This post is by Elly Vintiadis who recently guest-edited a special issue of Philosophical Psychology on psychedelic-assisted therapy and wrote a free access introduction to the special issue entitled The Promises and Perils of the Psychedlic Turn in Psychiatry.
 |
| Elly Vintiadis |
Psychedelic substances have been part of human culture for centuries, used in ritual, healing and spiritual contexts to induce altered states of consciousness that could bring insight and change. In recent years, they have re-emerged in psychiatry in psychedelic-assisted therapy (PAT), a therapeutic framework in which substances such as psilocybin, LSD, MDMA, ketamine, or ibogaine are administered in controlled conditions, accompanied by preparation, supervision and integration.
Research into psychedelic therapies flourished in the mid-20th century but came to a halt in the early 1970s, driven by shifting social attitudes and the onset of the War on Drugs. With their classification as Schedule I substances under the U.S. Controlled Substances Act, psychedelics became illegal and were deemed to have no accepted medical use and a high potential for abuse. Since the 1990s, however, interest in psychedelics and psychedelic assisted therapy has steadily resurfaced and early findings are striking: clinical trials indicate that psychedelic-assisted therapy (PAT) may provide rapid and lasting relief from depression, anxiety, PTSD and addiction, often succeeding where conventional treatments have failed.
The enthusiasm around this “psychedelic renaissance” is palpable. But alongside the promise, there are also perils and questions, both scientific and philosophical, that need to be asked and that demand careful attention. This is the theme of the new special issue of Philosophical Psychology, “The Promises and Perils of Psychedelic Therapy”.
One central question is methodological. The scientific evidence, though encouraging, is not yet decisive: small sample sizes, difficulties in maintaining placebo controls and stringent participant screening all complicate the interpretation of the data. Moreover, the unusually low dropout rates reported in many trials and the difficulty of separating drug effects from expectancy effects raise further concerns. As several authors in the special issue point out, it is important not only to refine study design but also to reflect on how far existing methods are suited to capture the complex interplay between pharmacology, therapeutic setting (broadly conceived) and subjective experience that characterizes psychedelic therapy.
Another set of questions concerns the mechanism of psychedelic therapy: If psychedelic therapy works, how does it work? Some argue that the benefits stem directly from the neurochemical effects of the drugs. Others suggest that the transformative subjective experiences they induce -experiences often described in terms of awe, ego-dissolution, encounters with the divine or altered temporality -play an essential role. There is evidence that patients who undergo such “mystical-type” experiences are more likely to benefit, yet not all do, and the precise mechanisms remain contested. This opens broader debates about whether PAT is best conceived as a new form of medication, a new form of therapy or something that transcends both categories.
Epistemological concerns are also not far away. Patients often report that psychedelic experiences come with what William James called a “noetic quality,” a sense of having encountered profound truths about the self, reality or existence. Are these revelations genuine insights, or are they, as Michael Pollan put it, merely “comforting delusions”? If the latter, can it still be ethical to use them therapeutically? Some philosophers argue that even if the content of such experiences is non-veridical, they may nonetheless be epistemically innocent, providing psychological and even epistemic benefits that outweigh their costs. Others caution against dismissing them too quickly, pointing out that to regard all non-naturalist interpretations of psychedelic experience as delusional risks a form of “naturalistic chauvinism.”
Lastly, ethical questions are equally pressing. Psychedelic experiences can be what L.A. Paul has called “transformative”: they can change a person’s values and worldview in ways that are difficult to anticipate. Some argue that this makes informed consent especially challenging. How can one consent in advance to changes one cannot yet imagine and not knowing what one’s changed self will value in the future? Moreover, psychedelic states can render individuals highly suggestible, raising concerns about vulnerability to undue influence, whether by therapists, institutions or cultural forces. Some contributors to the special issue argue for the need for safeguards to protect autonomy and emphasize the need for ethical frameworks that include marginalized voices and indigenous perspectives, lest psychedelic research simply replicate patterns of exclusion and exploitation.
Ultimately, the philosophical significance of PAT extends well beyond psychiatry. It forces us to confront fundamental questions about the mind, knowledge and the nature of healing. Should psychiatry confine itself to symptom reduction or should it also engage with existential questions of meaning and selfhood? Are peak experiences merely epiphenomenal by-products of brain chemistry (where the real work is done), or can they be understood as genuine ways of knowing? If patients adopt metaphysical or spiritual worldviews in the course of therapy, should these be regarded as pathological, benign or valuable? These are not just scientific or clinical questions: they cut to the heart of philosophy’s concern with truth, value and, even, the good life.
The promise of psychedelic therapy is real, but so too are the perils. By drawing together contributions from philosophy, cognitive science and psychiatry this special issue of Philosophical Psychology aims to enrich the debate and to ensure that as the psychedelic ‘renaissance’ continues, it does so with both critical rigor and philosophical depth.