In this opinion piece we propose the investigation of psychedelic-assisted psychotherapy for the treatment of body dysmorphic disorder (BDD). BDD is a psychiatric disorder characterised by appearance-based preoccupations and accompanying compulsions. While safe and effective treatments for BDD exist, non-response and relapse rates remain high. Therefore, there is a need to investigate promising new treatment options for this highly debilitating condition. Preliminary evidence suggests safety, feasibility, and potential efficacy of psychedelic treatments in disorders that share similar psychopathological mechanisms (...) with BDD. Drawing on this evidence, as well as on relevant qualitative reports and theoretical proposals, we argue that it would be worthwhile to conduct a phase 2a study aimed at assessing the safety and feasibility of psychedelic-assisted psychotherapy in BDD. We also offer some suggestions for how future research ought to proceed. (shrink)

In the historical context of a crisis in biological psychiatry, psychedelic drugs paired with psychotherapy are globally re-emerging in research clinics as a potential transdiagnostic therapy for treating mood disorders, addictions, and other forms of psychological distress. The treatments are poised to soon shift from clinical trials to widespread service delivery in places like Australia, North America, and Europe, which has prompted ethical questions by social scientists and bioethicists. Taking a broader view, we argue that the ethics of (...) psychedelic therapy concerns not simply how psychotherapies are different when paired with psychedelic drugs, but how psychedelic therapies shape and are shaped by different values, norms, and metaphysical commitments. Drawing from the published literature and interviews with seven psychedelic therapists working in clinical trials in the United States, Germany, Switzerland, and Australia, this article opens the black box of the treatments to consider the values and informal debates currently animating the therapies. Considering questions of patient autonomy, mechanisms of therapeutic action, and which therapies are best suited to pair with psychedelic substances, we examine the ethics of psychedelic therapy as an emergent form of life. To bring this form of life out in fuller relief, we conclude by comparing and contrasting it with ayahuasca use in Amazonian shamanism. (shrink)

Much of my book Philosophy of Psychedelics is devoted to elaborating and defending two basic claims: that psychedelic therapy works mainly by changing mental representations of the self, and that it has many epistemic benefits consistent with a naturalistic worldview. The commentaries in this symposium generally focus on one or the other of these claims. On the mechanistic front, the commentaries by Hoffman and by Martin and Sterzer seek to supplement my account by drawing attention to factors it (...) does not emphasize. In this reply I agree with most of their claims, but propose some important qualifications. Meanwhile, the commentaries by Lyon and Farrenikova and by Colombo challenge some core commitments of my account. I agree with many of their claims, but defend some of these core commitments. On the epistemological front, Bortolotti and Murphy-Hollies endorse the overall shape of my account and make some productive connections to ideas concerning agency-first epistemology and self know-how. Caporuscio brings into play the idea of self-shaping, which connects to self know-how, but argues against certain core claims of my account. I endorse many of these claims about agency-first, self know-how, and self-shaping, but propose some important qualifications. Finally, Fink agrees that psychedelic experiences can have some epistemic benefits, but argues that these do not pertain to epistemic justification, and that the main benefit is increased understanding. I am sympathetic to Fink’s proposal about understanding, but criticize some of his arguments for the thesis of Psychedelic Justification Impossibilism. (shrink)

Letheby’s naturalistic theory of psychedelic therapy argues that the therapeutic power of psychedelics lies in their ability to allow individuals “to discover the contingency, mutability and simulatory nature of their own sense of identity and habitual modes of attention.” The general shape of this project is persuasive; it is hard to see how the claim that successful therapy must involve changes to the self could be objected to, and Letheby sketches a consistent, if speculative, picture of (...) class='Hi'>psychedelic experience. But the role of affect in psychedelic therapy is insufficiently explored by Letheby as a comparison to MDMA-assisted therapy indicates. This comparison further suggests that Letheby’s reliance on a particular conceptualization of ego dissolution experiences is in need of further explanation and justification. (shrink)

Dating back to the late 1990s, the growing popularity of psychedelics is not a recent trend. Psychiatrists, psychologists, and neuroscientists are paying increasing attention to these hallucinogeni...

Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted therapies have shown to be highly efficacious for post-traumatic stress disorder and major depression. Recent research trials for psychedelic-assisted therapies (PAT) have demonstrated that although they are resource-intensive, their effects are rapid-acting, durable and cost-effective. These results have generated enthusiasm among researchers seeking to investigate psychedelic therapies in (...) active-duty service members of the US military, particularly those with treatment refractory mental health conditions. At the same time, psychedelics remain in early stages of clinical investigation, have not yet achieved regulatory approval for general clinical use and may confer unique psychological and neurobiological effects that could raise novel ethical considerations when treating active-duty service members. Should psychedelics achieve regulatory approval, military relevant considerations may include issues of access to these treatments, appropriate procedures for informed consent, confidentiality standards, and possible unanticipated mental health risks and other psychological sequelae. A service member’s deployability, as well as their ability to return to full military duty following PAT, may also be of unique concern. The authors argue that MDMA-assisted therapy currently represents a promising treatment that should be more rapidly investigated as a clinical therapy for service members while still taking a measured approach that accounts for the many military-specific uncertainties that remain. (shrink)

