The dichotomy between body and soul (mind) is one of the fundamental schemata of Western (Judeo-Christian) thought (Taylor, 1989, Bynum 1995). The majority of philosophers who argue that body and soul (mind) are somehow separate entities, trace the origin of this belief back to the works of Socrates and Aristotle whose views later got incorporated into Judeo-Christian religious tradition.
Depending on prevailing intellectual currents of the time but existing simultaneously, (mental) health issues, including depression, have been either considered as biological phenomenon, arising from the imbalance of four ‘humours’, or as an experience of mind/soul, arising from a lack of faith or caused by demonic influence, moral failing or sin (Foucault 1961, Jackson 1981). The depression was treated according to its perceived cause, either by diet, exercise, bloodletting, emetics and cathartics to balance the humours, or by light work, routine and prayers, often administered by religious clergy to address assumed moral deficits (Foucault 1961).
Though this dualism has been continuously challenged from various intellectual positions throughout its history, it peaked in the Enlightenment period with modern dualism of body and mind by Rene Descartes (1691). In the era of Enlightenment, he posited differentiation between two radically different phenomena, the immaterial and indivisible mind or soul, unconstrained by space; and a material, divisible body, subject to the laws of physics which do not interact routinely (Cottingham 1986). Since this period, mental distress has become increasingly secularised (Foucault 1961, Porter 2002), (new) medical and psychological explanations emerged and proliferated (Shorter, 1997; Goldstein, 1987) and mental illness was conceptualised as a disease of nerves and brain (Weiner 2008). Psychiatry emerged as a medical profession in the framework of science, research, rationality and measurement (Hoff, 2009). The neuroanatomical and biological research of the late 19th century situated mental disorders as biological illness of the brain.
Freud (1917) conceptualized depression as the internalization of anger and loss, a mechanism which generates ambivalent feelings in the afflicted individual. This psychoanalytic approach is again situated within the Western schemata with its central focus on the conflict between conscious rational processes of the mind and subconscious drives of the body (Heelas and Lock, 1981) and provided the framework for psychodynamic therapies. The pharmacological and imaging advances in the mid-20th century brought further attention on biological aspects of depression and psychological and psychotherapeutic approaches situated it in the mind.
Some still see depression as a moral or religious failure. For example, this can be argued for various contemporary prosperity gospels (Bowler, 2018, Lofton 2017, Ehrenreich, 2009), (corporate) positive thinking culture and wellness or wellbeing culture (Ehrenreich, 2009). These contemporary ideas echo old understanding of depression as a moral issue and consequence of the lack of faith because in this frame, sadness might be posited as a failure to wanting to get better and as ingratitude which prevents an individual to succeed, but also as a ‘cause’ for getting ill in the first place.
These understandings were challenged by the biopsychosocial (BPS) model of (mental) health (Engel, 1977) in which the (mental) health of an individual is an intersection of dynamic interactions among biological, psychological, and social factors. Since its inception, BPS has become dominant theoretical model in psychiatry and medicine (Borrell-Carrió et al., 2004, Ghaemi 2009) which is the basis for the contemporary concept and practice of patient-centered care (Mezzich et al., 2010). However, the criticisms have been raised that this model is but a rhetorical adherence to the importance of psychosocial factors while the model is fundamentally biological (Ghaemi, 2009)
Treatment-resistant depression and psychedelics
In the 1980s, new pharmacological treatments achieved great success in treatment of depression, especially after introduction of selective serotonin reuptake inhibitors class drugs, such as fluoxetine (Prozac) and several treatments with novel pathways of action in the 1980s. The subsequent four decades, however, brought no breakthrough treatments. This is of critical concern because approximately up to 30% of all patients with depression do not respond positively to current pharmacological treatments (McIntyre et al., 2023, Bartove et al., 2019) and meet criteria for treatment-resistant depression (TRD). Even though there is no universal consensus as to definition of TRD, most clinical studies use the one proposed by the medicines regulatory authorities, the US Food and Drug Administration (FDA) and the European Medicines Agency. These institutions define TRD as depression where the patients have inadequate response to at least two antidepressants, despite standard treatment duration and adherence (in Norman, 2025).
