Psychiatry has returned to studying psychedelics, and public interest has grown even faster. This text, published in the Portuguese health news site Saúde Online in 2023, asks what can go wrong when enthusiasm runs ahead of clinical practice, and what is needed for these experiences to be therapeutic.
What is the question?
The article starts from a change: psychiatry, which kept psychedelics on the margins for decades, has returned to studying them. The author notes that studies of psilocybin and MDMA have shown remarkable results in treatment-resistant depression and post-traumatic stress disorder.
The question he raises is a different one: what happens when this scientific interest reaches the public faster than clinical practice. He says he is worried about the “exaggerated promises and inappropriate practices” (our translation) emerging from this wave of enthusiasm, fuelled in part by social media.
What arguments does he make?
The central argument is psychological. A psychedelic experience can bring difficult emotional material to the surface, including traumatic memories. Drawing on Freud’s idea that repression serves a self-preserving function, the author argues that in severe trauma repression only postpones the problem; but releasing that material without rigorous preparation and without the capacity to integrate it can do more harm than good.
To illustrate this, he describes complications he has seen in his practice in people who used psychedelics outside a medical setting. We do not reproduce those cases. He notes that situations like these do not appear in documentaries.
He also acknowledges that adverse effects occur across medicine and that this does not cancel the value of these approaches: he remains convinced that psychedelics can transform psychiatry. However, given the potential risks, he writes, “I cannot promote this field lightly or with unrealistic promises” (our translation).
What does responsible practice require, according to the author?
The article describes four conditions for a psychedelic experience to be therapeutic:
- careful preparation of the person’s psychological state;
- a favourable setting;
- experience and training on the part of those providing support, to hold what emerges during the experience;
- effective integration after the session.
What does he conclude?
The author sums up the idea in one sentence: “This is the great potential of psychedelics, and also their great danger” (our translation). He argues that the field should move forward with a balance between promise and prudence, so that today’s mistakes do not lead back to the prohibition of the 1960s and 1970s.
What are the limits of this text?
It cites no specific studies and gives no figures: it rests on the author’s clinical experience and on cases from his practice. It was written in 2023; research and regulation have moved on since then, and we summarise them on our scientific evidence page and, for ketamine and esketamine, on a page of their own.
What it means in Portugal
KETAMED commentary. In Portugal, psilocybin and MDMA are controlled substances under Decree-Law 15/93 and are not authorised as medicines. Outside authorised clinical trials, they are not available as treatment. The status of each substance is described on our substances under research page.
At KETAMED, any treatment decision is made after an individual assessment and within the Portuguese legal framework, which distinguishes what is under research from what is authorised as a medicine. Preparation and integration are part of our treatment options.