Chris Letheby’s defence of psychedelic therapy hinges on the premise that psychedelic-facilitated insights about the self are in a better epistemic position than those about the external world. In this commentary, I argue that such a claim is not sufficiently defended. More precisely, I argue that one element is underexplored in Letheby’s otherwise compelling picture: namely, that unlike new beliefs about the external world, beliefs about oneself have the capacity to turn into self-fulfilling prophecies. Recognising the (...) class='Hi'>psychedelic experience and the subsequent integration process as opportunities not only to apprehend certain facts about the self but also to actively shape and redetermine those facts is key to understanding the epistemic differences between insights patients have about themselves and about the external world. (shrink)

An emerging body of research suggests that psychedelic experiences can change users’ religious or metaphysical beliefs. Here I explore issues concerning psychedelic-induced belief change via a critique of some recent arguments by Wayne Glausser. Two scientific studies seem to show that psychedelic experiences can convert atheists to belief in God, but Glausser holds that academic and popular discussions of these studies are misleading. I offer a different analysis of the relevant findings, attempting to preserve the insights of (...) Glausser’s critique while setting the record straight on some important points. For one thing, the studies provide stronger evidence for atheist deconversion than Glausser allows. For another, Glausser’s arguments against the “Metaphysical Belief Theory” of psychedelic therapy involve scientifically dubious claims and inferences. Finally, in evaluating this theory, we ought to focus on its strongest version, which posits belief shifts from metaphysical naturalism to non-naturalism, rather than from atheism to classical monotheism. (shrink)

Psychedelic Harm Reduction and Integration is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which (...) psychedelics are placed, it is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented. (shrink)

In this paper, I explore scientific attempts to articulate a unified theory of the serotonin system and to explain the effects of psychedelic substances. I consider how certain accounts of psychedelic action have focused primarily on cognitive states, and I propose some phenomenological insights to supplement these models and inform work on psychedelics as therapeutic agents. Specifically, I argue that considering “psychological transformation” to be a core desideratum of psychedelic therapy should lead us to investigate the (...) role of affect in guiding significant psychological change. The phenomenological tradition offers resources for describing the relationship between knowledge and affect, and I argue that epistemically significant affective states such as fascination and revelation are more central to psychedelic experience than is commonly acknowledged. I propose that understanding the role of affect in psychedelic experiences is critical to developing a plausible account of the potential for using these substances therapeutically. (shrink)

“Classic”, serotonergic psychedelic drugs such as LSD and psilocybin are the objects of renewed attention in science and psychiatry. A recent spate of research has produced evidence that psychedelics might be safe and effective adjuncts to the treatment of mood and addictive disorders, agents of positive psychological change in healthy subjects, and valuable tools for studying the neural mechanisms of perception and cognition. This chapter surveys three philosophical debates that have arisen in response to this “renaissance” of psychedelic (...) research. The first concerns the mechanisms of psychedelic-assisted psychotherapy (“psychedelic therapy”): How, exactly, does psychedelic administration in controlled conditions cause lasting psychological benefits? The second concerns the implications of psychedelic research for the philosophy of mind: Does psychedelic evidence show that there can be conscious mental states lacking all forms of self-consciousness? The third concerns the epistemic status of the psychedelic state: Is it possible that certain kinds of knowledge, or other epistemic benefits, could be gained by undergoing a psychedelic experience? (shrink)

Recent clinical trials show that psychedelics such as LSD and psilocybin can be given safely in controlled conditions, and can cause lasting psychological benefits with one or two administrations. Supervised psychedelic sessions can reduce symptoms of anxiety, depression, and addiction, and improve well-being in healthy volunteers, for months or even years. But these benefits seem to be mediated by "mystical" experiences of cosmic consciousness, which prompts a philosophical concern: do psychedelics cause psychological benefits by inducing false or implausible beliefs (...) about the metaphysical nature of reality? This book is the first scholarly monograph in English devoted to the philosophical analysis of psychedelic drugs. Its central focus is the apparent conflict between the growing use of psychedelics in psychiatry and the philosophical worldview of naturalism. Within the book, Letheby integrates empirical evidence and philosophical considerations in the service of a simple conclusion: this "Comforting Delusion Objection" to psychedelic therapy fails. While exotic metaphysical ideas do sometimes come up, they are not, on closer inspection, the central driver of change in psychedelic therapy. Psychedelics lead to lasting benefits by altering the sense of self, and changing how people relate to their own minds and lives-not by changing their beliefs about the ultimate nature of reality. The upshot is that a traditional conception of psychedelics as agents of insight and spirituality can be reconciled with naturalism (the philosophical position that the natural world is all there is). Controlled psychedelic use can lead to genuine forms of knowledge gain and spiritual growth-even if no Cosmic Consciousness or transcendent divine Reality exists. Philosophy of Psychedelics is an indispensable guide to the literature for researchers already engaged in the field of psychedelic psychiatry, and for researchers-especially philosophers-who want to become acquainted with this increasingly topical field. (shrink)

In the present paper, we discuss the ethics of compassionate psychedelic psychotherapy and argue that it can be morally permissible. When talking about psychedelics, we mean specifically two substances: psilocybin and MDMA. When administered under supportive conditions and in conjunction with psychotherapy, therapies assisted by these substances show promising results. However, given the publicly controversial nature of psychedelics, compassionate psychedelic psychotherapy calls for ethical justification. We thus review the safety and efficacy of psilocybin- and MDMA-assisted therapies and claim (...) that it can be rational for some patients to try psychedelic therapy. We think it can be rational despite the uncertainty of outcomes associated with compassionate use as an unproven treatment regime, as the expected value of psychedelic psychotherapy can be assessed and can outweigh the expected value of routine care, palliative care, or no care at all. Furthermore, we respond to the objection that psychedelic psychotherapy is morally impermissible because it is epistemically harmful. We argue that given the current level of understanding of psychedelics, this objection is unsubstantiated for a number of reasons, but mainly because there is no experimental evidence to suggest that epistemic harm actually takes place. (shrink)

