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Capitalist Hegemony In Psychedelic Medicine

Excitement around psychedelics continues to grow with thousands set to attend the Psychedelic Science conference in Denver this week.

Proponents in the psychedelic space have promoted a strategy to focus on the “medicalization” to gain wider societal acceptance. But this could lead psychedelics to come under greater control, ensuring that they serve as profitable tools to maintain the status quo.

The Quest For Mainstream Acceptance: Magical Individual To Societal Healing

Today, in the effort to win mainstream acceptance of psychedelics, there are a number of voices in the room. Among them, the loudest are the ones who individualize illness through the medical lens while seeking legitimacy through access to powerful medical institutions, civil society, and the corporation in a proclaimed quest to “heal” those suffering in our society. We see anything from features in Forbes about 20-something tech billionaires microdosing to increase productivity, to 60 Minutes interviews with U.S. Iraq war veterans who report to be cured from PTSD, to miracle stories of ketamine working with the poor and formerly incarcerated. Ironically, as this piece is being published, a number of these voices will be discussing and debating the path of the psychedelic renaissance at Psychedelic Science conference, taking place June 19–23 and being marketed as the largest conference on psychedelics in history.

Organizationally, some of the best-known names in the psychedelic space are the Multidisciplinary Association for Psychedelic Studies (MAPS), the for-profit psychedelic mental health company Compass Pathways, and the nonprofit Usona Institute. Many inside these organizations often promote a course of thought claiming psychedelics in and of themselves can “heal” anything from PTSD to societal conflict. It’s as if there is a search for a balm, a real-life soma, to dissociate from the horrors of race and class. For many, psychedelics are the answer to this search.

Of those who believe psychedelics could find their way to addressing greater structural issues plaguing society, the reasoning often goes that “once the individual heals, then we can work on healing society — or even the world.” In one TED talk for example, MAPS founder Rick Doblin — one of the most prominent names in the psychedelic space — claims that psychedelic experiences have “the potential to help be an antidote to tribalism, to fundamentalism, to genocide and environmental destruction.” During the 2021 Fantastic Fungi Global Summit — an annual summit of mushroom enthusiasts — speaker after speaker discussed how important it is to expand the availability of psychedelics to “help heal the world.” We can expect much of the same rhetoric from various presenters at the Psychedelic Science conference.

The result of this theory of individualized mental health supposes that people and their mental lives exist in a vacuum. Trauma happens to an individual, so use psychedelics to heal the individual. But depression, stress, anxiety, etc., are not a result of personal failures but oppressive, exploitative, and alienating conditions of life under capitalism. Doblin and others will have us believe that we can “heal people” without dealing with the conditions of their lives, but by simply using psychedelics to change how they see those conditions. Far from healing the world, this approach reinforces the conditions that lead to the suffering itself.

There is a naivete born of goodwill, good acid, and a lack of structural analysis that could be amusing if the current state of the world were not so dire. It’s a kind of “magical societal healing” mantra that is echoing through the most progressive sectors of the so-called renaissance, i.e., “we simply gain acceptance to powerful institutions, give these drugs to people, getting them into existing systems of oppression and the change will come” or even more then change, “a more just society” will come. But, as we will discuss, in this process the psychedelic community ultimately seeks to incorporate itself into powerful, controlling institutions, which will not only prevent these substances from helping heal the world but also enlist them in maintaining the systems harming us all.

Gramscian Hegemony And Psychedelic Medicine

Proponents of psychedelics seek to gain acceptance for these substances by medicalizing them. Article after article is published on how psychedelics can help treat various forms of psychological suffering. But medicalization could play a role in further entrenching ruling-class control of psychedelics. To further examine this process, it is important to revisit the Italian Marxist Antonio Gramsci’s concept of hegemony.

