PSYCHEDELIC DRUGS have been making a quiet comeback, if mostly among a cultural elite. Thousands of users flock to Burning Man every year, or they head to Ayahuasca retreats in the Amazonian jungle to discover the wisdom of Shamans. If they’re tech workers, they may have different aspirations: they microdose on LSD to increase their productivity and get through the week, a subject explored in Ayelet Waldman’s recent book, A Really Good Day. In TED talks and podcasts, these new “lifehackers” explain how psychedelics not only increase their output but make them better people to boot. Even The New Yorker has weighed in, publishing two articles in the last few years on the subject, including a positive report from Michael Pollan on the beneficial effects of psilocybin therapy for cancer patients, and Ariel Levy’s glib account of drinking ayahuasca with Brooklyn hipsters.

Underpinning this trend is a dedicated network of clinical workers who are testing — with government approval — certain psychedelics drugs as therapeutic tools for treating PTSD, trauma, anxiety, and depression. Some advocates enthuse that we could be on the verge of a “post-Prohibition era.” Indeed, with respect to legalization, they claim mind-altering drugs may well be where marijuana was 10 years ago.

In Changing Our Minds: Psychedelic Sacraments and the New Psychotherapy, Don Lattin, a former newspaper journalist who has written a number of books on both psychedelics and religion, reports from nearly all corners of this reemergence, focusing especially on the specifics of how psychedelic drugs are being used for therapeutic and spiritual purposes. An unabashed enthusiast, he writes of “a transformational movement” that “is part of a larger shift in Western culture of people searching for new ways to connect mind, body and spirit.”

Casting a wide net, he details therapies that make use of MDMA (“ecstasy”), psilocybin (the active ingredient in “magic mushrooms”), LSD, ayahuasca (a South American psychedelic brew), ketamine (a dissociative used to treat depression), and Ibogaine (a drug derived from a West African plant and used to treat opiate addiction). He describes trying several of these himself in an effort to address his own depression.

The use of these substances for medical purposes is nothing new. LSD, first synthesized by Swiss chemist Albert Hoffman in 1938, quickly came to be seen as a novel window into the human mind. In the 1950s and 1960s, more than 40,000 people were given psychedelic therapy as part of experimental treatments for alcoholism, depression, and other problems. Studies showed that LSD might be particularly useful for treating alcoholism. Bill Wilson, the founder of Alcoholics Anonymous, touted the benefits of acid, saying it helped with spiritual awakening. The actor Cary Grant took LSD in more than 100 therapeutic sessions beginning in the late 1950s. He credited the drug with healing his crippling insecurity, and was quoted in a 1959 Look magazine article as claiming that thanks to LSD, “at last, I am close to happiness.” Intellectuals joined in, most notably Aldous Huxley, still arguably the best writer on the subject, who told the Paris Review in 1960, “It’s a very salutary thing to realize that the rather dull universe in which most of us spend most of our time is not the only universe there is.”

With the spread of positive reports about these drug trials in the 1960s, freelance chemists outside of the pharmaceutical industry cooked up batches of ultra-strong LSD, spreading them on the streets. Timothy Leary, the Harvard psychologist-turned-psychedelic cheerleader, encouraged kids to “tune in, turn on, and drop out.” Hippies descended on San Francisco, and freaked-out kids made visits to emergency rooms, unmoored by staggeringly strong doses of acid. After his 20-year-old daughter killed herself by jumping from a window in 1969, the actor Art Linkletter stated she’d had a bad LSD trip (she in fact had no drugs in her system when she died). Richard Nixon soon declared Leary “the most dangerous man in America.” Within a few years, substances such as LSD and psilocybin were not only illegal but also declared to have no legitimate medical use. The door had slammed shut.

The story of the underground years is certainly worthy of a premium cable television series. The cast of characters Lattin touches on includes the chemist Alexander “Sasha” Shulgin, who re-synthesized MDMA in his lab in the Berkeley Hills in the 1970s and then supplied it to a network of rogue psychotherapists. He also cooked up hundreds of other psychoactive drugs, which he sampled with his wife and friends, later publishing two books detailing his trips along with the formulas for recreating the drugs (available right now on Amazon for those interested).

Lattin also speaks to Dennis McKenna, who, with his brother Terence, traveled to South America in the early 1970s. They returned as vocal proponents of mushroom and ayahuasca use, Dennis as a scientist, and Terence as a writer and mesmerizing mystical speaker. Many of Terence’s talks have been uploaded to YouTube by fans who combine audio recordings, most of them of poor quality, with trippy visuals such as time-lapse images of clouds flowing over mountains.

