Moral Psychopharmacology Needs Moral Inquiry: The Case of Psychedelics

This opinion paper (2021) examines the effects of psychedelics on moral flexibility and argues that the context sensitivity of these substances entails that randomized placebo-controlled trials are insufficient for appreciating the full range of their possible effects. In order to understand its effects on moral behavior, the authors advocate a complementary approach of culture-controlled trials that investigate this moral psychopharmacology under different social and cultural circumstances with the help of anthropological, sociological, and philosophical observers, in order to determine what constitutes a good use of psychedelics beyond clinical trials.

Abstract

“The revival of psychedelic research coincided and more recently conjoined with psychopharmacological research on how drugs affect moral judgments and behaviors. This article makes the case for a moral psychopharmacology of psychedelics that examines whether psychedelics serve as non-specific amplifiers that enable subjects to (re-)connect with their values, or whether they promote specific moral-political orientations such as liberal and anti-authoritarian views, as recent psychopharmacological studies suggest. This question gains urgency from the fact that the return of psychedelics from counterculture and underground laboratories to mainstream science and society has been accompanied by a diversification of their users and uses. We propose bringing the pharmacological and neuroscientific literature into a conversation with historical and anthropological scholarship documenting the full spectrum of moral and political views associated with the uses of psychedelics. This paper sheds new light on the cultural plasticity of drug action and has implications for the design of psychedelic pharmacopsychotherapies. It also raises the question of whether other classes of psychoactive drugs have an equally rich moral and political life.”

Authors: Nicholas Langlitz, Erika Dyck, Milan Scheidegger & Dimitris Repantis

Summary

INTRODUCTION: A NEW FIELD OF RESEARCH

In the 2000s, neuropsychopharmacologists began to study the neurochemical foundations of moral behaviors. They found that certain drugs enhanced harm aversion, motivated in-group favoritism and out-group derogation, and decreased emotional empathy and altruism.

THE CONTEXT DEPENDENCE OF PSYCHEDELICS VARIES THEIR MORAL EFFECTS

Research shows that psychedelic drug use is likely to increase in non-medical contexts, and that a majority of the British public support the medical use of psychedelics for trauma-based injuries and end-of-life anxiety. The moral psychopharmacology of psychedelics is especially interesting because their effects depend crucially on extra-pharmacological factors. This is because the drugs’ 5HT2a receptor agonism renders the psychedelic experience exceptionally sensitive to context, both internal and external.

Psychedelic-assisted therapy of depression and other psychiatric conditions is context-dependent, and the subjective experience shaped by set and setting might not just be epiphenomenal but causally related to the drugs’ therapeutic effects. The relationship between drugs and cultural context opens up a dimension of moral psychopharmacology directly relevant to clinical work, where the question of how drugs affect human relationships and what makes a good relationship comes into the purview of psychiatric drug treatment. Psychedelics have different effects on people’s moral judgment and behavior depending on the context of their use and the mind-set of the user.

Psychedelics have been successfully mainstreamed through medical research, and their use has spread beyond the so-called psychedelic research community. Historical and ethnographic research can complement contemporary neuropsychopharmacology studies with studies of cultural contexts that examine other sets and settings in relation to drug uses and effects. Psychedelic therapists and progressive intellectuals suggest that psychedelic experiences can help to work through cultural trauma of racist discrimination, while a budding traditionalist scene finds inspiration in the right-wing writer and psychonaut Ernst Jünger.

TAKING PSYCHEDELIC RESEARCH BEYOND THE TWO-CULTURE DIVIDE

A well-established account of the moral and political versatility of psychedelics draws from an older naturalist ontology that suggests that there is one nature and many cultures that interpret it differently. However, this account is potentially misleading because it ignores new research on culture. Psychedelic drugs have moral effects that depend on the users’ personalities, expectations, and cultural beliefs, as well as the social setting in which they are ingested.

Extra-pharmacological factors have attracted attention in psychedelic research, which stimulates interdisciplinary debates and transdisciplinary collaborations. These factors can account for why psychedelics can be a “double-edged sword” that can either benefit or harm their users, or even do both at the same time.

Psychedelics have context-sensitive effects, and randomized placebo-controlled trials do not capture the diverse ways in which consumers may encounter psychedelics in medical and non-medical settings alike. Culture-controlled trials provide an opportunity to import experimental paradigms from social, moral, and political psychology.

“UPSTREAM” DESIGN OF NEW USES OF PSYCHEDELICS

The ethical plasticity of psychedelic-induced experiences poses a formidable bioethical problem. It is important to recognize that amplifying particular aspects of prosociality produces trade-offs and adverse effects, and that reducing one’s sense of self-importance can free up resources in favor of neighbors and strangers.

The model of bioethics presupposes conceptions of what counts as moral and measures technologies against them. However, psychedelics present a case where the means transform the ends, and the means reinforce the sense of disconnection and avoidance. Different psychedelic compounds produce different moral effects and ethical orientations. The challenge is to invent new research practices that observe and reflect on the combining of neurochemistry and morality.

Observing how psychedelics are used outside the laboratory and the clinic, and adopting practices from ethnopharmacology, ecology, and other areas of field biology, may provide further methodological inspiration for how to study the interplay between pharmacological and extrapharmacological factors.

The use of psychedelics as medicine will still largely depend on randomized placebo-controlled trials, but an upstream approach to the morally transformative effects of psychedelics places psychopharmacologists, psychiatrists, social researchers, and humanities scholars side by side to study, assess, and redesign psychedelic experiences in their social, cultural, and historical contexts.

CONCLUSION: EXTENDING RESEARCH AND DEVELOPMENT INTO THE EXTRA-PHARMACOLOGICAL REALM

Moral psychopharmacology should extend pharmaceutical research and development into the extra-pharmacological realm, and should be informed by best practices in clinical psychology and cognate fields. This process requires recursive research into psychopharmacological experimentation, clinical and ethnographic observation, historical research, and ethical reflection.