Psychedelics and the Inner Healer: Myth or Mechanism
Big Think: The Mechanisms of Action — How MDMA-Assisted Therapy Works — Inside the Battle for FDA Approval of MDMA Therapy
Notes by Natalie Ola
5 min read · 20.7.2025
When Saga Briggs asks Rick Doblin about mechanisms of action — how MDMA-assisted therapy works — his initial response is pragmatic.
“When you try to work with the FDA, you have to prove safety and efficacy, but you don’t have to prove any mechanism of action. Consequently, we have left the physiological mechanism of action to other scientists.”
With a wry smile, he adds: “You hear about translational neuroscience. What I would say is that nothing is translated from neuroscience to help the clinician.”
In recent years, researchers have found that MDMA reduces activity in the amygdala, increases activity in the frontal cortex, and increases connectivity between the amygdala and the hippocampus, where memories are put into long-term storage. Oxytocin and serotonin work together synergistically to enhance neuroplasticity.
“Those are good explanations, but none of that is really filtered down to how you do the therapy differently,” Doblin says, noting the thousands of years of psychedelic healing ceremonies preceding brain scans.
Doing the therapy differently, however, is the exact platform on which MAPS has sold itself.
“The main thing we’ve learned is that there’s this inner wisdom, this inner kind of logic to what’s emerging. It could be they’re moving into terror, they’re moving into shaking and just reenacting, reliving in their mind the trauma experience, or they’re talking about something in childhood, or they’re talking about happy memories. Whatever it is, the therapists don’t have an agenda. They support what’s emerging. We’ve called this the ‘inner healing intelligence.’ We know our body has this, that it heals itself in this quest to wholeness below our level of conscious awareness.”
“Inner healing intelligence” — which MAPS’ treatment manual defines as “a person’s innate capacity to heal the wounds of trauma” — seems intuitive enough. After all, cuts and scrapes heal on their own without direct intervention from the mind, so couldn’t your mind “get out of its own way,” through ego dissolution or some similar mechanism, to help facilitate emotional healing?
MAPS’ treatment strategy is based on the assumption that it can.
“Therapists should trust that any fear, memories, etc. that keep coming up are doing so to be healed, to be more fully understood, and that the participant’s psyche/inner healer knows when the best time is for this to occur,” states MAPS’ treatment manual. “This very process of surrendering ego/directed functions to self/inner healer may be the method of therapeutic action that is so hard to come by without the help of MDMA.”
Scientists have not empirically corroborated the existence of an “inner healer” or a “self” that seeks “wholeness” in the way MAPS describes it. Some also question the efficacy and safety of the non-directive therapeutic approach.
Neşe Devenot, a senior lecturer at Johns Hopkins who specializes in psychedelic bioethics and submitted a citizen petition to the FDA arguing against Lykos, wrote that assuming there’s an “inner healer” guiding the processing of trauma may prime “both clients and therapists to associate distress with healing, even in situations where actual harm is occurring,” and that it risks encouraging study participants to “interpret any outcome as successful.”
Doblin is aware of such criticisms within the science community.
“‘Oh, this inner healing intelligence. It’s woo, woo. It’s not scientific. It’s, you know, it’s terrible, it’s scary. You’re smuggling religion into this and stuff like that.’”
“I was just with a scientist from Johns Hopkins, and he said I should stop using the word ‘inner healing intelligence’ because people don’t know what we mean. None of that is true.
All it is is just to say that we support what’s emerging, whatever it is: If it’s terrifying, if it’s pleasant, if it’s just neutral, whatever it happens to be.
We let people come around to the trauma at their own pace, and people will always eventually get to it — because that’s what their problem is. But they might not get to it in a straight line, and that’s why the cognitive processing therapy and the prolonged exposure are so re-traumatizing. You say, ‘We’ve got an hour meeting. Tell me about your trauma.’ It’s just a different kind of approach.”
The idea of an inner healer phenomenon has caught the interest of certain figures within the psychedelic science community.
In a post last year on X, the neuroscientist Robin Carhart-Harris wrote: “Can someone quote me something from a book or in academic literature referring to the inner healing mechanisms of psychedelic therapy?” Several months later, he posted: “A small step on a brave journey to consider & examine the validity of the ‘inner healer’ phenomenon in context of psychedelics,” sharing his new paper on the topic, titled, “Psychedelics and the inner healer: myth or mechanism?” Carhart-Harris wrote that he “does not see it as a mystical/supernatural phenomenon at all.”
Doblin notes that proponents of the inner healing approach argue that it “helps people feel that they can trust what’s happening, even if it’s leading them into fear and terror,” adding that it’s a gentle salve for moments during a trip when someone might be thinking, “I’m going to lose control, I’m going to be crazy.”
“Difficult is not the same as bad in terms of psychedelic experiences,” Doblin tells me. “What turns something difficult into something bad is resistance. So I think, again, part of the mechanism of action is that you open up to it and you descend into it. If you are fully open to it—life is constant change—something will change.”
Reference:
Saga Briggs. Inside the Battle for FDA Approval of MDMA Therapy. Big Think. 27.12.2024.
