Consciousness, Religion, and Gurus: Pitfalls of Psychedelic Medicine

This opinion article (2020) describes three pitfalls of psychedelic research, namely 1) consciousness terminology, 2) religious beliefs of clinicians, and 3) clinical boundaries.

Abstract

“This viewpoint identifies pitfalls in the study of psychedelic compounds, including those that pose challenges for the potential use of psychedelics as medicines. They are as follows: (1) Sloppiness regarding use of the term “consciousness”. (2) Inappropriate introduction of religious/spiritual beliefs of investigators or clinicians. (3) Clinical boundaries and other ethical challenges associated with psychedelic treatments.”

Author: Matthew W. Johnson

Notes

Psychedelics hold promise as a bridge between psychology (e.g. talk therapy) and psychiatric medications (e.g. SSRIs). The effects are long-lasting if the acute experience elicits behavior change. Or in other words, both the biological processes (e.g. plasticity) and psychological insight (e.g. processing trauma) contribute to positive outcomes.

But psychedelic therapy and research are not without pitfalls, this article describes three of these:

1. Consciousness – the term not being used in the right way
   1. If used, it should be defined as it could mean many different things
   2. Psychedelic research has not substantially contributed to understanding consciousness
      1. Research with psychedelics that looks at the Default Mode Network (DMN) is far from conclusive or specific to psychedelics
      2. Researchers could make falsifiable hypotheses that, with psychedelics, we could help to find answers to ‘easy problems’ of consciousness
   3. That psychedelics alter our subjective experience, does not equal them (directly) being a tool to study consciousness
2. Religious/spiritual beliefs of investigators/clinicians – being introduced where not appropriate
   1. These beliefs are defined as supernatural ones (vs spiritual as being supportive, something that is of course encouraged)
   2. One should be supportive of patients with religious beliefs, but work (and do science) from a secular perspective
   3. This should also apply to the space (setting) where therapy is being given (e.g. no Buddha statues)
      1. This changes of course when explicitly given in such a setting (e.g. a Buddhist psychedelic retreat)
3. Ethical challenges (e.g. clinical boundaries)
   1. With psychedelics in play, one should be extra cautious about not overstepping clinical boundaries
   2. This ranges from sexual and inappropriate relationships to offering the therapists worldview (playing guru)
   3. Multiple therapy sessions without psychedelics and a transparent process could help with these challenges

Summary

Psychedelic compounds, especially psilocybin and MDMA, have shown promising results in the treatment of cancer-related depression and anxiety, tobacco use disorder, alcohol use disorder, and major depressive disorder. MDMA has shown promising findings for the treatment of post-traumatic stress disorder. These studies have administered psychedelics only one or a few times, after preparation and with monitoring and follow-up care, yet they have shown persisting clinical benefits.

Psychedelics are powerful therapeutic and scientific tools, but their use has been surrounded by epistemological and ethical challenges.

■ THE SLOPPINESS OF “CONSCIOUSNESS”

The public, the media, and even scientists have heralded psychedelics as providing scientific insights into consciousness. However, the word “consciousness” is often not defined, and can have a wide variety of meanings. One might question whether consciousness is a singular construct, but I propose that there are several concepts associated with consciousness, including sentience, wakefulness, self-awareness, the ability to describe mental states, discrimination of and reaction to stimuli, access consciousness, narrative consciousness, integration of information, and control of behavior. The “easy problems” of consciousness are explainable with advancement of science, but the “hard problem” of consciousness is outside the realm of empirical science.

Psychedelic science has not provided substantial advancement in our understanding of consciousness concepts, and personal psychedelic experience might have influenced ideas regarding consciousness developed by philosophers. However, no existing empirical research has systematically addressed how psychedelic experience affects one’s personal philosophy on consciousness.

Psychedelic science has provided preliminary understanding and generated testable hypotheses regarding how psychedelics work, but it is unclear whether these hypotheses have led to an advancement in understanding normal functioning.

Psychedelic research has strong potential in addressing many of the “easy problems” of consciousness, such as increasing access to autobiographical memories and understanding the psychology and neuroscience of self-awareness.

Some theoretical proposals have attempted to understand psychedelic effects within theories of consciousness, and empirical psychedelic research has been used to identify potential problems with these theories.

Some psychedelic researchers have argued that the study of psychedelics constitutes the study of consciousness, but I take issue with this. Psychedelic effects may not reveal the fundamental nature of consciousness, but they may reveal a supranormal and useful state.

RELIGIOUS/SPIRITUAL BELIEFS OF INVESTIGATORS OR CLINICIANS

A danger in psychedelic research is that scientists and clinicians impose their personal religious or spiritual beliefs on the practice of psychedelic medicine. This danger is particularly pronounced in the case of scientists and clinicians who hold loosely held eclectic collections of beliefs.

Clinicians and scientists should operate from a secular framework that is open to working with patients of any religious/spiritual background. It is also important to avoid introducing nonempirically supported beliefs such as perennialism or instructing participants that psychedelic effects will inform them about the nature of the mind.

Scientists and clinicians should not include religious icons in the session room or other clinical space, as this will alienate some people from psychedelic medicine.

I am not advocating for being neutral or cold in the relationship with the patient, and scientists and clinicians can certainly have their own religious or nonempirically based beliefs. However, they should not bring up these personal beliefs and insert them into therapeutic practice.

It is not the role of the clinician or scientist to introduce religious concepts into the therapeutic discussion of psychedelics, and it is not inappropriate to study the religious use of psychedelics as long as scientists are not recommending religious beliefs for participants.

CHALLENGES ASSOCIATED WITH PSYCHEDELIC TREATMENTS

In this final section, I warn against falling prey to the notion of “psychedelic exceptionalism”, where you believe that the normal rules do not apply to psychedelic experiences. This was one of the mistakes made by some investigators in the earlier era of psychedelic research. To guard against being associated with one of the meaningful experiences in a person’s life, have a transparent process and adhere strongly to established professional boundaries.

■ CONCLUSIONS

Use specific and well-grounded terms when speaking of concepts related to consciousness with regard to psychedelics, avoid using the word “consciousness” with regard to psychedelic research, and adhere strongly to the wisdom of professional boundaries.

Notes

The author declares the following competing financial interest(s): advisory relationships with several organizations regarding the medical development of psychedelics or related compounds.