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 char...
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Published in | Journal of medical ethics Vol. 47; no. 10; pp. 701 - 705 |
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Main Author | |
Format | Journal Article |
Language | English |
Published |
London
BMJ Publishing Group Ltd and Institute of Medical Ethics
01.10.2021
BMJ Publishing Group LTD |
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Abstract | 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. |
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AbstractList | 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. |
Author | Miceli McMillan, Riccardo |
Author_xml | – sequence: 1 givenname: Riccardo surname: Miceli McMillan fullname: Miceli McMillan, Riccardo email: riccardo.micelimcmillan@uqconnect.edu.au organization: University of Sydney, Sydney, New South Wales, Australia |
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CitedBy_id | crossref_primary_10_3389_fpsyt_2021_680064 crossref_primary_10_1177_00221678221136233 crossref_primary_10_1016_j_cptl_2022_04_019 crossref_primary_10_3390_philosophies8050076 crossref_primary_10_1007_s00213_024_06599_5 crossref_primary_10_3389_fpsyg_2024_1413111 |
Cites_doi | 10.3389/fpsyt.2018.00517 10.1177/0269881114568040 10.4103/0019-5545.102423 10.1007/s00213-006-0457-5 10.1111/zygo.12353 10.3109/00952990.2016.1170135 10.1176/appi.ajp.2019.19010035 10.3389/fphar.2018.00733 10.1080/15294145.2019.1689528 10.1007/s00213-017-4771-x 10.3389/fnins.2018.00129 10.1016/j.concog.2015.11.012 10.1007/7854_2017_474 |
ContentType | Journal Article |
Copyright | Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. |
Copyright_xml | – notice: Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. – notice: Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. – notice: 2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. |
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References | Majić, Schmidt, Gallinat (R2) 2015; 29 Hartogsohn (R5) 2018; 12 Reiff, Richman, Nemeroff (R12) 2020; 177 Carhart-Harris, Bolstridge, Day (R13) 2018; 235 Griffiths, Richards, McCann (R18) 2006; 187 Fischman (R25) 2019; 21 Ampalam, Gunturu, Padma (R17) 2012; 54 Hengartner, Plöderl (R14) 2018; 9 Letheby (R24) 2017; 52 Schenberg (R1) 2018; 9 Letheby (R21) 2016; 39 Corrigan, Watson (R20) 2002; 1 Johnson, Garcia-Romeu, Griffiths (R19) 2017; 43 Carhart-Harris, Bolstridge, Day 2018; 235 Fischman 2019; 21 Hengartner, Plöderl 2018; 9 Letheby 2016; 39 Griffiths, Richards, McCann 2006; 187 Letheby 2017; 52 Johnson, Garcia-Romeu, Griffiths 2017; 43 Majić, Schmidt, Gallinat 2015; 29 Corrigan, Watson 2002; 1 Hartogsohn 2018; 12 Reiff, Richman, Nemeroff 2020; 177 Ampalam, Gunturu, Padma 2012; 54 Schenberg 2018; 9 2021092310001090000_47.10.701.10 2021092310001090000_47.10.701.11 Johnson (2021092310001090000_47.10.701.19) 2017; 43 Hartogsohn (2021092310001090000_47.10.701.5) 2018; 12 Hengartner (2021092310001090000_47.10.701.14) 2018; 9 Letheby (2021092310001090000_47.10.701.21) 2016; 39 2021092310001090000_47.10.701.15 2021092310001090000_47.10.701.16 Griffiths (2021092310001090000_47.10.701.18) 2006; 187 Schenberg (2021092310001090000_47.10.701.1) 2018; 9 Reiff (2021092310001090000_47.10.701.12) 2020; 177 2021092310001090000_47.10.701.22 Fischman (2021092310001090000_47.10.701.25) 2019; 21 2021092310001090000_47.10.701.23 Majić (2021092310001090000_47.10.701.2) 2015; 29 2021092310001090000_47.10.701.3 2021092310001090000_47.10.701.4 2021092310001090000_47.10.701.9 Corrigan (2021092310001090000_47.10.701.20) 2002; 1 2021092310001090000_47.10.701.6 2021092310001090000_47.10.701.7 2021092310001090000_47.10.701.8 Carhart-Harris (2021092310001090000_47.10.701.13) 2018; 235 Ampalam (2021092310001090000_47.10.701.17) 2012; 54 Letheby (2021092310001090000_47.10.701.24) 2017; 52 |
