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Psychedelic innovations and the crisis of psychopharmacology

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Abstract

In the 2010s, psychopharmacological research and development experienced a crisis: since no genuinely new drugs for the treatment of mental illness had been successfully developed for decades, major pharmaceutical corporations decided to disinvest their neuropsychopharmacology departments. At the same time, however, one branch of psychopharmacology began to boom. The FDA declared psychedelic-assisted psychotherapy a breakthrough therapy and hundreds of start-up companies began to compete for this potentially emerging health care market. The article looks at the case of psychedelic research to examine three different responses to the innovation crisis in psychopharmacology: (1) the resumption of pharmacopsychotherapy as a half-century old but previously marginalized and discontinued practice; (2) the continuation of self-experimentation as a simultaneously repressed and revitalized method of drug development; (3) computational drug design as a cutting-edge approach currently used to create non-psychedelic psychedelics that reduce psychiatric symptoms without any mind-altering effects. These responses point to conflicting imaginaries of innovation that envisage the future of psychopharmacology and thereby provide different diagnoses of its current predicament.

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Data availability

Due to the ethical nature of the research, supporting interview data is not available. All other sources can be found in the bibliography.

Notes

  1. In the context of the psychedelic renaissance, Schwarz-Plaschg (2022) points out that the sociotechnical imaginaries blossoming in the biomedical realm are not the only “socio-psychedelic imaginaries” that are informing the integration of psychedelics into American society. This article is neither concerned with decriminalization and legalization of psychedelics nor with their sacramental use. It focuses on what Schwarz-Plaschg calls the biomedicalization imaginary.

  2. In psychedelic-assisted psychotherapy, the taboo surrounding the therapist’s personal experience with illegal psychedelic drugs (which may or may not be self-experimental in the strict sense of the word) puts a strain on the patient-therapist relationship and has stifled research on how the extrapharmacological factor of the therapist’s experience impacts treatment success, argued the psychotherapists Nielson and Guss (2018).

  3. One major reservation regarding Roth’s approach to drug discovery was raised in a personal communication with Hamilton Morris: “Roth's ULTRA-LSD* technique is designed to characterize high affinity ligands, which are then further screened for functional activity and receptor selectivity. Neither affinity nor selectivity are in and of themselves a determinant of therapeutic efficacy. These techniques would fail to recognize most of the psychedelics considered most important for their therapeutic effects, which often possess neither high affinity nor selectivity. LSD has high 5-HT2A affinity but very low selectivity. Psilocybin has high 5-HT2A affinity and low selectivity. Mescaline has such low affinity for 5-HT2A that it would likely be considered inactive via in vitro assays if it weren't for its known history of human use. I don't mean this as a criticism of Roth's work, I think what he is doing is totally brilliant. But concepts like affinity and selectivity, while extremely valuable in pharmacology research, are not immediately applicable to a therapeutic domain especially in the realm of psychedelics.”

  4. It should be noted, however, that there the field of psychedelic-assisted psychotherapy features a more diverse range of psychotherapeutic approaches, from psychoanalysis to Acceptance and Commitment Therapy and from Internal Family Systems Therapy to Cognitive Behavioral Therapy. And there are also researchers like Matthias Liechti who believe that the therapeutic effect of psychedelics does not require their application in a psychotherapeutic context.

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Acknowledgements

For helpful comments on this article, I would like to thank Talia Dan-Cohen, Andrew Lakoff, Rebecca Lemov, Dimitris Repantis, and three anonymous peer reviewers. I am also grateful to Hamilton Morris for conversations that have informed this article. The study on which the research is based has been subject to appropriate ethical review. I do not have any competing interests—intellectual or financial—in the research detailed in the manuscript.

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    Nicolas Langlitz

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Langlitz, N. Psychedelic innovations and the crisis of psychopharmacology. BioSocieties 19, 37–58 (2024). https://doi.org/10.1057/s41292-022-00294-4

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