One recent development in epistemology, the philosophical study of knowledge, is the notion of ‘epistemic innocence’ introduced by Bortolotti and colleagues. This concept expresses the idea that certain suboptimal cognitive processes may nonetheless have epistemic (knowledge-related) benefits. The idea that delusion or confabulation may have psychological benefits is familiar enough. What is novel and interesting is the idea that such conditions may also yield significant and otherwise unavailable epistemic benefits. I apply the notion of epistemic innocence to research on the (...) transformative potential of psychedelic drugs. The popular epithet ‘hallucinogen’ exemplifies a view of these substances as fundamentally epistemically detrimental. I argue that the picture is more complicated and that some psychedelic states can be epistemically innocent. This conclusion is highly relevant to policy debates about psychedelic therapy. Moreover, analysing the case of psychedelics can shed further light on the concept of epistemic innocence itself. (shrink)

Psychedelics such as psilocybin reliably produce significantly altered states of consciousness with a variety of subjectively experienced effects. These include certain changes to perception, cognition, and affect,1 which we refer to here as the acute subjective effects of psychedelics. In recent years, psychedelics such as psilocybin have also shown considerable promise as therapeutic agents when combined with talk therapy, for example, in the treatment of major depression or substance use disorder.2 However, it is currently unclear whether the aforementioned acute (...) subjective effects are necessary to bring about the observed therapeutic effects of psilocybin and other psychedelics. This uncertainty has sparked a lively—though still largely hypothetical—debate on whether psychedelics without subjective effects (“nonsubjective psychedelics” or “non-hallucinogenic psychedelics”) could still have the same therapeutic impact, or whether the acute subjective effects are in fact necessary for this impact to be fully realized.3,4,5. (shrink)

I highly recommend Philosophy of Psychedelics by Chris Letheby to both the public and academics who want to dig deeper into the modern therapeutic science of psychedelics. In this piece, I will draw attention to key topics covered in the book that I judge as particularly compelling and likely to influence psychedelic therapy and our understanding of it going forward. Clearly, the importance of philosophy in the modern psychedelic therapy renaissance will increase, and Letheby’s Philosophy of (...) Psychedelics will hold a place as a foundational work helping to shape this future. (shrink)

Increasing evidence suggests that psychedelic experiences, undergone in controlled conditions, can have various durable psychological benefits. One such benefit is reductions in fear of death, which have been attested in both psychiatric patients and healthy people. This paper addresses the question: how, exactly, do psychedelic experiences reduce fear of death? It argues, against some prominent proposals, that they do so mainly by promoting non-physicalist metaphysical beliefs. This conclusion has implications for two broader debates: one about the mechanisms of (...) psychedelic therapy, and one about the potential non-medical uses of psychedelics for the alleviation of existential angst in psychiatrically healthy people. On the first count, the paper argues that the role of metaphysical belief change in fear of death supports the “Relaxed Beliefs Under Psychedelics” (REBUS) model of psychedelic therapy over alternative accounts. On the second count, the paper argues that the role of metaphysical belief change undermines the proposed use of psychedelics in the “neuroexistentialist” project of naturalizing spirituality. The best available evidence suggests that when psychedelic experiences reduce existential angst and restore a sense of meaning in life, they do so primarily by persuading people of the falsity of a broadly naturalistic worldview, and thus do not help reconcile people to the truth of such a worldview. (shrink)

Letheby’s "Philosophy of Psychedelics" relies on Predictive Processing to try and find unifying explanations relevant to understanding how serotonergic psychedelics work in psychiatric therapy, what subjective experiences are associated with their use and whether such experiences are epistemically defective. But if Predictive Processing lacks genuinely explanatory unifying power, Letheby’s account of psychedelic therapy risks being unwarranted. In this commentary, I motivate this worry and sketch an alternative interpretation of psychedelic therapy within the Reinforcement Learning framework.

I welcome with great enthusiasm Meling and Scheidegger’s (2023; henceforth “M&S”) timely contribution to advance an enactive approach to psychedelic therapy, especially to the complex causality involved. Their two main research questions concerned:(i) the causal interaction between the psychedelic molecule and brain activity; and (ii) the causal interaction between brain activity and the psychedelic experience. While I largely agree with and celebrate much of what is proposed by M&S, especially their employment of key enactive concepts to (...) advance our understanding of the first research question, in the following, I will present some worries regarding their answers to the second. Although I agree that there is probably a two-way reciprocal relationship between neural activity and experience, I have several points of contention regarding M&S’s proposal. My hope is to stimulate discussion on M&S’s important contribution, and to help advance a much-needed enactive science of psychedelics. (shrink)

Recent scientific research into the therapeutic potential and mechanisms of psychedelic drugs raises intriguing and hitherto largely unexplored philosophical questions. A brief overview of the relevant science is given before addressing these questions. It is argued that psychedelic transformation is a distinctive psycho- pharmacological intervention because its mechanism of action ineliminably involves conscious mental representations, and thus is more transparent to the subject than the mechanisms of other drug therapies. This argument connects with issues in the philosophy of (...) (cognitive) scientific explanation. It is also argued that transformative psychedelic experiences may well confer three distinct kinds of epistemic benefits: knowledge by acquaintance of the subject's psychological potential, knowledge by acquaintance of the meta-physical nature of the (sense of) self, and revitalized capacities for the acquisition of modal knowledge. Non-naturalistic metaphysical and epistemological claims abound in psychedelic circles; thus, it is important to realize that psychedelics may yield naturalistically acceptable epistemic benefits. (shrink)