References_xml | – volume: 9 year: 2018 ident: R14 article-title: Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that the drugs work: effect size and method bias matter! publication-title: Front Psychiatry doi: 10.3389/fpsyt.2018.00517 contributor: fullname: Plöderl – volume: 29 start-page: 241 issue: 3 year: 2015 ident: R2 article-title: Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences? publication-title: J Psychopharmacol doi: 10.1177/0269881114568040 contributor: fullname: Gallinat – volume: 1 issue: 1 year: 2002 ident: R20 article-title: Understanding the impact of stigma on people with mental illness publication-title: World Psychiatry contributor: fullname: Watson – volume: 54 issue: 3 year: 2012 ident: R17 article-title: A comparative study of caregiver burden in psychiatric illness and chronic medical illness publication-title: Indian J Psychiatry doi: 10.4103/0019-5545.102423 contributor: fullname: Padma – volume: 187 start-page: 268 issue: 3 year: 2006 ident: R18 article-title: Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance publication-title: Psychopharmacology doi: 10.1007/s00213-006-0457-5 contributor: fullname: McCann – volume: 52 start-page: 623 issue: 3 year: 2017 ident: R24 article-title: NATURALIZING psychedelic spirituality publication-title: Zygon® doi: 10.1111/zygo.12353 contributor: fullname: Letheby – volume: 43 start-page: 55 issue: 1 year: 2017 ident: R19 article-title: Long-Term follow-up of psilocybin-facilitated smoking cessation publication-title: Am J Drug Alcohol Abuse doi: 10.3109/00952990.2016.1170135 contributor: fullname: Griffiths – volume: 177 start-page: 391 issue: 5 year: 2020 ident: R12 article-title: Psychedelics and Psychedelic-Assisted psychotherapy publication-title: Am J Psychiatry doi: 10.1176/appi.ajp.2019.19010035 contributor: fullname: Nemeroff – volume: 9 year: 2018 ident: R1 article-title: Psychedelic-assisted psychotherapy: a paradigm shift in psychiatric research and development publication-title: Front Pharmacol doi: 10.3389/fphar.2018.00733 contributor: fullname: Schenberg – volume: 21 start-page: 53 issue: 2 year: 2019 ident: R25 article-title: Seeing without self: discovering new meaning with psychedelic-assisted psychotherapy publication-title: Neuropsychoanalysis doi: 10.1080/15294145.2019.1689528 contributor: fullname: Fischman – volume: 235 start-page: 399 issue: 2 year: 2018 ident: R13 article-title: Psilocybin with psychological support for treatment-resistant depression: six-month follow-up publication-title: Psychopharmacology doi: 10.1007/s00213-017-4771-x contributor: fullname: Day – volume: 12 year: 2018 ident: R5 article-title: The meaning-enhancing properties of psychedelics and their mediator role in psychedelic therapy, spirituality, and creativity publication-title: Front Neurosci doi: 10.3389/fnins.2018.00129 contributor: fullname: Hartogsohn – volume: 39 start-page: 28 year: 2016 ident: R21 article-title: The epistemic innocence of psychedelic states publication-title: Conscious Cogn doi: 10.1016/j.concog.2015.11.012 contributor: fullname: Letheby – volume: 9 year: 2018 article-title: Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that the drugs work: effect size and method bias matter! publication-title: Front Psychiatry doi: 10.3389/fpsyt.2018.00517 contributor: fullname: Plöderl – volume: 9 year: 2018 article-title: Psychedelic-assisted psychotherapy: a paradigm shift in psychiatric research and development publication-title: Front Pharmacol doi: 10.3389/fphar.2018.00733 contributor: fullname: Schenberg – volume: 235 start-page: 399 issue: 2 year: 2018 article-title: Psilocybin with psychological support for treatment-resistant depression: six-month follow-up publication-title: Psychopharmacology doi: 10.1007/s00213-017-4771-x contributor: fullname: Day – volume: 21 start-page: 53 issue: 2 year: 2019 article-title: Seeing without self: discovering new meaning with psychedelic-assisted psychotherapy