Psychedelics are a class of potent psychoactive compounds that induce profound alterations in perception, mood, sense of self and affect a range of cognitive functions. Current empirical evidence suggests that these substances exhibit a favorable physiological safety profile and do not cause dependence or addiction (Nichols, 2016). Psychotherapy in conjunction with psychedelic drugs is believed to be crucial for the success (Norman, 2025). The psychedelic intervention is therefore usually administered during counselling, referred to as ‘psychedelic-assisted psychotherapy’. After having established rapport with the therapist during several previous visits, the drug assisted part of the therapy is six to eight hours long in the presence of a psychotherapist and assistant in an environment which appears as non-clinical as possible (Norman 2025).
Brief History of psychedelics
Many psychedelics have long history of use in ceremonial, healing and religious purposes in traditional societies across the world (Schultes and Hofmann, 1992, Nichols, 2016). The first semi-synthetic psychedelic LSD (lysergic acid diethylamide) was created by chemist Albert Hofmann in 1938 when researching ergot alkaloids. When experimenting with mind bending characteristics of the new substance, Humphrey Osmonds named these new drugs ‘psychedelic’ in 1957 because of their mind-altering properties. In the 1960ss, psychedelic drugs were used by youth counter-culturalists, protesting against conventional social norms and the war in Vietnam. The authorities reacted by prohibition of psychedelics and by the late 1960s and early 1970s, psychedelics were illegal in most countries across the globe. As a consequence, the research was very limited until 1990s and 2000 when there was a great revival in interest in the use of psychedelic drugs in mental health purposes (Nichols, 2016).
In the 21st century, psychedelics, such as LSD, psilocybin and psilocin, ayahuasca, MDMA, ketamine etc. have been identified as potentially highly effective means for treatment-resistant depression (Palhano-Fontes et al., 2019, Carhart-Harris, 2016, Han et al., 2016). Between 2017 and 2019, initial clinical trial data on a number of psychedelics demonstrated sufficient evidence to prompt FDA to grant Breakthrough Therapy designation to psilocybin- and MDMA-assisted therapies for major depressive and post-traumatic stress disorder. Consequently, by 2021, approximately 600 pharmaceutical startups were actively preparing to enter the mental health market, once anticipated regulatory approvals for these novel medical applications are granted (UNODC, 2024).
Legal aspects of the use of psychedelics
Some of the barriers to the research and adoption of psychedelics can be attributed to their legal status. Most of the traditional and newer psychedelics are still illegal, and would require changes in legalisation. They might also not be acceptable to those who are cautious about their association with counter-cultural context and illegal status. Jilka et al. (2019) point out that psychedelic or other drug naïve patients frequently mention fear of addiction as a barrier to use such treatments. Their fear is not substantiated by research as follow-up studies for up to 28 days post-treatment found no evidence to support them (Rosenblat et al., 2019) and psychedelic treatments are considered non-addictive (Nichols, 2016). The apprehension of addition might be based on the association that a treatment is illegal if it is addictive and otherwise destructive.
Less discussed issue is the association with the (illegal) use of prohibited substances might also not be acceptable on religious grounds. For example, it has been documented that Muslim consumers avoid products which not only contain haram ingredients, such as alcohol, but are not directly ingested and might be just (symbolically) associated with the production of alcohol (Wilson 2010 et Liu). Muslims therefore might avoid buying any products, associated with making alcohol or are involved in its production and might shun products as psychedelics because as Walaszek et al. (2025) reports, they might make patients feeling ‘drunk’.
Psychedelics can also induce visuals and visions, and mystical, spiritual and religious experiences which might contain transcendental, spiritual and religious elements (Breeksema et al. 2020, Walaszek et al. 2025). Some users might object to the use of psychedelics for religious reasons. For example, Carrol (2025) argues from the perspective of Catholic doctrine that the use of psychedelics in therapeutic purposes is or might be legitimate when not intentionally looking for mystical experiences. However, the belief-altering properties of psychedelic substances which might lead believers away from the Catholic faith makes their use illicit in most other contexts. Langlitz (2023) invites debate from an anthropological and secular perspective on what kind of consequences the proliferation of mystical experiences might have for contemporary societies.