Jane Arden’s debut feature film The Other Side of the Underneath is an adaptation of the radical feminist play A New Communion for Freaks, Prophets and Witches. In both the play and the later film, the all-female cast re-enact personal and archetypal situations using autobiographical material, which was collectively gathered from group therapy sessions led by the director. Psychedelic drugs were also consumed during the group therapy sessions. In this article, I will situate Arden’s distinct approach to (...) performance in the film within the framework of psychodrama, focusing specifically on the role that psychedelic drugs play in unleashing performers’ repressed feelings of trauma, rage, and desire; these emotions are harnessed into a dynamic mode of performance that amplifies the cathartic possibilities of women’s speech. The film’s heady brew of radical feminist politics, group therapy, and countercultural self-actualisation is both challenging and contentious. I argue that Arden’s pursuit of consciousness liberation through psychodrama and psychedelics—in other words, through ‘raising’ and ‘expanding’ consciousness—is best understood as a concerted attempt to align countercultural and radical feminist tactics for unravelling repressive forms of social conditioning. (shrink)

This paper argues that practitioners of psychedelic-assisted therapy could learn a great deal from Deleuze and Guattari’s critique of psychoanalysis in Anti-Oedipus, as well as the practice of materialist psychiatry – schizoanalysis – that they offer in its stead. Much of the clinical research on psychedelics (particularly psilocybin) over the past fifteen years has privileged mystical experience, assessed according to a quantifiable scale, as the goal of psychedelic-assisted psychotherapy and source of cure ( Griffiths et al. 2006, (...) 2016 ; Barrett and Griffiths 2018 ; Pollan 2018 ). Has ‘mystical experience’ become the ‘imperialism of Oedipus’ within the psychedelic revival, towards which all psychedelic experience and activity of the unconscious is expected to tend? Distressed patients would be better held, I contend, through a therapeutic practice that adopts Deleuze and Guattari’s concept of the unconscious as a desiring-machine and the cure as a completion of the process of desiring-production that is not arrested and reduced to pre-assigned ends. In this mode of working with psychedelics, the embodied memories, visions and sensations of the patient do not in a predetermined way ‘express’ or ‘represent’ a perennial, quantifiable experience (or myth). Rather, they enable the positive task of schizoanalysis of learning what a subject’s desiring-machines are and how they work, and the negative task of identifying and destroying all that stands in the way of their functioning. (shrink)

Background: Psychedelics are known for their powerful mental effects due to the activation of 5HT-2A receptors in the brain. During the 1950s and 1960s, research was conducted on these molecules until their criminalization. However, their clinical investigation as therapeutic tools for psychiatric disorders has revived the deontological ethics surrounding this subject. Questions arise as research on their therapeutic outcome becomes a reality. We aim to explore deontological ethics to understand the implications of psychedelics for the clinician, patient, and society. Results: (...) A total of 42 articles were considered for this review. Methods: A methodological search of psychedelic studies from 2017 to 2022 was conducted in PubMed, Scopus, EBSCOhost, and ScienceDirect to address the deontological ethics of clinical psychedelic use. Conclusion: Psychedelics need to be culturally contextualized, epistemic harm minimized and represented to ensure informed consent. Open data and commissions are needed to ensure safe and equal distribution. (shrink)

This special issue focuses on the Philosophy of Psychedelics by Chris Letheby in the form of a book symposium. Introduced by Matthew Johnson, Letheby presents the main claims of this book that explores the apparent conflict between psychedelic therapy and naturalism in a préci​s.​​ Seven contributions criticize, expand or comment on Letheby's arguments, focusing either on his proposed mechanism for psychedelic therapy or on the epistemic implications. The symposium concludes with Letheby’s replies to these commentaries.

Recent research offers good reason to think that various psychedelic drugs—including psilocybin, ayahuasca, ketamine, MDMA, and LSD—may have significant therapeutic potential in the treatment of various mental health conditions, including post-traumatic stress disorder, depression, existential distress, and addiction. Although the use of psychoactive drugs, such as Diazepam or Ritalin, is well established, psychedelics arguably represent a therapeutic step change. As experiential therapies, their value would seem to lie in the subjective experiences they induce. As it is the only way (...) for trainee psychedelic therapists to fully understand their subjective effects, some have suggested that firsthand experience of psychedelics should form part of training programs. We question this notion. First, we consider whether the epistemic benefits offered by drug-induced psychedelic experience are as unique as is supposed. We then reflect on the value it might have in regard to the training of psychedelic therapists. We conclude that, absent stronger evidence of the contribution drug-induced experiences make to the training of psychedelic therapists, requiring trainees to take psychedelic drugs does not seem ethically legitimate. However, given the potential for epistemic benefit cannot be entirely ruled out, permitting trainees who wish to gain first-hand experience of psychedelics may be permissible. (shrink)

Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid (...) beliefs revisable by increasing the influence of bottom-up input. Put differently, patients become highly suggestible and sensitive to context during a psychedelic session, amplifying therapeutic influence and effects. Due to that, patients are more vulnerable in psychedelic-assisted therapy than in other therapeutic interventions; they lose control during a psychedelic session and become dependent on the therapeutic setting (including the therapist). This enhanced vulnerability is ethically relevant and has been exploited by some therapists in the past. Therefore, patients in current research settings and starting mainstream medical settings need to be well informed about psychedelics’ mechanisms and their implications to give valid informed consent to treatment. Furthermore, other security measures are warranted to protect patients from the vulnerability coming with psychedelic-assisted therapy. (shrink)

Peterson et al. (2023) identify important ethical issues that are relevant to psychedelic therapy and research in various clinical populations and contexts. This is certainly the case in palliative...

