Six misconceptions about psychedelics in mental health (clarification)

Clarification published after the 3 episodes of the Psychedelics and Mental Health series

This debate on psychedelics is causing reactions on LinkedIn. I am not writing to settle the matter, but because the objections circulating are almost always based on the same confusions.

I have seen this debate passing through LinkedIn and Instagram in recent days. It arouses a lot of emotion and controversy, and that is understandable: it touches simultaneously on psychiatry, trauma, and trust in research. I am not writing here to settle a controversy or to join a side, but to clarify, because the objections circulating are almost always based on the same confusions, and they deserve a measured response.

"Having trips heals." This is the formula that summarizes the central misunderstanding. No, it is not the trip that heals, and no one serious in this field argues that. The model being studied is that of a brief window of plasticity opened by the molecule, within which a structured psychotherapeutic work takes place, with preparation upstream and integration downstream. Inducing an altered state is not the act of care. The act of care is the work conducted within the framework surrounding this state. As long as this distinction is not maintained, all the rest of the reasoning slips away.

Neuroscience presented as a confession. Citing the fact that teams correlate EEG or fMRI markers with the reported subjective experience, or describing increased suggestibility and phenomena of dissolution of the boundaries of the self, is not exhibiting incriminating evidence. It is describing a documented methodology and phenomenology. Describing increased suggestibility is not confessing to manipulation. This is the very reason why serious protocols mandate screening, a double clinical presence, an explicit therapeutic contract, and technical neutrality. Naming a risk is not leaving it unanswered.

The confusion between a supervised protocol and unregulated use. People who have consumed ayahuasca for years without resolving their problem, neo-shamans, charlatans: these situations are real, and I do not downplay them. But they are exactly what supervised research protocols seek not to be. Opposing chronic unsupervised ceremonial use to a single-dose protocol conducted under regulatory authorization is comparing two different objects and attributing the limitations of one to the other.

The argument of false memories. It deserves better than a shortcut. Psychedelic-assisted therapy protocols are not centered on memory recovery, contrary to what is often assumed. Furthermore, the phenomenon of reconstructed memories is real and has been documented for a long time, from Freud to contemporary cognitive psychology. This is precisely why serious psychotherapeutic protocols, EMDR included, incorporate caution on this point. The mnesic phenomenon and the "false memory syndrome" as a unified diagnostic category, constructed in the United States in the 1990s, do not overlap. Vigilance is legitimate. It does not invalidate a field, it compels it.

The definition of psychotherapy. The idea that psychotherapy aims for autonomy through structured psychological work, the identification of defense mechanisms, and emotional regulation is one I entirely share. What seems important to me is that this definition is not opposed to the framework studied here: it is its objective. The window of plasticity is not supposed to replace this work, but to make it more accessible for patients for whom it stalls, most often those suffering from treatment-resistant disorders for which existing options have failed. The opposition between "real psychotherapy" and psychedelics is constructed, not observed.

Commercial interest. That this field represents a market is true, as it is for all pharmacology. This is a reason for methodological vigilance, not an argument that settles the scientific question. It can also be noted that regulatory agencies have shown they know how to say no and demand additional trials rather than follow the hype. Rigor on evidence is the best response to the fear of instrumentalization, not rejection on principle.

Ultimately, part of the mistrust expressed in this debate is legitimate. The idea that psychedelics are the future of psychiatry is an overpromise, and I dedicated an entire episode to showing why the demonstration of a clear clinical superiority remains fragile as long as the question of blinding is not better controlled. Being critical of this field is necessary. But criticism only has strength if it addresses the actual setup, not a caricatured version. It is under this condition that the debate remains useful, for psychiatry as well as for patients.