Just as important in these underground years were the organizers and fundraisers. Rick Doblin, who holds a PhD from Harvard’s Kennedy School of Government, founded the Multidisciplinary Association for Psychedelic Studies (MAPS) in 1986. He has spent the last 30 years raising money and getting approval for small-scale clinical trials for psychedelic therapies — for instance, for using MDMA to treat PTSD. David E. Nichols, a pharmacologist and medical chemist, founded the Heffter Research Institute in 1993. Its work primarily focuses on the therapeutic use of psilocybin for addiction and cancer-related distress. Adept at massaging the federal bureaucracy and at pitching to the well heeled, these two men have raised millions of dollars.

Lattin takes us inside several therapy sessions, including one with a veteran suffering from PTSD and others with patients facing debilitating illnesses. MDMA seems to alleviate PTSD by helping patients confide in their therapists, be in the moment, and feel empathy for themselves. The spiritual aspects of psilocybin — the feeling that everything in the universe is connected and “one” —purportedly helps people with depression, cancer, and other illnesses. Though the trials have been small so far, MDMA appears to be effective with a subset of PTSD patients who have not had success with traditional treatments. In a study of 29 cancer patients at NYU, treatment with psilocybin produced “immediate, substantial and sustained improvements in anxiety and depression.”

With such a wealth of promising material, it’s unfortunate that Changing Our Minds lacks organization and reads in the episodic manner of newspaper articles tacked end to end. Lattin introduces dozens of characters, sketching many of them with only the barest of detail. When he refers to them in later chapters, the reader is hard put to figure out who he’s talking about. More disconcertingly still: Despite his professed enthusiasm, his own experiments with ayahuasca, psilocybin, and ketamine come across as surprisingly inert. He claims psychological insights, but he himself seems unconvinced they’ll result in any lasting change.

For example, looking back at his ayahuasca experiences, he writes, “They linger as meaningful memories but have not changed my life, at least not in any significant way that I can see at this point in time.” Ketamine provides a bit of relief, but Lattin observes that “the problem with ketamine, at least for me, is that the effects wear off.” Of “mushroom medicine,” he reports, it “inspired me to stop doing and start feeling — at least for a couple hours. The challenge, of course, is to take the moments of insight on the mushrooms or the MDMA or the ketamine back into the ‘real world.’ But there’s no rush — only the rest of my life.” These personal forays hardly add up to a rousing call-to-arms for using psychedelic therapies over Prozac, for instance, or talk therapy.

Which raises the question, how exactly do these drugs work? Basically, we don’t know. Lattin interviews neuroscientists who dose people up on psychedelics and then observe their brain functions with MRI scans. The testing confirms that psychedelic use affects neural activity. What exactly is going on remains stubbornly unclear, however. It’s perhaps in part for this reason that Lattin spends a good portion of the book exploring spiritual dimensions — such as ego dissolution, interconnectedness, and “oneness” — in mystical rather than medical terms.

Spiritual well-being seems to be the key benefit in all these treatments, which doesn’t lend itself to scrutiny via the scientific research method. Nor does it fit easily into traditional religion, where access to the divine is mediated through a hierarchical structure. The line between the medical and spiritual in psychedelic use is intriguingly murky, and perhaps the most that can be said is that the current zeal for psychedelic experiences — including in tech circles — raises philosophical and existential questions about the persistent human desire for transcendence.

This said, the strategy of gradually legitimizing psychedelics through clinical research into treatment for PTSD or cancer-related anxiety certainly has been smart — no one really wants to deny a veteran or a cancer patient a chance at relief from their suffering. Treating them with psychedelics poses no threat to the smooth functioning of society, and so, thus far, the government under the Trump administration continues to approve clinical trials.

Rick Doblin, the founder of MAPS, however, wants nothing less than full legalization. He believes that exploring one’s mind is a human right. Whatever the merits of his argument, observers as far back as Aldous Huxley have cautioned that the use of psychedelics without careful preparation — professionals now refer to the importance of “set and setting” — can lead to terrible results.

As Lattin notes throughout his reporting, the safe administration of psychedelic therapies requires time — by way of counseling for the duration of trips, as well as before and after. He ends the book on a hopeful note, arguing that we are on the cusp of a new era of psychedelic acceptance and wider spiritual awakening. But, much as in the 1950s, it seems far more likely that this freedom will be limited to relatively few people — those with addictions, depression, and other problems that qualify them for clinical trials as described above, and to a privileged few who know how to work around the system, can pay for it, and are in a position to circumvent law enforcement.

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Doug Merlino is the author of Beast: Blood, Struggle and Dreams at the Heart of Mixed Martial Arts and The Hustle: One Team and Ten Lives in Black and White. He has written for outlets including Slate, Wired, Men’s Journal, and Vice.