Therapeutic role of psychedelic community
A solution to most of the above issues might be the development treatments without the subjective effects of psychedelics or psychoplastogens. Several such treatments are in development (Olson 2021, Cameron 2021, Cao 2022, Kaplan 2022). They are based on the premise that psychedelic treatments are effective because they promote greater brain neuroplasticity, not because they induce subjective hallucinogenic experiences (Ly et al. 2018). This assumption is supported by clinical evidence, such as of Daws et al. (2022) who have recently reported their clinical finding that positive therapeutic outcomes are correlated but not strictly dependent upon subjective mystical experiences.
Roseman et al. (2022) argue against such reductionism without taking into consideration the role of broader social interactions in the (psychedelic) healing process and point out that the research and experience indicate that psychedelics are ‘notoriously context dependent’ (p. 2). Collective, social and cultural environment therefore themselves have therapeutic effect and support building relationships of trust, and therapeutic process and change (Roseman et al. 2022) where music, words, language, symbols, beliefs and social relationships are important contextual therapeutic factors of treatment effectiveness (Walaszek et al., 2025).
This was explicitly recognised in the systematic review of Walaszek et al., (2025) which reports patient narratives on experiences of taking psychedelics as a part of participating in clinical trials. The participants praised competent, caring and available staff and feeling safe in the therapeutic environment as an equally important part of the treatment as undergoing psychedelic intervention. Kettner et al. (2021) also point out that intersubjective experiences within psychedelic-assisted therapy session are predictive of sustained, positive alterations in psychological wellbeing and perceived social connectedness
Roseman et al. (2022) also argue that a decline in meaningful social connections within contemporary societies is a significant contributor to the rising prevalence of mental health disorders. This argument is supported by qualitative data; for instance, a systematic review by Breeksema et al. (2020) documents patients attributing therapeutic gains to a renewed sense of connection with their natural and social environments during psychedelic-assisted therapy. This reconnection is theorized to be a mutually reinforcing process.
A growing body of clinical research indicates that psychedelics can reliably induce prosocial and empathogenic states (Markopoulos et al., 2022). Consequently, a singular focus on the biological mechanisms of psychedelic action—while disregarding the essential socio-environmental context of their use—risks undermining full therapeutic benefits by neglecting a critical component of the healing process.
As already discussed above, some psychedelics (magic mushrooms, ayahuasca brew) have a long history of indigenous use in communal settings in healing, spiritual and/ or religious ceremonial purposes (Schultes and Hofmann, 1992, Nichols, 2016). Isolating their psychoactive components to use them as commercialised pharmaceutical treatments and thus ignoring the original work of indigenous people (George et al., 2020a, Sanabria 2025) raise issues of unequal power relations and neo-colonialism (George et al., 2020b), cultural appropriation and leaving communities who experimented with these substances and collected data on the use throughout millennia without appropriate financial acknowledgement.
This argument does not only apply to traditional societies. Söderberg (2022) argues that because public research into psychedelics in the West was illegal for half a century, it was drug user communities who collected valuable data on drug toxicity, dosing, side-effects and other aspects. These data were taken over by pharmaceutical companies as valuable pointers for further scientific research to be patented, without properly recompensing these drug user lay innovators.
Conclusion
The treatment of depression through Western history has a strong underpinning in persistent dualism of body and mind (soul) which require different treatment approaches. Despite medical advances and tendency to situate depression in the biology, or psychological and psychotherapeutic interventions to treat the mind, ideas that depression is a moral failure or sin are still implicit in the wellness culture. The contemporary BPS model of mental health unites Western dualism by positing health by putting the patient in the centre of the biological, psychological, and social factors. While welcoming new pharmacological advances, psychedelic treatments and psychedelic-assisted therapies can only thrive in such a model because of therapeutic effects of psychological factors and social context.
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