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)

In this paper, we examine the case of psychedelic medicine for Alzheimer’s disease and related dementias (AD/ADRD). These “mind-altering” drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; (...) the impact of “ego dissolution” on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards’ orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations. (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)

Serotonergic (or “classic”) psychedelics have struck many researchers as raising significant philosophical questions that, until recently, were largely unexplored by academic philosophers. This paper provides an overview of four emerging lines of research at the intersection of academic philosophy and psychedelic science that have gained considerable traction in the last decade: selfless consciousness, psychedelic epistemology, psychedelic ethics, and spiritual/religious naturalism. In this paper, we highlight philosophical questions concerning (i) psychedelics, self-consciousness, and phenomenal consciousness, (ii) the epistemic profile of the psychedelic (...) experience; (iii) ethical concerns about the appropriate use of psychedelics; and (iv) whether spiritual or religious dimensions of psychedelic use are compatible with a naturalistic worldview. (shrink)

I argue for constraining the nomological possibility space of temporal experiences and endorsing the Succession Requirement for agents. The Succession Requirement holds that the basic structure of temporal experience must be successive for agentive subjects, at least in worlds that are law-like in the same way as ours. I aim to establish the Succession Requirement by showing non-successively experiencing agents are not possible for three main reasons, namely that they (1) fail to stand in the right sort of causal relationship (...) to the outcomes of their actions, (2) exhibit the wrong sort of epistemic status for agency, and (3) lack the requisite agentive mental attitude of intentionality. I conclude that agency is incompatible with non-successive experience and therefore we should view the successive temporal structure of experience as a necessary condition for agency. I also suggest that the Succession Requirement may actually extend beyond my main focus on agency, offering preliminary considerations in favor of seeing successive experience as a precondition for selfhood as well. The consequences of the Succession Requirement are wide-ranging, and I discuss various implications for our understanding of agency, the self, time consciousness, and theology, among other things. (shrink)

Psychedelic Harm Reduction and Integration (PHRI) 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)

Self-transcendence has been characterized as a decrease in self-saliency (ego disillusionment) and increased connection, and has been growing in research interest in the past decade. Several measures have been developed and published with some degree of psychometric validity and reliability. However, to date, there has been no review systematically describing, contrasting, and evaluating the different methodological approaches toward measuring self-transcendence including questionnaires, neurological and physiological measures, and qualitative methods. To address this gap, we conducted a review to describe existing methods (...) of measuring self-transcendence, evaluate the strengths and weaknesses of these methods, and discuss research avenues to advance assessment of self-transcendence, including recommendations for suitability of methods given research contexts. (shrink)

Research on meditation and mindfulness practice has flourished in recent years. While much of this research has focused on well-being outcomes associated with mindfulness practice, less research has focused on how perception of self may change as a result of mindfulness practice, or whether these changes in self-perception may be mechanisms of mindfulness in action. This is somewhat surprising given that mindfulness derives from traditions often described as guiding people to realise and experience the non-separation of self from the world (...) or its ‘oneness’ with the whole of reality. The current study used a collective intelligence methodology, Interactive Management (IM), to explore the nature of oneness experiences. Five IM sessions were conducted with five separate groups of experienced meditators. Participants generated, clarified, and selected oneness self-perceptions they believed most characterised their experience both during meditation and in their everyday experience in the world. Each group also developed structural models describing how highly ranked aspects of oneness self-perceptions are interrelated in a system. Consistent themes and categories of oneness experience appeared across the five IM sessions, with changes in the sense of space (unboundedness), time, identity, wholeness and flow highlighted as most influential. Results are discussed in light of emerging theory and research on oneness self-perception and non-dual awareness. (shrink)

Psychedelic drugs such as psilocybin, LSD and DMT are known to induce powerful alterations in phenomenology. Perhaps of most philosophical and scientific interest is their capacity to disrupt and even “dissolve” one of the most primary features of normal experience: that of being a self. Such “peak” or “mystical” experiences are of increasing interest for their potentially transformative therapeutic value. While empirical research is underway, a theoretical conception of the mechanisms underpinning these experiences remains elusive. In the following paper, psychedelic-induced (...) ego-dissolution is accounted for within an active inference framework, as a collapse in the “temporal thickness” of an agent’s deep temporal model, as a result of lowered precision on high-level priors. The argument here is composed of three moves: first, a view of the self-model is proposed as arising within a temporally deep generative model of an embodied organism navigating an affordance landscape in the service of allostasis. Next, a view of the action of psychedelics as lowering the precision of high-level priors within the generative model is unpacked in terms of a high Bayesian learning rate. Finally, the relaxation of high-level priors is argued to cause a “collapse” in the temporal thickness of the generative model, resulting in a collapse in the self-model and a loss of the ordinary sense of being a self. This account has implications for our understanding of ordinary self-consciousness and disruptions in self-consciousness present in psychosis, autism, depression, and dissociative disorders. The philosophical, theoretical and therapeutic implications of this account are touched upon. (shrink)

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M.” I have argued in previous work that a (...) HOT theorist can adequately respond to this concern with respect to somatoparaphrenia and thought insertion. There is also Cotard syndrome which is a rare neuropsychiatric disorder in which people hold the delusional belief that they are dead, do not exist, or have lost their blood or internal organs. In this paper, I argue that HOT theory has nothing to fear from it either and can consistently account for what happens in such unusual cases. I analyze Cotard syndrome in light of my previous discussion of somatoparaphrenia and thought insertion, and argue that HOT theory can provide a somewhat analogous account without the worry of inconsistency. It is crucial to recognize that there are multiple “self-concepts” and levels of HOTs which can help to provide a more nuanced explanation. With regard to the connection between consciousness and self-consciousness, it is proposed that Cotard patients are indeed capable of having some “I-thoughts” about their bodies and mental states. (shrink)