Recollections of humanistic and transpersonal psychology’s origin’s morph into the pros and cons of humanistic/transpersonal oriented schools developing APA accredited clinical programs. This discussion dovetails with the question will ATP ever become an APA division, raising an interesting alternative for those of us considering a career in counseling: becoming a spiritual coach. Enter the issue of psychedelic therapy and the Supreme Courts decision to allow ayahuasca as a sacrament by the Uniao Do Vegetal Church, and the importance of (...) why humanistic and transpersonal psychology need to clearly map out the territories and sub-divisions of science and religion. Finally this conversation raises a concern, that Maslow’s call for a “trans-human” psychology sought to encourage creating what we now call ecopsychology. (shrink)

ABSTRACT:Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects—specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications (...) of each framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special Section on Psychedelics Research and TreatmentDominic SistiAgainst a backdrop of post-pandemic malaise, diseases of despair, and a fragmented mental health care system, psychedelics have enjoyed a resurgence of interest as powerful psychotherapeutic agents and as catalysts of personal growth. The true power of these substances—some of which are considered sacramental by Indigenous peoples—has been shrouded for half a century by cultural mythology, political propaganda, and (...) misuse. From about 1940 to 1970, psychedelics including psilocybin and LSD were studied and used by clinicians to treat a range of psychiatric disorders from alcoholism and depression in adults to "autistic schizophrenia" in children.In June 1971, the Nixon administration's racist and illiberal War on Drugs inaugurated what was essentially a total ban on psychedelics. Society was robbed of half a century of scientific progress, and one can only speculate how differently our society might now function, and how many people might have been spared the trauma of mental illness and incarceration. Thankfully, it appears the time has arrived for psychedelic medicines to be decriminalized and included again in the pharmacopeia.In June 2023, a group of psychedelic researchers, therapists, bioethicists, Indigenous scholars, and advocates met at the Banbury Conference Center at Cold Spring Harbor Laboratory. There, this interdisciplinary group discussed several pressing ethical issues in psychedelics research and treatment that continue to [End Page 114] challenge the field. The aim of this meeting was to develop a bioethical framework for the use of psychedelics in mainstream medical settings. That is, how should psychedelics be employed responsibly by everyday clinicians, including psychiatrists, psychologists, social workers, and other behavioral health-care providers? This special section offers a sampling of three topics in psychedelic bioethics raised by the Banbury group, several of whom appear as coauthors.In our first paper, Logan Neitzke-Spruill and colleagues offer an overview of explanatory models describing the therapeutic mechanisms of psychedelic substances and how each of these models generates unique ethical quandaries. Starting from molecular biology and moving to neural circuitry and networks, neurobiological models now propel contemporary scientific research into psychedelics. Knowing how these substances work on a molecular level may offer promising ways forward in the development of new molecules designed to treat serious mental illnesses and other neurologic conditions. Perhaps neuroplastic mechanisms will be harnessed to develop new therapies without necessitating a psychedelic trip—a controversial premise discussed in our third paper, by Katherine Cheung, Brian Earp, and David Yaden.Such "neuroreductionism" risks ignoring the subjective psychological and spiritual experiences of patients that appear to be pivotal in psychedelic-assisted therapy, often described as mystical and utterly transformative. At the psychological level, these substances engender a kind of vulnerability and suggestibility requiring clear ethical standards to ensure patients' psychological and physical safety. And so too, practitioners will need structural and cultural competency to recognize the spiritual or moral values that inspire patient reactions during and after their psychedelic experiences. Ethically informed psychedelic practitioners will have to navigate between disciplinary silos and explanatory models. One practical upshot is the open question of how best to train psychedelic practitioners who hold this broad set of competencies.To that end, well-trained practitioners will need to be able to disclose in some way the transformative properties of psychedelics to prepare patients for their experiences. But how does one describe the ineffable? This raises the question of how or if it is possible for patients to truly consent to the transformative experience elicited by psychedelics, often described as one of the most important experiences of a person's life. The experience might stimulate significant emotional healing, or it might be horrifying. This sounds like a problem uniquely attached to psychedelics: after all, most pharmaceuticals don't trigger changes in one's fundamental moral values, life choices, and commitments, nor are they intended to. Yet, Brent Kious, Andrew Peterson, and Amy McGuire challenge the view that the psychedelic experience is uniquely transformative and impervious to the disclosure requirements of informed consent, a bedrock of bioethics. Ultimately, the writers show how consent is possible even if the experiences are dramatically different from most medical interventions, endorsing a practical view of consent [End... (shrink)

