their theories weren’t entirely discounted. “Even in the ’60s we knew they had a medical use, but the drugs were terrifying to the public, so they were scheduled very severely by the FDA,” she says. “Even to this day, if you want to study them and research them, you have to jump through hoops.”
Following the government’s failed “War on Drugs,” we are now in the third wave, characterized by serious studies elevating psychedelics to the level of medicines developed by Big Pharma, mostly thanks to two important non-profit players in the field: the Multidisciplinary Association for Psychedelic Studies (MAPS) and the Usona Institute, which helps fund clinical research on psilocybin and other “consciousness-expanding medicines,” as the website puts it. (“Big Pharma has been mostly quiet, but it’s clear they are watching,” says Mitchell.) MAPS, in particular, has been around for 35 years and persevered with studies even after the government criminalized LSD and psilocybin.
When studies showed promising results, other scientists were forced to pay attention. “A lot of people have paved the way for us to not be scared of psychedelics and understand that in the right environment and in the right container, they can be very useful,” says Yehuda.
Patients like Gaetano, who are not willing to wait for MDMA and psilocybin to be cleared for use, are traveling to foreign countries such as Mexico, Jamaica and Costa Rica to try the therapies now. They should do their homework. “It’s a mixed bag,” Mitchell says. Some places are fantastic, she notes, but some individuals have also told her team that they felt vulnerable while tripping because they did not feel safe with their guides—or even that they were physically or sexually abused while under the influence.
And, of course, there’s always the potential for a bad trip, with creepy or frightening hallucinations. Afterward, users might still feel lost and confused, especially if they relive a painful experience while on the drug. They might even feel worse than they did before. “We don’t have enough data to know what the long-term effects of a bad trip are and how long these could last,” Mitchell acknowledges. “My guess is that as much harm as healing can occur in the throes of a vulnerable psychedelic experience. That is why facilitators are so very important. They guide the experience and help make the journey.
Even good trips can have a downside, according to Mike Arnold, director of Silo Wellness, a mushroom company that also stages psychedelic retreats in Jamaica (for psilocybin) and Oregon (for ketamine, but mushrooms will follow as soon as they are legal). “One of the risk factors is that there are people who think they are not only communing with God but have some sort of special relationship with the divine, like the ancient Gnostics,” he says, adding that their grandiose notions can lead them to believe they now possess “the secrets of the universe.” “That is so dangerous. They are so vulnerable and impressionable, and it’s so important that the participants in this industry do the least amount of harm and the most amount of good possible.”
During a trip, some hallucinate and see themselves flying through the universe.
At Silo, in addition to tripping, participants meditate in waterfalls, white-water raft and dance under the stars. “People need to travel inwards and outwards,” says Arnold.
The benefit of these retreats, which last about a week, is that they allow participants to gain trust with the facilitators before their mind explorations. “Research shows trust takes 40 to 80 hours of person-to-person contact,” he says. “That is what we are trying to cultivate.”
Experiencing hallucinogens in nature the way first-wavers did may hold a certain primal allure, but metropolitan outposts are proliferating, offering ketamine treatments for $500 to $1,000 per session; a series generally consists of six sessions over three weeks, each lasting an hour. (MDMA, by contrast, will probably take three eight-hour sessions to show any therapeutic impact. Godfrey is getting price estimates of $15,000 to $30,000 per treatment series, although the effects could last for life.)
Hudson Medical, for example, stands on the same block as a sex-toy shop and a coffee store. Inside, patients seeking to alleviate their depression or anxiety are taking ketamine trips, armed with noise-canceling headphones and eye masks and surrounded by living green walls and Native American–inspired dream catchers.
Scientists in psychedelics talk a lot about set and setting, the former being a user’s mindset (Are they relaxed? Stressed? Do they trust the professional?) and the latter being the physical space. “We expect that set and setting matters a lot,” says Mitchell. In other words, whether you are tripping in the Ritz, the rainforest or a hospital, in the presence of your friends, a doctor or a total stranger, might make a big difference. Which seems plausible.
Anecdotally, people do seem to have more positive trips in places where they feel comfortable, according to Ronan Levy, executive chairman of Field Trip, which operates 12 psychedelic wellness centers, most of them in the US. “If you are in an environment where you feel safe and at ease and relaxed,” he says, “you will have a better experience.”
So, many centers are trying to evoke spas, with weighted blankets to help guests feel cozy and protected, plus plenty of snacks as well as coaches—often therapists, nurse practitioners or medical assistants—trained to guide them. Mindbloom, by contrast, sends ketamine lozenges to a client’s home to be taken in front of a telehealth provider, which is a boon for patients who live in more remote areas—or those who want to undergo the treatment at a ski or beach house or on a business trip.
Whatever the venue, the results, for some, can be remarkable.
In January 2020, Kris Giorgetti, who lives in Atlanta, started a new job working as a management consultant at the director level for a 10,000-person firm. He was thriving until the following December, after a public run-in with a team member. “I was waking up in the middle of the night with anxiety attacks,” he says. “I was having trouble remembering things. I couldn’t even watch television shows because I couldn’t concentrate long enough.” After 10 years without a sick day, he asked for a leave of absence.
A psychiatrist diagnosed him with PTSD. Researching treatment options, Giorgetti came across ketamine infusions. “I read that it reorganizes your brain and creates new neurons and connections,” he says. “I chose to do ketamine-assisted psychotherapy over other medicine because I wanted something that would cure me. You don’t want to take cold medicine when you could take something that cures the cold.”
He did six sessions and had powerful visions from the get-go. “I could see everything from how I came together as cells to myself being buried,” he says. “I saw my entire cycle of life.” But it wasn’t scary.
“During the experience, you realize you are part of nature, and now when my feet touch the ground, I no longer feel separate from the earth.”
Giorgetti also saw memories of himself coming out as gay in high school and feeling ostracized by friends—just as he’d felt shunned by his colleagues. Witnessing the bullying, he strengthened his empathy for himself back then as well as in the present.
“I had what I called the worry wheel in my head, where I couldn’t stop thinking about what had been done to me at work,” he says. “After the first treatment, there was nothing in my mind. It was clear of all the lists, the worries, the things to do, the pain, everything. It was all gone. It was the most peaceful, calming experience to sit there and not hear any of the background noise.” By the third treatment he was sleeping through the night. After six he was back at work.
Start-ups report their audiences have diversified, especially over the past year. “Last night I talked to a conservative Mid-western Catholic who wants to come to a retreat,” says Arnold from Silo Wellness. “We saw the same thing with cannabis years ago: different kinds of people slowly hearing about success stories and wanting to try it.”
People report emerging from their trips feeling at one with nature or having newfound empathy.
Once more psychedelics are approved for use, doctors in the field say they will be able to create mix-and-match regimens for patients depending on their needs. “You will come in, fill out a survey; we will map your brain and do functional MRIs,” says Kuo of Hudson Medical, “and then we will have this treatment algorithm where we say, ‘OK, we’re going to start with ketamine and then move on to MDMA and this and that until you’re healed.’ ”
“There is an opportunity for this to be part of everyone’s wellness regime,” he enthuses. The same way you might seek out a doctor when you are sick, you might do ketamine once in a while when you need a new perspective.
Even though Giorgetti says his PTSD is 90 percent gone, he continues to take ketamine every six months for maintenance. “Every time I do a session, I feel something remarkable,” he says. “It’s almost like you could pick up the phone and call the universe and say, ‘What is wrong with me?’ It’s like communing with the universe.”