The Truth About Psychedelics: Why Psychedelics Don’t Heal Everyone with John O’Connor

Why psychedelics don’t heal everyone is a question I’ve been sitting with for a long time — and one that I think the modern wellness movement has been quietly avoiding. Depending on who you ask, psychedelics are either a miracle, a dangerous escape, a spiritual technology, or a therapy on the verge of transforming mental healthcare. The headlines are glowing. The clinics are opening. The influencers are microdosing. And underneath all of it, there’s a much quieter story unfolding — the story of the people for whom the medicine did not work the way they were promised it would.

I recently sat down for a conversation on Leading with Spirit with author and Boston College professor John O’Connor, whose book A Short and Strange Trip traces the history of psychedelic culture, the famous La Chorrera experiment that shaped Terence McKenna’s work, and the complicated relationship between psychedelics, mysticism, healing, and human psychology. John came into this work as both a longtime writer on the subject and as a son — his father had struggled for decades with alcoholism and depression, and John himself suggested psychedelic therapy as a possible path forward. What happened next reshaped how John talks about these medicines. And it’s the kind of story most of the current coverage of psychedelics is quietly leaving out.

The Cultural Moment We’re In

Psychedelics are having their loudest cultural moment in over half a century. Ketamine clinics are opening across the country. Oregon and Colorado have legalized supervised psilocybin therapy. A recent presidential executive order signaled federal openness to the space. Investors are pouring in. Practitioners are certifying. And on social media, the story being told is remarkably clean: these medicines heal trauma, dissolve depression, cure addiction, and unlock your true self.

As John pointed out in our conversation, this is a strange reversal from the cultural narrative most of us grew up with. For decades, the war-on-drugs vernacular told us all drugs were bad — full stop, no nuance. Now we’ve flipped one set of assumptions for another, where all drugs are good — full stop, no nuance. Neither framing tells the truth.

Because the truth is that sometimes psychedelics create healing. Sometimes they create confusion. Sometimes they create meaning. And sometimes they amplify the exact thing someone is trying to escape.

I’ve come to believe that understanding why psychedelics don’t heal everyone requires being willing to sit inside that complexity, instead of collapsing it into a slogan.

What Actually Happens When the Medicine Doesn’t Work

John shared his father’s story with me in the episode. His father had spent decades struggling with alcoholism and depression — the kind of long, quiet suffering that so many people are living inside of and looking for a way out of. When psychedelic therapy became more accessible, John encouraged him to try it. First ketamine at a clinic in Michigan. Then psilocybin therapy with a guide.

Neither worked. In fact, John described both experiences as, in different ways, disastrous.

This is the part of the psychedelic conversation that almost never makes it into the mainstream coverage. The person who did the therapy and did not get better. The person who got worse. The person who found themselves more dysregulated after the medicine than they were before. These people exist in significant numbers, and their stories are being subordinated — as John put it — to the last paragraph of every hopeful article.

Why psychedelics don’t heal everyone isn’t a rhetorical question for me. It’s a lived reality I encounter in the people I work with, and one I hear in the stories John and so many others carry.

The Missing Piece: Integration

Here’s where the conversation got specific for me — and where it starts to actually offer something useful.

The current cultural framing treats the psychedelic experience itself as the healing. Take the medicine, have the vision, come back changed. But as John noted, if you actually read the research articles that get published about these therapies, buried in the last penultimate paragraph you’ll find something like: “These drugs require ongoing psychotherapy before and after dosing.”

That’s not a footnote. That’s the whole game.

Plant medicine integration — the work you do before and after the journey — is where the healing actually happens. The medicine opens something. Integration is what determines whether that opening becomes real, embodied change, or whether it collapses back into the same patterns you had before. Sometimes it collapses back worse than before, because now your nervous system is more sensitized to what you weren’t ready to face.

This is one of the hardest realities to communicate in a culture that wants a shortcut. People are hurting. They’re desperate. They’ve tried everything. And here comes what looks like a miracle cure. The temptation to skip the integration work and just take the medicine is enormous. But integration ayahuasca practitioners, ethical psilocybin guides, and experienced shamanic facilitators will all tell you the same thing: without the container of preparation and integration, the medicine has nowhere to land.

Why psychedelics don’t heal everyone is often, in the end, a question about integration. Or the lack of it.

The Indigenous Reality Most People Aren’t Told About

One of the parts of our conversation that stayed with me most was John’s account of going to La Chorrera — the remote village in the Colombian Putumayo where Terence and Dennis McKenna undertook their famous 1971 experiment. He went there to research the book, to talk with the Witoto and Bora people who call it home, and to see the place for himself.

What he found upended most of what the Western psychedelic imagination assumes about indigenous plant medicine practice.

There were no mushrooms. The psilocybe mushrooms that had grown in the dung of the missionaries’ cattle in 1971 were long gone, along with the missionaries and their cattle. The mushrooms had never been indigenous to that area in the first place.

More surprising: the shamans John spoke with had a very different relationship to ayahuasca than the Western imagination projects onto them. It wasn’t primarily used for therapy or trauma healing or expanded consciousness exploration. It was used, they told him, for practical purposes — finding lost objects, communicating with ancestors, seeking luck in the hunt. One of the shamans John and his filmmaker friend spent time with had been apprenticing for fourteen years and had never taken ayahuasca herself. She was scared of it.

The therapeutic framing of these medicines, as John pointed out, is largely a product of white contact. It’s a veneer layered onto plants that had a very different original relationship with the people who first stewarded them.