Abstractabstract:Recent clinical trials of psychedelic drugs aim to treat a range of psychiatric conditions in adults. MDMA and psilocybin administered with psychotherapy have received FDA designation as "breakthrough therapies" for post-traumatic stress disorder (PTSD) and treatment-resistant depression (TRD) respectively. Given the potential benefit for minors burdened with many of the same disorders, calls to expand experimentation to minors are inevitable. This essay examines psychedelic research conducted on children from 1959 to 1974, highlighting methodological and ethical flaws. It provides (...) ethics and policy recommendations for psychedelics research involving children and adolescents, including recognizing that the psychedelic experience is an ineffable one that makes informed proxy consent for parents, guardians, and others especially challenging. Psychedelic experiences are associated with novel benefits and risks, such as significant personality changes, shifts in fundamental values, and possible re-exposure to traumatic memories. These effects may alter the process of personality development in minors. Recommendations for ethically sound psychedelics research in minors include strict adherence to eligibility criteria, including a comprehensive family and individual psychiatric, substance use, and trauma history. An age-appropriate assent process that includes considerations related to the use of therapeutic touch should be developed. In addition, oversight by data safety monitoring boards and patient and family advocates, coupled with the adoption of pharmacoequity best practices, will help to ensure safety and fairness of psychedelics research in children. (shrink)

The "people of knowledge" of traditional Mazatec medicine have preserved until today the ritual use of psilocybin mushrooms as part of their health care systems. The renewed interest in the effect of psilocybin on human consciousness for both therapeutic and recreational purposes usually obviates the historical and cultural background of indigenous peoples, as well as the legitimation of their practices and knowledge. In this article, through the case study of a foreign person who attended a Mazatec ritual specialist to participate (...) in a ritual night ceremony known as velada, we show the importance of approaching research on psychoactive plants and mushrooms from a transdisciplinary and intercultural perspective, so that we can appreciate the profound complexity of the healing processes that take place in traditional indigenous contexts, as well as the limits of recreational uses or exclusively neopositivist and clinical approaches. (shrink)

In this précis I summarise the main ideas of my book Philosophy of Psychedelics. The book discusses philosophical issues arising from the therapeutic use of “classic” psychedelic drugs such as psilocybin and LSD. The book is organised around what I call the Comforting Delusion Objection to psychedelic therapy: the concern that this novel and promising treatment relies essentially on the induction of non-naturalistic metaphysical beliefs, rendering it epistemically objectionable. I begin the précis by summarizing material from chapters (...) two and three of the book, which review evidence for the therapeutic efficacy of psychedelics, and the facts about their clinical use that prompt the Comforting Delusion Objection. I then summarize materials from chapters four and five of the book, which argue that psychedelic therapy works neither by experience-independent processes of neuroplasticity, nor by inducing non-naturalistic metaphysical ideations, but by altering mental representations of the self. Next, I summarise the specific, speculative account of how this might work that is developed in chapters six and seven of the book. This account is based on the predictive processing theory of brain function and the self-binding theory of self-representation. Chapters eight and nine of the book argue, on the basis of this account, that psychedelic therapy can have significant epistemic and spiritual benefits that are compatible with a naturalistic worldview. I summarize this material, and then, finally, the overall conclusions about psychedelic therapy drawn in the tenth and final chapter of the book. (shrink)

Ayahuasca, an ancient Amazonian psychedelic tea traditionally used ceremonially among indigenous peoples, has recently become known as a possible treatment for a wide range of disorders. The awareness of this sacred medicine has grown exponentially over the past decade, attracting westerners from a wide variety of backgrounds, hoping to find treatment for a myriad of emotional and physical illnesses, as well as spiritual needs. In the wake of the commercialization and westernization of the use of ayahuasca, and the subsequent (...) proliferation of ayahuasca treatment centers, this paper examines the benefits and possible risks of this form of therapy in an effort to create a safety protocol for Westerners in this context. The most practical approach to increasing safety for Westerners attending these Amazonian treatment centers is to educate the seeker prior to treatment and to provide access to specialized therapeutic aftercare services. (shrink)

In Philosophy of Psychedelics, Letheby provides a convincing basis for the idea that psychedelics primarily derive their therapeutic potential through mediating favourable changes to self-related belief systems. In this commentary, we take a closer look at the role that contextual factors play in Letheby’s two-factor account of psychedelic therapy. While Letheby acknowledges that psychedelic effects are highly context-dependent, the exact role that context plays in self-modelling during the acute experience is not entirely clear. We argue that context (...) plays an essential role in shaping the ‘discovery’ of alternate self-conceptions during the acute experience. Specifically, users are more likely to experience alterations in self-conception that are consistent with context-dependent features, such as one’s prior mindset and aspects of the external environment. This is consistent with a REBUS model of psychedelic effects, where a corollary effect of relaxing high-level prior beliefs is that the system becomes increasingly sensitised to bottom-up information from lower-level intrinsic sources and the sensory periphery. Furthermore, it may explain why a positive well-intentioned state of mind and a supportive therapeutic environment are more likely to result in positive acute experiences and long-term improvements in mental wellbeing. We see this position as being largely compatible with Letheby’s proposal, but may shift some aspects of its emphasis and framing. In particular, it may conflict with Letheby’s notion that psychedelics lead to a ‘level cognitive playing field’, where self-related hypotheses are thought to be assigned more or less equal probability. (shrink)

