Governing in the Gaps: Legitimacy Assembly in Psychedelic Care

• In Event: Sociology of Mental Healthcare

Abstract

This article examines how practitioners construct legitimacy and govern care within Canada’s largely unregulated field of psychedelic-assisted psychotherapy (PAP). Although Health Canada’s Special Access Program (SAP) provides a narrow legal pathway for treatment, access remains highly restricted, contributing to the growth of underground services. At the same time, no formal standards of training, certification, or professional regulation govern this work. Despite this absence of institutional infrastructure, practitioners do not treat psychedelic therapy as unstructured. Instead, they act as if standards exist, articulating norms of competence, ethics, and responsibility and developing informal mechanisms of accountability. Drawing on 40 semi-structured interviews with underground practitioners of psilocybin-assisted therapy in Canada, this article conceptualizes governance in this emerging mental health field as a process of legitimacy assembly. Rather than treating legitimacy as a stable attribute or symbolic resource, I show how practitioners recombine historically distinct repertoires of authority—experiential, spiritual, relational, and clinical—to structure access, define competence, enforce accountability, and manage risk in the absence of formal regulation. Legitimacy thus performs regulatory work. This case engages debates on professionalization and medicalization by examining how biomedical authority is selectively incorporated without consolidating jurisdiction. Rather than reflecting either full medicalization or demedicalization, psychedelic care demonstrates an uneven and negotiated relationship to institutional medicine. While biomedical discourse provides tools for screening and risk management, it remains one repertoire among others, while governance persists without professional closure or epistemic convergence.

Author

• Sarah Badr, McGill University