In the last five decades, we have witnessed broad-based increases in economic prosperity, life expectancy and educational attainment globally. This progress has, however, been coupled with increasing rates of depression, anxiety and suicide.1 Many emerging mental health treatment modalities focus on cutting-edge solutions such as smartphone chatbots and apps, predictive analytics, consumer neurotechnology and immersive technologies2. A suite of treatments using psychedelics has also been in development at leading universities for the last two and a half decades, after a long hiatus.345 Trials have yielded promising results for the treatment of an array of conditions as varied as depression, anxiety, smoking cessation and anorexia nervosa. As lab results lead to therapy modalities, health technology assessment practitioners should aid the development of an ethics informed by mainstream medical practice, but also capable of addressing the transcendent nature of the patient experience, an ethics rooted in, and cognizant of, ancient practices of shamanic tradition. In the following, I will attempt to expand on these goals within a framework calling for recognition of and care for the indigenous roots of psychedelic medicines, as well as for the critical evaluation of ethical issues specific to psychedelic treatment.
In the opening chapter of Lo-Tek, Design by Radical Indigenism, Julia Watson speaks of “a new architecture of the heart”. She imagines that there is a “an option, a way out, a means to imagine anew the relationship between place, nature, and the physical spaces we construct and inhabit for most of the hours of our lives.”6 The examples she gives of nature-integrated architecture attempt to reincarnate and incorporate indigenous philosophy into Western practices. Such integration can only take place via a translation into methods that rhyme with their ancestral lineage, but are also informed by the realities of standards and regulations in the 21st century. Watson also offers a description of Macchu Picchu as dominating “over the rich lowland valleys of Antisuyu, the eastern quarter of the empire and source of such essentials as coca, medicinal plants, plumage and shamanic inspiration.”7 This nod to ancient healing practices suggests a useful parallel: it is not only architecture that can benefit from reintegration of nature and indigenous practices into modernity, but also medicine.
Shamanism and the plants used in its practice have been embedded in Amazon8 culture, rituals and ceremonies for millennia, and are now being evaluated by Global North medical epistemic authorities. This translation doesn’t have to be extractive, exploitative and reductive of indigenous practices. Decolonising TA doesn’t mean saying no to adapting psychedelic mental health technologies before adopting them. Widespread acceptance outside ancestral practice areas will require some translation from rainforest-bound ceremonies to treatment room friendly modalities. Scientific policy advice owes a debt to both the modern knowledges it is rooted in, and to the ones which provide Western science with fresh indigenous impetus. This debt can be repaid through a commitment that the heritage of both the social and the material/chemical elements of shamanic practice remain present in emerging Western paradigms.
Many accounts of modern coloniality speak to us through a lens of Western science being imposed on subaltern test subjects. Jenna Grant (2016) writes about Cambodian sex workers portrayed as lacking agency, as a population that is being experimented on, who may be denied the benefits resulting from a successful trial, while internalising potential trial harms through their lack of insurance. In contrast, utilising indigenous knowledge and practices, and testing these on Western subjects in order to alleviate mental health disorders partially caused by over-use of modern technology9, almost turns the proverbial tables. The remaining common colonial denominator here are extractive, knowledge harvesting practices that fail to grant due credit and pay little respect to communities where the root knowledge originates: “the resurgence of Western psychedelic research and practice has led to increasing concerns from many Indigenous Nations regarding cultural appropriation, lack of recognition of the sacred cultural positioning of these medicines, exclusionary practices in research and praxis, and patenting of traditional medicines”.10 In formulating their position on psychedelic medicine adoption in Western mental healthcare, TA practitioners should heed Arora and Van Dyck’s (2025) call for a “decolonial TA (that) foregrounds radical care for social-material bases of Indigenous and other colonially marginalized ways of knowing and being.”11
A concern for indigenous knowledge remaining sidelined or colonised is also palpable in McGuire et al (2024). They contrast Western medicine that is rooted in “enlightenment concepts of scientific realism, individual autonomy, and rationality and prioritizes evidence-based practice”12 with “many indigenous healing and scientific traditions grounded in relationality”, which possess “physical, emotional, cognitive, and spiritual qualities that make indigenous systems interdependent, participatory, and ecologically based.”13 This dichotomy creates potential for exploitation and colonialisation of knowledge as Global Northern health systems integrate psychedelic medicines in their mental health protocols. The authors propose a “framework centered on reparations and reciprocity, equity, and respect.”14 Concrete suggestions promoting care for indigenous ways of knowing include: non-interference with indigenous uses, representation of the historically marginalised in policy making, inclusion of indigenous worldviews in training and certification, acknowledgement in publications, inclusion, and promotion of data sharing. I believe implementing these into policy and practice would give indigenous practitioners a voice, their culture a continued standing and their people increased agentic independence.