This is the fourth of four online Companions to Velmans, M. (ed.) (2018) Consciousness (Critical Concepts in Psychology), a 4-volume collection of Major Works on Consciousness commissioned by Routledge, London. -/- The Companion (and Volume) begins with a review of mental influences on states of the body and brain (psychogenesis), which are often thought of as theoretically problematic for conventional materialist theories of mind. The evidence is nevertheless extensive, for example in psychosomatic illnesses and studies of the physiological consequences of (...) meditation, imagery, biofeedback and hypnosis. Such effects are also central to developments in psychoneuroimmunology and studies of placebos, dealing not only with how to control for such effects in clinical trials, but with how such effects operate, and how to harness them for the benefit of patients. The Companion then surveys altered states of consciousness, including the conditions for their emergence, their adaptive as well as maladaptive potential, and the influences of culture on how these are understood. The analysis deepens with reviews of the major ways in which consciousness can be usefully transformed, starting with the burgeoning literature on the nature and effects of meditation practices, including their effects on neural dynamics and the varied ways in which they have, in recent years, been incorporated into a range of psychological therapies, focusing particularly on mindfulness and its potential consequences for psychological health. The survey then turns to mystical experiences, which, of all the positive altered states of consciousness, are perhaps the most extraordinary and transformative. Reported over millennia and recognized by William James to combine ineffability with a noetic quality, their generation, effects and interpretation have, once more, become the subject of research. In this connection, we also review the resurgent interest in the use of drugs in the transformation of consciousness focusing particularly on recent research on the clinical and neurophysiological effects of major psychedelics such as psilocybin and LSD. It will be apparent that the four Volumes of this Collection cover a vast range of phenomena that cannot comfortably be accommodated into a materialist, reductionist worldview, and so this Companion (and the entire collection) concludes with a diverse sample of non-reductive, integrative theories that offer unifying ways of understanding consciousness, drawing on information theory, neuropsychology, psychodynamics, physics, psychology, parapsychology, and philosophy. -/- As with the other Companions to these Volumes there are many links to background resources (marked in pink) and to the selected readings themselves (marked in blue). -/- . (shrink)

A psychedelic renaissance is currently taking place in mental healthcare. The number of psychedelic-assisted therapy trials is growing steadily, and some countries already grant psychiatrists special permission to use psychedelics in non-research contexts under certain conditions. These clinical advances must be accompanied by ethical inquiry. One pressing ethical question involves whether patients can even give informed consent to psychedelic-assisted therapy: the treatment’s transformative nature seems to block its assessment, suggesting that patients are unable to understand (...) what undergoing psychedelic-assisted therapy actually means for them and whether it aligns with their values. The present paper argues that patients often have sufficient knowledge to give informed consent because they know that they want to change their negative status quo and that psychedelic-assisted therapy offers an effective way to do so. Accordingly, patients can understand what the transformative nature of psychedelic-assisted therapy means for them and a make a value-aligned choice even if they are unable to anticipate the manifestation of a psychedelic experience. (shrink)

In the past decade, the consumption of psilocybin mushrooms has become a popular therapeutic tool for people looking to deal with mental and emotional health issues. The emerging interest in psilocybin therapy in the global north has led to the development of retreat centers in locations where psilocybin is legal or unregulated. Drawing on ethnographic research at a psilocybin retreat center in Jamaica, this article examines the emotional and somatic reactions attributed to psilocybin that influence the social interactions and (...) the mental and emotional state of the guests at this retreat center. We argue that guests go through a symbolic healing process that involves the construction of a meaning response based on internal and collective experiences of altered consciousness via psilocybin. Additionally, we emphasize how both attending the retreat and the psychedelic experience there can be considered a liminal state that leads to different modes of relation while in Jamaica. (shrink)

Research on psychedelic-assisted psychotherapy has shown that music affects therapeutic outcomes at a fundamental level. The development of such therapies calls for research on the use of music with consciousness-altering substances, especially in contexts informed by their traditional use. Informed by ethnographic reports, our project answers this call, investigating the phenomenology of listening to icaros (medicine songs) during ayahuasca ceremonies as reported by addiction rehabilitation patients at Perú’s Centro Takiwasi. We found that icaros were therapeutically significant. They elicited experiences (...) of healing by modulating patients’ emotions and the altered state induced by ayahuasca. They helped patients feel safe while guiding them through difficult memories and emotions, and facilitating experiences of healing and learning about their addictions. Thus, similar therapies must carefully consider how they incorporate music in their protocols. We suggest further research to better understand the synergistic, therapeutic effects of music and altered states of consciousness, especially in cross-cultural environments. (shrink)

For the past two years, I have taught a seminar on medical research scandals. The syllabus looks like a highlight reel of exploitation and abuse: children fed plutonium-laced breakfast cereal, prisoners dosed with the active ingredient in Agent Orange, mental patients given psychedelic drugs and massive electroconvulsive therapy before being sent into curare-induced paralysis and a coma. I designed the seminar to crush the idealism of future physicians by illuminating the dark patterns that research scandals typically follow. The (...) most recent scandal we examined happened to be one of the most lurid. (shrink)

Tehseen noorani’s article “Containment Matters: Set and Setting in Contemporary Psychedelic Psychiatry” presents a comprehensive, deeply researched ethnographic perspective on current research practices in psychedelic-assisted therapy. This is rapidly evolving terrain scientifically, clinically, legally, and socially. Noorani’s on-the-ground observations from within the Johns Hopkins research program are fascinating and timely given the numerous challenges faced in investigating and developing this emerging mode of psychiatric treatment as well as the complex history psychedelics represent. The level of detail afforded (...) by Noorani’s embedded work between 2015 and 2019 in characterizing the complexities of this... (shrink)