There is converging evidence that high doses of hallucinogenic drugs can produce significant alterations of self-experience, described as the dissolution of the sense of self and the loss of boundaries between self and world. This article discusses the relevance of this phenomenon, known as “drug-induced ego dissolution (DIED)”, for cognitive neuroscience, psychology and philosophy of mind. Data from self-report questionnaires suggest that three neuropharmacological classes of drugs can induce ego dissolution: classical psychedelics, dissociative anesthetics and agonists of the kappa opioid (...) receptor (KOR). While these substances act on different neurotransmitter receptors, they all produce strong subjective effects that can be compared to the symptoms of acute psychosis, including ego dissolution. It has been suggested that neuroimaging of DIED can indirectly shed light on the neural correlates of the self. While this line of inquiry is promising, its results must be interpreted with caution. First, neural correlates of ego dissolution might reveal the necessary neurophysiological conditions for the maintenance of the sense of self, but it is more doubtful that this method can reveal its minimally sufficient conditions. Second, it is necessary to define the relevant notion of self at play in the phenomenon of DIED. This article suggests that DIED consists in the disruption of subpersonal processes underlying the “minimal” or “embodied” self, i.e., the basic experience of being a self rooted in multimodal integration of self-related stimuli. This hypothesis is consistent with Bayesian models of phenomenal selfhood, according to which the subjective structure of conscious experience ultimately results from the optimization of predictions in perception and action. Finally, it is argued that DIED is also of particular interest for philosophy of mind. On the one hand, it challenges theories according to which consciousness always involves self-awareness. On the other hand, it suggests that ordinary conscious experience might involve a minimal kind of self-awareness rooted in multisensory processing, which is what appears to fade away during DIED. (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)

Background and aims Research into the social aspects of set and setting have demonstrated that race is a significant factor in psychedelic experiences for racially marginalized populations. Yet, many studies of psychedelic-induced experiences continue to proceed without collecting data on or considering the influence of race or other social categories. These approaches abstract subjectivity from its embodied and historical conditions, isolating consciousness in ways that do not accord with lived experience. -/- Methods This article draws on critical phenomenology, anthropology, and (...) treatments of race in the field of psychedelic studies to outline how social categories mediate subjective experience in historically specific ways through the framework of embodiment. -/- Results I argue that consciousness is fundamentally intersubjective, including during psychedelic-induced experiences. Intersubjectivity is an existential condition that makes possible meaning, communication, and socialization, processes which rely on and are perpetually (re)enacted through social categories. Therefore, studies of psychedelic-induced experiences must account for the foundational role that social categories play in constituting such embodied experiences and their effects. -/- Conclusions This approach makes embodied differences matter to the study of psychedelic-induced experiences, opening new avenues of inquiry that foreground identity, power, and context in both clinical and naturalistic research. (shrink)

This article proposes a model of comparative mysticism that bases its rationale for comparison in the dynamic interaction between three components: neurocognitive mechanisms and substrates, phenomenal experiences, and noetic accounts. In examining the phenomenon of ego- dissolution ( EDn), using this model, a scholar can identify universal and contextual components of a mystic’s experiences. The neurocognitive component is derived from neuroscientific studies including brain injury, psychedelics, and meditative practices. The phenomenal and noetic components are derived from personal accounts as narrated (...) by the mystics themselves. These three components will be applied to the ego- dissolution experiences of the modern Indian mystic Sadhguru (1957–Present), the medieval Spanish mystic Teresa of Ávila (1515–1583), and individuals, including scientists, using the psychedelics psilocybin and LSD. This model should introduce an alternative approach to comparative mysticism as a response to the long-standing debate between Walter T. Stace’s essentialist model and Steven T. Katz’s contextualist model, respectively. In particular, the neurocognitive component should function as a bridge providing a deeper level of analysis encompassing and undermining differences between universalist and contextualist reductions. The advent of comparative mysticism may be seen as a collaborative effort that is multidisciplinary in nature, contributing to theology, religious studies, philosophy, history, cognitive neuroscience, and many other disciplines. (shrink)

Psychoactive drugs have been central to many human group rituals throughout modern human evolution. Despite such experiences often being inherently social, bonding and associated prosocial behaviors have rarely been empirically tested as an outcome. Here we investigate a novel measure of the mechanisms that generate altered states of consciousness during group rituals, the 4Ds: dance, drums, sleep deprivation, and drugs. We conducted a retrospective online survey examining experiences at a highly ritualized cultural phenomenon where drug use is relatively uninhibited- raves (...) and illegal free parties. Engaging in the 4Ds at raves or free parties was associated with personal transformation for those who experienced the event as awe-inspiring, especially for people with open personalities. Without awe, or a ritual context, indulging in the 4Ds was associated with a lack of personal growth, or anomie. A complex SEM revealed that personal transformation following awe-inspiring raves was associated with bonding to other ravers and prosocial behavior toward this group at a cost to self in a simple economic game. Bonding to humanity was not associated with these events. The findings suggest that employing the 4Ds in a ritualized environment - particularly dancing and drug use – can help build meaningful social bonds with associated positive behavioral outcomes. (shrink)