Gramsci terms the control wielded by the ruling-class “hegemony.” Gramsci believed that if the ruling class was unable to maintain control over the masses, the masses may seek to change circumstances around their ongoing exploitation. For Gramsci, the ruling class does not always need to use domination or coercion to maintain its authority — and actually using these forms of control can sometimes be more destabilizing or fragile for the ruling classes. Instead, they can use “cultural, moral and ideological” leadership to gain a high level of consent among the general population. The ruling class manipulates language, culture, even morality itself to subtly convince the masses that the status quo is normal, natural, and the best course for everyone in society. This helps maintain power in capitalist society and make sure the interests of the capitalist state are represented in the minds of the ranks of the masses.

As Bruce Cohen notes in Psychiatric Hegemony: A Marxist Theory of Mental Illness, an institution continually used to impose ruling-class ideology today is the institution of medicine. Control through institutions such as medicine have proved quite effective for the ruling class because they provide a guise of perceived objectivity. Cohen notes,

These civic institutions are much more effective than direct, repressive organs of the state in manipulating the masses due to their perceived detachment from elite control. Hegemonic power is conducted under the guise of objective and neutral institutional practice, though it is in reality nothing of the sort. Instead, intellectuals and professionals are responsible for the legitimation of ruling-class ideas within the public sphere, articulating such values as seemingly natural and taken-for-granted knowledge about the world.

As we discussed in our previous piece, the medical system helps uphold the status quo by finding ways to reduce natural reactions to damaging systems to specific quantified diagnoses, which can be documented and billed for. This allows for the commodification of natural physical and psychological reactions to oppressive systems. Medical professionals can help in “depoliticizing inherently political problems” in the words of physician and activist Vicente Navarro, leading people to believe that individual action or improvement is the answer instead of collective action for societal change. In this way, the institution of medicine helps impose ruling-class ideology by misdirecting condemnation away from violent systems, which benefit the ruling class, and instead onto individuals.

The medicalization of psychedelics is so useful because it gives the guise of neutral exploration of the science for individual therapeutic purposes while at the same time funneling them into a more subtle form of control, which benefits the ruling class. By being presented as scientifically objective, medical professionals can be effective in the task of instituting ruling-class hegemony because as physician and activist Howard Waitzkin argues, “doctors may be more effective in enforcing societal norms than other social control agents; doctors are less accountable to the public and therefore freer to inject class and professional biases into their relationships with clients.”

But it goes further than shifting from system-based analysis to individual-based analysis. The process of medicalization also leads to material control of these substances by institutions that serve the ruling class. The medicalization of psychedelics means substances that can profoundly affect consciousness and one’s perception of society as a whole will be more likely to be “available” strictly through medical gatekeeping. This will lead to more control over how psychedelics are used, what the outcome of their usage is, all while ensuring a profitable market is created within the medical system that poses no threat to the status quo. Psychedelics in the hands of capitalist doctors, therapists, companies, will be used to reinforce capitalist ideology, individualized psychiatry, and a continued obfuscation of the social and structural factors affecting health and well-being.

Why Incorporate Psychedelics As Medicine?

This brings us to questions around why medical control of psychedelics would be useful. We can propose a number of ideas. One compelling theory is suggested by Caitlin Johnstone in her piece “‘Psychedelic Renaissance’ Entirely about Corporate Greed.” The author notes “the abusive nature of capitalism is causing a widespread mental health crisis that our rulers have a vested interest in preventing so the slaves will keep turning the gears of the machine.” The proposals range anywhere from treating alienation and depression resulting from workplace exploitation with psilocybin to giving MDMA to soldiers to make it easier for them to advance imperialist policy through killing and military violence. Could this latter example be why we see military personnel gathering to conferences like Psychedelic Science like moths to a flame?