A second cluster of issues requiring attention and care are the ethical norms adopted when the use of psychedelics eventually enters mental health practice. Standards that we take for granted in mainstream medicine need critical re-evaluation due to the commonly reported transcendent nature of the psychedelic experience.
In most everyday situations, informed consent is crucial and also possible: it turns “a rape into love-making, a kidnapping into a Sunday drive, a battery into a football tackle, a theft into a gift, and a trespass into a dinner party.”15 But what if an experience could change who you are as a person, and that new person is unknowable upfront? Emily Jacobs (2023) speaks of psychedelic sessions as “epistemically transformative”, because they are so different from any previous experience. This makes consent protocols less meaningful and care in their design process even more important. McGuire et al (2024) also take up this point and make some salient recommendations regarding trial design, patient communication and the setting of treatments.16
A second potentially contentious ethical issue is that of physical touch. Although precise treatment modalities have not yet been settled upon, the eventual protocols will contain a combination of licensed chemical formulas and psychotherapeutic care. The second of these elements is indispensable, and while it would resemble traditional psychotherapy during preparation and integration sessions, it will likely differ substantially during the 5-6 hours of psychedelic therapy. McGuire et al (2024) note that “reassuring or therapeutic touch, including providing resistance to facilitate release, is often used and considered necessary by some. It is also not uncommon in many indigenous practices for healers to use physical touch as part of their modality.”17 This necessity underscores the importance of developing thoughtful ethics codes guiding the use of physical touch when patients are extremely vulnerable, while also linking therapy to its indigenous roots and caring for the continuation of a long lineage of practice.
Another ethical issue that deserves attention is that of personal experience. While indigenous healers have a lot of personal experience ingesting psychedelics, this isn’t necessarily the case with therapists and guides in the West (it may be counter-indicated for some, illegal for others). Further research needs to be undertaken to “study whether there is something unique about psychedelic medicine that confers benefit on practitioners having their own personal experience, and examine potential conflicts of interest or bias that might arise when practitioners with personal experience advocate for or prescribe psychedelic drugs.”18
The authorities tasked with licensing guides, therapists and other practitioners will have a very important role in the process through determining the number and degree of training of psychotherapeutically licensed care individuals, and therefore the capacity and scope of training programmes. Given the low manufacturing cost of the chemical compounds,19 the determining factor for treatment availability will likely become the number of qualified human carers. If the bar for licensure is set too high, there is a risk of making treatment prohibitively exclusive; if it is too low, then the risk for malpractice, negative outcomes and reputational damage increases. Finally, (non)inclusion in the list of government and insurance covered treatments will determine the fairness and equality of access of treatment, which should be needs and not means based.
The complexity of designing an ethical framework for this newly emerging modality is presented by Viña and Stephens (2023) who highlight the need for further examination of psychedelic effects on different ethnic, gender and socioeconomic groups. Their own study results show that richer white men are more likely to use psychedelics, white men and women of higher socio-economic status are more likely to benefit from psychedelic use, while “black people do not gain health benefits from psychedelics regardless of class or arrest history,”20 due to systemic inequality. Protocol designs should reflect such realities as much as possible through providing a reassuring, caring and safe environment for all patients. Nonetheless, these interventions may be insufficient within a structural order where the societal fault lines have pre-existing programming of health and other types of inequality.
While modern medicine has scaled much of our healthcare through a high degree of standardisation, it appears that mental healthcare doesn’t scale as well. Anna Tsing (2017) speaks of listening to and telling “a rush of stories”21 as a method, while noting the scale limits of this approach. Stories run into the often-insurmountable hurdles whose overcoming is required for standardisation and the rollout of ‘blockbuster drugs’, the ne plus ultra of pharma heaven. But isn’t a deep focus on the ‘rush of stories’ what mental healthcare is about? The stories we tell ourselves during internal monologue, the stories we tell the world as we curate our self-presentation and preservation, the stories that therapists hear and engage with? All of these cannot be neatly summed up without taking the risk of creating Xanaxed societies, somnambulistically wading through shallow waters. What is required instead, is to retain and embrace the heightened density and deeper focus which has always accompanied mental healthcare.22
TA practitioners should take this depth requirement into account when evaluating psychopharmaceuticals and the treatment protocols designed around their ingestion. A strong case can be made for paying close attention to original shamanic practices in order not only to elevate indigenous ways of knowing, but also to inform design and use in practice. Naturally, bringing the rainforest to the treatment room is a challenge, but translation can happen indirectly through adapted adoption of practices and modalities, such as musical accompaniment, setting design, personalisation and trust-building.