publication-title: Neuropsychoanalysis doi: 10.1080/15294145.2019.1689528 contributor: fullname: Fischman – volume: 43 start-page: 55 issue: 1 year: 2017 article-title: Long-Term follow-up of psilocybin-facilitated smoking cessation publication-title: Am J Drug Alcohol Abuse doi: 10.3109/00952990.2016.1170135 contributor: fullname: Griffiths – volume: 39 start-page: 28 year: 2016 article-title: The epistemic innocence of psychedelic states publication-title: Conscious Cogn doi: 10.1016/j.concog.2015.11.012 contributor: fullname: Letheby – volume: 12 year: 2018 article-title: The meaning-enhancing properties of psychedelics and their mediator role in psychedelic therapy, spirituality, and creativity publication-title: Front Neurosci doi: 10.3389/fnins.2018.00129 contributor: fullname: Hartogsohn – volume: 29 start-page: 241 issue: 3 year: 2015 article-title: Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences? publication-title: J Psychopharmacol doi: 10.1177/0269881114568040 contributor: fullname: Gallinat – volume: 187 start-page: 268 issue: 3 year: 2006 article-title: Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance publication-title: Psychopharmacology doi: 10.1007/s00213-006-0457-5 contributor: fullname: McCann – volume: 177 start-page: 391 issue: 5 year: 2020 article-title: Psychedelics and Psychedelic-Assisted psychotherapy publication-title: Am J Psychiatry doi: 10.1176/appi.ajp.2019.19010035 contributor: fullname: Nemeroff – volume: 54 issue: 3 year: 2012 article-title: A comparative study of caregiver burden in psychiatric illness and chronic medical illness publication-title: Indian J Psychiatry doi: 10.4103/0019-5545.102423 contributor: fullname: Padma – volume: 1 issue: 1 year: 2002 article-title: Understanding the impact of stigma on people with mental illness publication-title: World Psychiatry contributor: fullname: Watson – volume: 52 start-page: 623 issue: 3 year: 2017 article-title: NATURALIZING psychedelic spirituality publication-title: Zygon® doi: 10.1111/zygo.12353 contributor: fullname: Letheby – ident: 2021092310001090000_47.10.701.9 – ident: 2021092310001090000_47.10.701.16 – ident: 2021092310001090000_47.10.701.22 – volume: 21 start-page: 53 issue: 2 year: 2019 ident: 2021092310001090000_47.10.701.25 article-title: Seeing without self: discovering new meaning with psychedelic-assisted psychotherapy publication-title: Neuropsychoanalysis doi: 10.1080/15294145.2019.1689528 contributor: fullname: Fischman – volume: 39 start-page: 28 year: 2016 ident: 2021092310001090000_47.10.701.21 article-title: The epistemic innocence of psychedelic states publication-title: Conscious Cogn doi: 10.1016/j.concog.2015.11.012 contributor: fullname: Letheby – volume: 12 year: 2018 ident: 2021092310001090000_47.10.701.5 article-title: The meaning-enhancing properties of psychedelics and their mediator role in psychedelic therapy, spirituality, and creativity publication-title: Front Neurosci doi: 10.3389/fnins.2018.00129 contributor: fullname: Hartogsohn – volume: 177 start-page: 391 issue: 5 year: 2020 ident: 2021092310001090000_47.10.701.12 article-title: Psychedelics and Psychedelic-Assisted psychotherapy publication-title: Am J Psychiatry doi: 10.1176/appi.ajp.2019.19010035 contributor: fullname: Reiff – volume: 52 start-page: 623 issue: 3 year: 2017 ident: 2021092310001090000_47.10.701.24 article-title: NATURALIZING psychedelic spirituality publication-title: Zygon® doi: 10.1111/zygo.12353 contributor: fullname: Letheby – volume: 9 year: 2018 ident: 2021092310001090000_47.10.701.14 article-title: Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that the drugs work: effect size and method bias matter! 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Title | Prescribing meaning: hedonistic perspectives on the therapeutic use of psychedelic-assisted meaning enhancement |
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