This report presents the personal experiences of three individuals who ingested iboga or ibogaine in different contexts and for different reasons. Narrative analysis reveals a connection with previously identified phenomenological categories of experience, however demonstrating a wide variability. Most notably, each of these interviewees reported a distinct impression of transpersonal communication, either with “iboga/ine” or with visions of others encountered in the oneirogenic experience. This relates with a sense of transpersonal presence that is mentioned elsewhere in literature describing waking REM (...) experiences, such as sleep paralysis. Within these cases, a sense of transpersonal intersubjectivity appears to contribute a sense of ontological realism and meaningfulness of the experiences. Similar deep engagement with narrative reports may better inform future research, as well as ibogaine‐assisted therapies. (shrink)

Several authors have recently suggested that classic psychedelics might be safe and effective agents of moral enhancement. This raises the question: can we learn anything interesting about the nature of moral experience from a close examination of transformative psychedelic experiences? The interdisciplinary enterprise of philosophical psychopathology attempts to learn about the structure and function of the “ordinary” mind by studying the radically altered mind. By analogy, in this chapter we argue that we can gain knowledge about the everyday moral (...) life by studying extraordinary experiences of altered moral cognition and experience. We focus on a specific class of cases: experiences of forgiveness induced by psychedelics. We argue that close attention to such experiences reveals the importance of thought/emotion coherence and dissonance in the moral life and vindicates some heterodox ideas about moral phenomenology and psychology. (shrink)

Induced by intake of the psychedelic substances LSD, psilocybin, DMT and mescaline, psychedelic experiences have been extensively described by subjects as entailing a most unusual increase in the scope and quality of their consciousness. Accordingly, psychedelic experiences have been widely characterised as an “expansion of consciousness.” This article poses the following question, as yet unaddressed in contemporary philosophy and the tradition of phenomenology: to what exactly does “expansion of consciousness” refer as a general characterisation of psychedelic (...) experiences, and what role might attention play therein? On the basis of Aron Gurwitsch’s phenomenology of attention, the following thesis is presented: (a) “expansion of consciousness” refers to a particular restructuration of consciousness in psychedelic experiences. (b) This occurs by means of certain extreme transformations in direction, scope, mode and degree of attention. In order to explicate this thesis, the characteristic features of psychedelic experiences that pertain to expansion of consciousness and attention are first systematically identified from a survey of subject reports. Second, it is demonstrated that the few previous attempts to understand expansion of consciousness in terms of attention as a filter/reducing-valve, spotlight or zoom-lens each fail to explain how consciousness is structured in psychedelic experiences. Third, it is argued that psychedelic expansion of consciousness is a general restructuration of consciousness by means of extreme attentional transformations. In conclusion, brief consideration is given to the question of whether psychedelic expansion of consciousness can have epistemic and ethical value for life. (shrink)

The urgent need for solutions to critical environmental challenges is well attested, but often environmental problems are understood as fundamentally collective action problems. However, to solve to these problems, there is also a need to change individual behavior. Hence, there is a pressing need to inculcate in individuals the environmental virtues — virtues of character that relate to our environmental place in the world. We propose a way of meeting this need, by the judicious, safe, and controlled administration of “classic” (...) psychedelic drugs as a way to catalyze the development of environmental virtues – a form of moral bio-enhancement. Recent evidence shows that psychedelics can be given safely in controlled environments, and can induce vivid experiences of unity and connectedness. These experiences, in turn, can durably increase feelings of nature-relatedness and pro-environmental behaviors. Therefore, we argue that responsible psychedelic use can reliably catalyze the development of a key environmental virtue known as living in place. This is a “master environmental virtue” that subsumes the qualities of respect for nature, proper humility, and aesthetic wonder and awe. Our account advances the environmental virtues debate by introducing a relevant practical proposal, and advances the psychedelic moral enhancement debate by providing a much-needed conceptual framework. (shrink)

In recent years, the scientific study of meditation and psychedelic drugs has seen remarkable developments. The increased focus on meditation in cognitive neuroscience has led to a cross-cultural classification of standard meditation styles validated by functional and structural neuroanatomical data. Meanwhile, the renaissance of psychedelic research has shed light on the neurophysiology of altered states of consciousness induced by classical psychedelics, such as psilocybin and LSD, whose effects are mainly mediated by agonism of serotonin receptors. Few attempts have (...) been made at bridging these two domains of inquiry, despite intriguing evidence of overlap between the phenomenology and neurophysiology of meditation practice and psychedelic states. In particular, many contemplative traditions explicitly aim at dissolving the sense of self by eliciting altered states of consciousness through meditation, while classical psychedelics are known to produce significant disruptions of self-consciousness, a phenomenon known as drug-induced ego dissolution. In this article, we discuss available evidence regarding convergences and differences between phenomenological and neurophysiological data on meditation practice and psychedelic drug-induced states, with a particular emphasis on alterations of self-experience. While both meditation and psychedelics may disrupt self-consciousness and underlying neural processes, we emphasize that neither meditation nor psychedelic states can be conceived as simple, uniform categories. Moreover, we suggest that there are important phenomenological differences even between conscious states described as experiences of self-loss. As a result, we propose that self-consciousness may be best construed as a multidimensional construct, and that “self-loss,” far from being an unequivocal phenomenon, can take several forms. Indeed, various aspects of self-consciousness, including narrative aspects linked to autobiographical memory, self-related thoughts and mental time travel, and embodied aspects rooted in multisensory processes, may be differently affected by psychedelics and meditation practices. Finally, we consider long-term outcomes of experiences of self-loss induced by meditation and psychedelics on individual traits and prosocial behavior. We call for caution regarding the problematic conflation of temporary states of self-loss with “selflessness” as a behavioral or social trait, although there is preliminary evidence that correlations between short-term experiences of self-loss and long-term trait alterations may exist. (shrink)