Finally, a point should be made about ideological decontamination. Research with psychedelics exploded in the 1950s and 60s and was driven on the one hand by New Left leaning academics and counterculture, but also by the CIA through its MKULTRA thought control and psychological warfare programme. It then came to an abrupt end with the Nixon Administration Controlled Substances Act, which made continued lab/university research nearly impossible. The current resurgence in interest is politically pluripotent and supported by figures as ideologically opposed as left-leaning academic researchers associated with Imperial College London and MAPS on the one hand, and Peter Thiel and the Mercer Family Foundation on the other.23
This pluripotency of psychedelic psychotherapy potentially makes the job of TA practitioners easier as it straddles ideological divides. Pielke’s (2007) stylised framework offers a useful simplification of the role of science and TA practitioners in society and can inform this discussion. The societal need for different, deeper, more focused mental healthcare has been established and puts the issue squarely in the “use-inspired basic research”24 stakeholder category. Political pluripotency partially collapses the distinction between honest broker and issue advocate as the support for the development and introduction of psychopharmaceutical mental health protocols appears bi/multi-partisan. Clearly, ideological divides may remain in the reasoning of different actors, but potential disagreements cascade down from the “if” to the “how” part of the policy problem, and therefore take society one step closer to deeper, more intentional mental healthcare.
Following from the above, I would like to close by reiterating Mario Pansera’s (2025) call for the building of broader coalitions in the specific issue, but perhaps also in TA more broadly. In his discussion of planned obsolescence he notes that “calls for maintenance and care in technology are transversal: they come up among alternative hippie communities in Berlin, in Fab Labs; but, also, among rednecks in the US who complain that they cannot fix their tractors because of the newly installed hardware keys; among US soldiers in Afghanistan who need their screen to be repaired, but don’t have the license to do that. Unfortunately, the general left refuses to engage with this diversity. With this refusal and denial, we are missing out on a lot of possibilities to create alliances.”25 It is only broader alliances that win the support of majorities, that win elections. Movements that require acquiescence and ideological purity either remain small or limit the longevity of any eventual success they may enjoy, and therefore risk the undoing of their achievements by those who follow them in short order. True plurality listens to the hubbub created by the rush of all stories.
Research into integrating psychopharmaceuticals into Global North mental health practice is well on its way. Reputed institutes and pharmaceutical companies will do what they do best: clinical trials, dosage and formulaic adjustments. From an ethical point of view, scientific advisory bodies should heed calls for indigenous recognition, agency and role in protocols design, as well as for modifying mainstream medical protocols to account for the transcendent nature of psychedelic experiences, which sets them apart from other treatment modalities. Eventual access should be needs-based and covered by state sponsored insurance programmes. With these measures in mind, I am hopeful that mental healthcare will benefit from the inclusion of an effective, ancient modality in our roster of treatments over the next decade.
The 1950s saw the first well-documented meeting of Western science with Central and South American shamanic traditions when R. Gordon Wasson documented his experiences of a Mazatec healing ceremony in an expose in Life magazine (https://en.wikipedia.org/wiki/Seeking_the_Magic_Mushroom), one of the first known encounters of a Westerner with what we now colloquially call magic mushrooms. Contemporaneously, Aldous Huxley published The Doors of Perception in 1954 (https://en.wikipedia.org/wiki/The_Doors_of_Perception), an account of his experience with mescaline (and inspiration for the naming of music giants The Doors), a substance contained in the Peyote cactus and used ceremonially for eons by tribes in Northern Mexico. In 1943 Albert Hofmann, a Swiss scientist at pharmaceutical giant Sandoz, accidentally ingested lysergic acid diethylamide (LSD), a compound he had created in the late 1930s, originally as a respiratory stimulant.
The above developments took place within a very short timeframe, in an era of non-existent substance regulation and were eventually elevated to the status of psychedelic lore. The use of psychedelics in the Western World underwent a proverbial mushrooming and had a huge influence on the cultural and anti-war movements of the 1960s, on the emergence of modern environmental consciousness and arguably on many Silicon Valley technologists (https://www.businessinsider.com/ceos-founders-who-used-psychedelics-lsd-acid-magic-mushrooms).
