Book Review
Trippy: The Peril and Promise of Medicinal Psychedelics
By Ernesto Londoño
Celadon Books: 320 pages, $29.99
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Ernesto Londoño’s engrossing and unsettling new book, “Trippy: The Peril and Promise of Medicinal Psychedelics,” is part memoir, part work of journalism. It tells of how Londoño sought relief from depression with mind-altering drugs. It also investigates the current fad of “medicinal” psychedelics as a treatment for those struggling with depression, trauma, suicidality and other conditions.
Like other psychedelic enthusiasts, Londoño — a journalist who reported in conflict zones such as Iraq and Afghanistan and served as the New York Times’ Brazil bureau chief — wants us to like psychedelics. They relieve him of depression and suicidality. He then continues to “trip” to engage in self-exploration: escape reality, journey into himself and return with an expanded view of the world.
A rare condition called hallucinogen persisting perception disorder has puzzled researchers and raised alarms as psychedelics go mainstream.
Calling street drugs and hallucinogenics such as psilocybin, MDMA/ecstasy, LSD and ayahuasca “medicine” is problematic. Psychedelic psychiatry has had a resurgence in the past decade, though only among a minority of medical professionals. Mainstream psychiatry largely abandoned psychedelics by the 1970s, for a variety of reasons.
The renewed interest in psychedelics as a treatment seems to arise more from hope than science — a wish that medicinal psychedelics will be effective because our current treatments are inadequate. Antidepressants known as SSRIs and other approaches are often ineffectual, but that doesn’t mean psychedelics, which can be damaging to many in acute distress, should be tried.
Dozens of California studies on psychedelics or addiction treatment that need to be vetted by a little-known government panel are now in limbo. Some scientists want to abolish the panel entirely.
Londoño is more balanced in discussing the benefits and dangers than Michael Pollan and others. Pollan’s bestselling book-turned-Netflix-series “How to Change Your Mind” proselytizes medicinal psychedelics in a way that “Trippy” thankfully doesn’t.
Londoño brings a healthy dose of skepticism. Psychedelics aren’t romanticized with examples of the counterculture movement of the 1960s or hyped by listing celebrities currently using them. The author often questions how much of what he’s part of is “a cult” and if what he’s taking is “voodoo,” not medicine.
“Trippy” is a fascinating account of the world of medicinal psychedelics. We attend psychedelic retreats in the Amazon and Latin America. We drink ayahuasca, a syrupy, foul-tasting psychoactive tea that induces vomiting and hallucinations. Ayahuasca calls back “memories” — some real, others false — that participants take as the cause of their emotional ill health.
We visit a ketamine clinic, where Londoño feels a “blissful withdrawal,” retaining “strong powers of perception” but losing “any sense of being a body with limbs that can move at will.”
We watch MDMA (a German pharmaceutical from 1912 now best known as the street drug called ecstasy or molly) being administered at a veterans hospital to treat post-traumatic stress disorder. At a “treatment center”/church/spiritual refuge in Austin, Texas, we witness tobacco being blown into a man’s nostrils, extract from an Amazonian plant squirted into his eyes, and toad venom burned into his forearms under the guise of spiritual salvation.
Unlike the unbridled enthusiasts, Londoño exposes the predatory nature of the psychedelic industry and how it exoticizes the use of hallucinogens as Indigenous medicines. We’re privy to some scandals in this field, specifically sexual abuse and harassment and taking advantage of vulnerable people looking for help.
It’s an engaging memoir of one man’s experiences with psychedelics. Londoño’s little asides, like when he’s talking about meeting the man who would become his husband, endear him to us: “I saw the profile of a handsome man visiting from Minnesota for the weekend. He was a vegetarian and veterinarian. Swoon!”
But as a work of mental health journalism, “Trippy” isn’t, as the book jacket suggests, “the definitive book on psychedelics and mental health today.”
Much is overlooked and left out. Londoño fails to stress that these treatments best serve the “worried well,” those struggling with relatively mild complaints, but can be extremely unsafe for those with serious mental illness, meaning severe dysfunction. Such a person has typically been diagnosed with bipolar disorder, major depressive disorder with suicidality, post-traumatic stress or schizophrenia. They can’t hold a job or live independently, often for years.
Most people Londoño interviews in “Trippy” seek “bliss,” not lifesaving measures to give them a chance at basic functioning. The retreats are less mental health centers than gatherings of spiritual seekers.
Full disclosure: I read “Trippy” with an open mind and as someone who spent 25 years in the American mental health system with serious mental illness. Those years passed the way they do for so many: a string of hospitalizations endured, countless therapeutic modalities tried, numerous mental health professionals seen and myriad psychiatric medications taken (yes, in the double digits).
“Medicinal” psychedelics never came up as a potential treatment. I recovered before fringe psychiatry’s renewed interest in psychedelics became a fad in the past decade.
It’s unsettling that Londoño doesn’t mention the recovery movement and what we know can lead to mental health recovery. He doesn’t mention the five Ps, which are based on the four Ps that Thomas Insel, former head of the National Institute of Mental Health, writes about in “Healing: Our Path from Mental Illness to Mental Health.” To heal, we need people (social support), place (a safe home), purpose (meaning in life), payment (access to mental health care) and physical health (a clean diet and, ironically, no drugs or alcohol).
In this, Londoño fails to explore whether his recovery had as much to do with the changes he made as a result of his first treatment/trip as with psychedelics themselves: changes in diet, renewed purpose, finding love, moving into a new home, leaving his stressful job. If two centuries of psychiatric research has taught us one thing, it’s that there is no magic bullet for mental health recovery.
The book’s most compelling explorations into psychedelics as mental health treatments come when Londoño discusses their use in treating trauma, particularly that which war journalists and veterans experience.
He also explores the pervasiveness of mental health issues and the particular challenges LGBTQ+ people can face.
“Trippy” raises seminal questions we need to be asking as the psychedelic industry reaches further into mental health treatment:
What is “medicine” and what is an illicit drug?
Are we trying to treat those in crisis or simply help anyone escape the suffering that’s part of the human experience?
Should we continue to try more and more extreme treatments?
Or should we finally pay attention to and change systemic issues that are the root cause of so much mental and emotional distress?
Sarah Fay is the author of the bestselling memoirs “Pathological: The True Story of Six Misdiagnoses” and “Cured.”
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