Psychedelics themselves do not have an inherent right or left ideology built into them. They have the power to either break down or reinforce traditionally held beliefs around people’s relation to themselves, their loved ones, society, and even reality itself. They can threaten hegemonic ideologies, or they can reinforce and deepen the acceptance of ruling-class ideologies. For some, when combined with critical political analysis, psychedelics can reconnect the user to greater inner purpose, reconnect to community, reestablish the interconnectivity of all living things. With this reconnection could come the potential of a realization of the truly destructive nature of oppressive systems. This opens the possibility for one to see the destructive systems outside of him or herself as the true causes of suffering and develop resolve to fight to destroy those systems. When combined with revolutionary political analysis, this can give these substances revolutionary potential in some cases.

We saw at least some of this process play out in the “first psychedelic wave” in the ’60s as there were often direct connections made between psychedelic use and anti-establishment related political practice. It comes as no surprise, then, that now proponents of the medicalization of psychedelics fear a repeat of the hit the movement took at that time. It’s partially why there is a strong focus on not letting anything “go off the rails” and a condemnation of the connection between political practice and psychedelic use.

The political potential of psychedelic use is what makes it even more important for the ruling class to gain hegemonic control over how these substances are used and made available to the public. It makes it that much more important for medical professionals, for example, to help push bourgeois ideology by helping perpetuate individualization and internalization of psychological suffering, for example, ultimately misdirecting the gaze away from a critical, system-based analysis.

When Gramsci discussed hegemony, he saw the process of the ruling class maintaining ideological control as a constant battle in which ruling-class “norms” are constantly destabilized or questioned. This process of questioning ruling-class hegemony becomes heightened in times of crisis. Today, capitalism creates more and more crises around the globe. The Covid-19 pandemic exposed the limits to the biomedical model of maintaining health and well-being. Now, postpandemic peaks, overdose deaths are increasing, and suicides are once again on the rise. We see increasing military conflicts around the globe and the current geopolitical landscape compounding things with rising inflation making it harder for people to make ends meet. These co-occurring crises can cause people to question whether ruling-class institutions such as medicine can actually help treat or alleviate the suffering of the masses. In this context, it is no wonder that medicine would naturally incorporate psychedelics as therapeutic modalities as it becomes even more crucial for capitalist class to restrengthen the legitimacy of ruling-class institutions at this time.

The Need For A Revolutionary Perspective In The Renaissance

By incorporating these substances into medicine and other mainstream institutions, proponents can claim that we are moving toward making these substances more available to help a greater number of people. At the same time, the trend will help keep psychedelics from playing any role in pushing the toiling masses to upend the entire system. As we argue above, hegemonic institutions such as medicine can help monitor and control the conclusions reached by those using these substances. And this obviously extends beyond the strict limits of medicine. For example, those acting as guides or doing integration work are going to be some of the most influential people in influencing the conclusions individuals come to from using psychedelics. This makes their political praxis that much more crucial toward influencing outcomes.

We can already see some of the outcomes of the quest for acceptance into hegemonic institutions in real time today — the venture capitalist, the investor bros, fresh from their journey with “my shaman,” having seen the creation and destruction of the universe, now emerge as new beings. And yet the capitalist capture is so complete, their only recourse is to commodify. They have created companies now traded on the NASDAQ — with all the typical bells and whistles of “fair trade,” “sustainability,” and “equity.” But, contrary to what some may hope, the power and money will not shift post-ayahuasca enlightenment. We should know that these drugs have been available to the rich and powerful for 70 years, many whom were the architects of neoliberalism.

We want to be clear, any possibility of psychedelics helping mitigate suffering under capitalism can be positive. But as these substances are incorporated into hegemonic institutions such as medicine, we should ask ourselves, What is our goal? Is our goal to simply blunt suffering, or is our goal to actually reduce and eliminate suffering? If we want to strive for both, we must question the structures these substances are being incorporated into and how they function to further entrench ruling-class control. We must understand how ruling-class hegemony functions through class institutions.

Overall, our hope is that psychedelics can meet their revolutionary potential and have a role in not only mitigating suffering caused by violent systems, but also help us eliminate those systems altogether. But if system-based analysis is absent from the growing renaissance, and if revolutionary politics are not central to our analysis, then the potential to actually fight systems which create suffering does not exist.

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