Understanding subjective experience in psychedelic-assisted psychotherapy: The need for phenomenology.

Psychedelic-assisted psychotherapy is being investigated as a treatment for a range of psychiatric illnesses. Current research suggests that the kinds of subjective experiences induced by psychedelic compounds play key roles in producing therapeutic outcomes. To date, most knowledge of therapeutic psychedelic experiences are derived from psychometric assessments with scales such as the Mystical Experience Questionnaire. While these approaches are insightful, more nuanced and detailed descriptions of psychedelic-induced changes to subjective experience are required. Drawing on recent advancements in qualitative methods arising from the interdisciplinary field of phenomenological psychopathology, we propose a systematic and comprehensive investigation into how psychedelic-assisted psychotherapy alters subjective experience. This research programme aims to characterise the nature of therapeutic psychedelic experiences by drawing on concepts from philosophical phenomenology. Such characterisations should, moreover, contribute to our understanding of the mechanisms of psychedelic therapy, the role of integration therapy, and related philosophical debates.

Psychedelic injustice: should bioethics tune in to the voices of psychedelic-using communities?

Psychedelic compounds are regaining widespread interest due to emerging evidence surrounding their therapeutic effects. The controversial nature of these compounds highlights the need for extensive bioethical input to guide the process of medicalisation. To date there is no bioethics literature that consults the voices of psychedelic-using communities in order to help guide normative considerations of psychedelic medicalisation. In this paper I argue that psychedelic-using communities ought to be included in bioethical discussions that guide normative elements of psychedelic medicalisation. I argue this by presenting two points. First, psychedelic-using communities hold a degree of epistemic expertise regarding psychedelics by virtue of their embodied experiences with these compounds. Therefore, these communities are able to identify normative considerations that communities without embodied experiences would overlook. Second, psychedelic-using communities are uniquely and heavily affected by psychedelic medicalisation. Therefore, the needs of these communities ought to be considered when evaluating and implementing normative changes that alter psychedelic usage in society. The counterargument that psychedelic-using communities should not guide normative considerations of psychedelic medicalisation is presented by highlighting empirical data that suggest groups of the public with embodied experiences regarding a topic are less able to engage in deliberative reasoning on the said topic than the lay public. However, I propose that even if this is the case, psychedelic-using communities are owed consultation by agents of psychedelic medicalisation in order to undo and cease perpetuating epistemic injustice against these communities.

Psychedelic-assisted psychotherapy for the treatment of major depression: a synthesis of phenomenological explanations.

Psychedelic-assisted Psychotherapy (PAP) combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder (MDD), and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or "unhomelike being-in-the-world": (1) illness suffering, which relates to embodiment; (2) existential suffering, which relates to self-narratives, and (3) political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility-one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting.

Prescribing meaning: hedonistic perspectives on the therapeutic use of psychedelic-assisted meaning enhancement.

The recent renaissance in research on psychedelic-assisted psychotherapy is showing great promise for the treatment of many psychiatric conditions. Interestingly, therapeutic outcomes for patients undergoing these treatments are predicted by the occurrence of a mystical experience-an experience characterised in part by a sense of profound meaning. This has led to hypotheses that psychedelic-assisted psychotherapy is therapeutic because it enhances perception of meaning, and consequently leads to a meaning response (a therapeutic mechanism that has been well described in the philosophical literature on the placebo effect). The putative mechanism of action of psychedelics as meaning enhancers raises normative ethical questions as to whether it can be justified to pharmacologically increase the perception of meaning in order to heal patients. Using the perspectives of hedonistic moral theories, this paper argues that if psychedelics operate as meaning enhancers, psychedelic-assisted psychotherapy can be ethically justified. An anti-hedonistic objection is presented by applying Robert Nozick's Experience Machine thought experiment to the case of psychedelic-assisted psychotherapy. However, it is argued that this objection falls short for two reasons. First, even if pleasure and pain are not the only consequences which have moral value they are not morally irrelevant, therefore, therapeutic meaning enhancement can still be justified in cases of extreme suffering. Second, it is possible that psychedelic states of consciousness do not represent a false reality, hence their therapeutic meaning enhancement is not problematic according to Nozick's standards.