I want to be careful with this one. This doesn’t mean psychedelics can’t be used therapeutically — I’ve seen them do beautiful, real work in the people I’ve sat with. But it does mean the story we’re telling ourselves — that indigenous shamans have been using these medicines to heal trauma for thousands of years and we’re just finally catching up — is not exactly what happened. And when we build an entire industry on a story that isn’t quite true, we build something wobbly. The spirit of ayahuasca, the spirit medicine of these plants, deserves more honesty than that.

When the Container Fails: The Shadow Facilitator Problem

I want to share a story that came up in our conversation, because it’s one I’ve seen play out too many times.

A friend of mine got into medicine work specifically for alcohol recovery. He picked a place in South America, went to work with a facilitator, and ended up with what I’d call a shadow facilitator — someone without genuine training, ethical grounding, or the kind of skill this work actually requires.

He had a terrible experience. Years later, he’s still integrating the fallout. He was drinking beer the next month.

But — and this is the part that matters most to me — he stuck with the work. Not because the medicine had failed him, but because he understood that healing was never going to be a one-and-done event. He kept going. He kept doing the work. And eventually, real change came.

This is the piece that gets erased in the miracle-cure framing. The medicine is a doorway. It is not the room. What you do on the other side of the door, and who you do it with, is where the actual life change happens. A shamanic journey is not a fix. Spirit medicine is not a fix. Plant medicine is not a fix. They are tools that reveal things — and what you do with what’s been revealed is the work.

The Trap of Linear Thinking

One of the things I brought into the conversation with John — because I see it constantly in my own work — is how much preparing someone for plant medicine involves helping them let go of black-and-white, linear thinking before the medicine is even taken. If someone walks into a journey expecting a clear, tidy, cause-and-effect outcome, they will struggle to navigate what actually happens.

Psychedelic experiences don’t follow linear logic. Healing doesn’t follow linear logic. Transformation doesn’t follow linear logic. And people who walk into these medicines expecting them to work like a prescription — take X, get result Y — often find themselves lost in the terrain that opens up.

Why psychedelics don’t heal everyone is often, at its heart, a question about frame of reference. The medicine works with the container you bring to it. If the container is “fix me,” the medicine can only respond to that request in ways that either overwhelm or disappoint. If the container is “show me,” something different becomes possible.

What Terence McKenna Was Really After

John came to his book as, in his own words, a Terence McKenna fanboy. He’d bought True Hallucinations during the pandemic, put it on a shelf like he does with most books he buys, and pulled it down one day thinking it was going to be hippie-esoteric material with no real relevance to him. He was floored. He wrote a book because of it.

But as he did the research — talking with Colombian anthropologists, with shamans, with people who had been in that region — his relationship to McKenna cooled. Some of what Terence had claimed didn’t quite hold up. Some things, John suspects, Terence made up because he thought they would sell well with his audience.

And then, by the end of the writing, John came back around. Not to the specifics of McKenna’s cosmology — the machine elves, the timewave, the end of history — but to what he understood as Terence’s actual underlying project. Which was, simply, human flourishing. He genuinely wanted the best for people.

John’s view — and this landed with me — is that Terence went about it in a way that missed something essential. The best route to human well-being isn’t through the exotic frontiers of consciousness. It’s through love and compassion for the actual people in our actual lives. Not machine elves at the end of history. Just each other, right here.

That’s a quieter thesis than the one the psychedelic movement has built itself on. But I think it might be the truer one.

What I Want You to Know If You’re Considering Psychedelic Work

If you’re recognizing yourself in any of this — considering psychedelic therapy, curious about plant medicine, or already three journeys deep and wondering why nothing seems to be sticking — here’s what I want you to hear.

First, the medicine is not the healing. It’s a catalyst. The healing is what you do with what the medicine reveals, in the days and weeks and months after the experience. Plant medicine integration isn’t optional. It’s the actual work.

Second, who you work with matters more than what you take. A skilled facilitator with a real relationship to the medicine, to lineage, to their own inner work is not the same as someone who charges money to sit next to you while you drink something. If you can’t tell the difference before the journey, you’ll learn the difference during it. This is the part that isn’t optional either.

Third, if psychedelics haven’t worked for you — or worse, if they’ve made things harder — you are not alone, and it doesn’t mean you’re broken. It might mean the container wasn’t right. It might mean the timing wasn’t right. It might mean this particular medicine isn’t your path. All of these are real possibilities. None of them mean you’re beyond help.

Fourth, be careful with linear expectations. Real healing rarely arrives in a single dramatic event. It arrives in slow, layered, sometimes unglamorous work. The people I’ve seen transform most through this medicine are the ones who did the least dramatic and most sustained work around the experience.

Why psychedelics don’t heal everyone is, in the end, less a warning against these medicines than an invitation into a more honest relationship with them. They’re powerful. They’re also limited. They can open doors. They can also amplify what’s already broken if the container is wrong.

The people I’ve watched benefit most from this work are usually the ones who arrived without the expectation of being saved by it. Who understood it was part of a larger practice, not a replacement for one. Who came in with love and compassion for themselves and their people — which, as John reminded me, is the same thing Terence was pointing at all along.

The medicine can help. It just can’t do the work for you. And knowing that going in is what turns a psychedelic experience into an actual healing journey.

If you’re recognizing yourself in this, in the searching, the disappointment when the medicine didn’t do what you hoped, the quiet suspicion that the real work is still ahead of you that recognition is worth paying attention to. Because before you can know what container, what facilitator, or what next step is actually right for you, it helps to understand the pattern you’re working with in the first place.

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And if part of what’s stirring in you isn’t just about your own healing, if you’ve sat with someone else’s pain and thought I could hold better space than that, or you’re the friend people already turn to in crisis that’s worth listening to as well. Skilled, ethical facilitation is exactly what’s missing in so many of the stories above, and it’s not something people are born knowing. It’s trained.

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