While research on the potential mental health benefits of targeted psychedelic use blossomed in the 1950s and 1960s, it came to a grinding halt when the US government declared psychedelic substances an enemy of the state in the late 1960s as a reaction to the strong counterculture fuelling its use on university campuses and beyond (see https://en.wikipedia.org/wiki/Timothy_Leary). Much promising scientific work was aborted and collected dust on the shelves of university and clinic libraries for the next four decades, while use carried on clandestinely.
Recently, renewed interest and deregulation have led to a rebirth of scientific enquiry and research into the mental health benefits of psychedelic use and the founding of numerous university research centres and companies exploring various psychedelic substances and their potential mental health benefits. Below is a selection:
Michael Pollan’s 2018 book How to Change Your Mind, is a great introduction to the topic by a Pulitzer winning author.
Arora S. and Van Dyck B. Decolonizing technology assessment: Towards a radical transformation of the modern world. Journal for Technology Assessment in Theory and Practice, 34/1 (2025).
Bertuccio P. et al. Global trends in youth suicide from 1990 to 2020: an analysis of data from the WHO mortality database. EclinicalMedicine. Volume 70. (2024).
Celidwen Y. et al. Ethical principles of traditional Indigenous medicine to guide western psychedelic research and practice. The Lancet Regional Health – America. Volume 18. (2023).
Chen M. et al. Epidemiological trends of depression and anxiety at global, regional, and national level: A population-based observational study from 1990 to 2021 based on Global Burden of Disease 2021. Medicine (Baltimore). 105/2. (2026).
Fengsai B. et al. Rising global burden of anxiety disorders among adolescents and young adults: trends, risk factors, and the impact of socioeconomic disparities and COVID-19 from 1990 to 2021. Frontiers in Psychiatry. Volume 15. (2024).
Grant J. From subjects to relations: Bioethics and the articulation of postcolonial politics in the Cambodia Pre-Exposure Prophylaxis trial, Social Studies of Science. 46/2. (2016).
Kastenhofer K. et al. Technology assessment in ‘imperialist ruins’?: Towards solidarity, conviviality and care. Journal for Technology Assessment in Theory and Practice. 34/3 (2025).
Jacobs E. Transformative experience and informed consent to psychedelic-assisted psychotherapy. Frontiers in Psychology. Volume 14. (2023).
McGuire A. et al. Developing an Ethics and Policy Framework for Psychedelic Clinical Care: A Consensus Statement. JAMA Network Open. 7/6. (2024).
Murarescu B. The Immortality Key: The Secret History of the Religion with No Name. St Martin’s Press. (2023).
Nuffield Council on Bioethics. 2024 Horizon Scan Longlist: Methods and evidence pack, (2024). https://cdn.nuffieldbioethics.org/wp-content/uploads/2024-Horizon-Scan-Methods-and-Evidence-Pack.pdf.
Nuffield Council on Bioethics. The role of technology in mental healthcare. (2022). https://cdn.nuffieldbioethics.org/wp-content/uploads/NCOB-Briefing-The-role-of-technology-in-mental-healthcare.pdf.
Pielke R. A. Jr. The Honest Broker: Making Sense of Science in Policy and Politics. Cambridge University Press. (2007).
Pollan M. How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. Penguin. (2018).
Tsing A. L. The mushroom at the end of the world. Princeton University Press. (2017).
Viña S. and Stephens A. Minorities’ diminished psychedelic returns. Drug Science, Policy and Law. Volume 9. (2023).
Watson J. Lo-TEK Design by Radical Indigenism. Taschen. (2019).
World Health Organization. Regional Office for Europe. Child and youth mental health in the WHO European Region: status and actions to strengthen the quality of care. World Health Organization. Regional Office for Europe. (2025) https://iris.who.int/items/db8027f2-e082-4532-8546-3c95094632dc.
Wu Y. et al. Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years. Epidemiology and Psychiatric Sciences. 7/32. (2023).
The paper will make use of cross-country survey data, George Monbiot’s epiphany, academic research papers and opinion pieces in popular media and some basic economic logics in order to trace the development of pronuclear argumentation.
Künstliche Intelligenz, die nicht nur beeinflusst was wir denken, sondern auch wie wir es tun. Was nach dystopischer Science-Fiction klingen mag, ist vielleicht näher an der Realität als uns lieb ist. Das legt zumindest eine aktuelle Studie zu KI-Schreibassistenten nahe.
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