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Is There A Case For Skepticism Of Psychedelic Therapy?

There’s been an explosion of interest in the use of psychedelics in psychiatry. Like everyone else, I hope this works out. But recent discussion has been so overwhelmingly positive that it’s worth reviewing whether there’s a case for skepticism. I think it would look something like this:

1. Psychedelics have mostly been investigated in small studies run by true believers. These are the conditions that produce a field made of unreplicable results, like the effects of 5-HTTLPR. Some of the most exciting psychedelic findings have already failed to replicate; for example, a study two years ago found that psilocybin did not permanently increase the Openness personality trait. This was one of the most exciting studies and had shaped a lot of my thinking around the issue. Now it’s gone.

2. Some of the most impressive stories involve psychedelic-assisted psychotherapy, where people who talk with a therapist, while on a substance, obtain true insight and get real closure. But every psychotherapy has amazing success stories floating out there. Back when psychoanalysis was new, the whole world was full of people telling their amazing success stories about how Dr. Freud helped them obtain true insight and get real closure. I think of psychotherapy as a domain where people can get as many amazing success stories as they want whether or not they’re really doing anything right, for unclear reasons.

3. Ketamine is the best comparison for psychedelics. Like psychedelics, it’s often used as a recreational drug, and produces profound experiences. Like psychedelics, it got hyped as an exciting new innovation that was going to revolutionize everything in psychiatry (in this case, depression treatment). But it’s been in pretty common (albeit non-formulary) use for five years now, and nothing has been revolutionized; my (very anecdotal) impression is that most patients who seek ketamine treatment find it only about as helpful as anything else. The gold-standard FDA studies are abysmal, worse than most other antidepressant medications. I’m sure ketamine works great for some people, just as SSRIs, therapy, and diet/exercise work well for some people. But at least so far it hasn’t been revolutionary.

4. Another good comparison is NSI-189. Again, a totally revolutionary new drug with a totally revolutionary new mechanism, with so many anecdotes of amazing success that depressed people started getting it on the black market before the FDA trials were even underway. People were posting testimonials that NSI-189 changed their life and that it was going to destroy the market for every other antidepressant. When the FDA trials finally finished, it was discovered to be ineffective. Seriously, the graveyards are littered with revolutionary new treatments for treatment-resistant depression that have great success in anecdotes and preliminary studies.

5. Between 10% and 50% of Americans have tried psychedelics. If psychedelics did something shocking, we would already know about it. I occasionally hear stories like “I did LSD and my depression went away”, but I also occasionally hear stories like “I did LSD and then my depression got worse”, so whatever. I know plenty of people who use heroic amounts of LSD all the time, and are still nervous wrecks. It’s possible there’s some set and setting that will improve this, but see part 7 below.

(one exception to this might be microdosing, which is a pretty new idea and might work differently from regular trips.)

6. In my model of psychedelics, they artificially stimulate your insight system the same way heroin artificially stimulates your happiness system. This leads to all those stories where people feel like they discovered the secret of the universe, but when they recover their faculties, they find it was only some inane triviality. This sounds very likely to produce people who think their psychedelic experience has changed everything and solved all their problems, which means we should discount these impressions as evidence that psychedelics really do change everything and solve all your problems. Granted, feeling like you truly understand the universe may itself help with depression, but I worry this is not a very lasting effect. See my posts on PIHKal and Universal Love, Said The Cactus Person.

7. Even if all of the above are wrong and psychedelics work very well, the FDA could kill them with a thousand paper cuts. Again, look at ketamine: the new FDA approval ensures people will be getting the slightly different esketamine, through a weird route of administration, while paying $600 a pop, in specialized clinics that will probably be hard to find. Given the price and inconvenience, insurance companies will probably restrict it to the most treatment-resistant patients, and it probably won’t help them (treatment-resistant patients tend to stay that way). Given the panic around psychedelics, I expect it to be similarly difficult to get them even if they are legal and technically FDA-approved. Depressed people will never be able to walk into a psychiatrist’s office and get LSD. They’ll walk into a psychiatrist’s office, try Prozac for three months, try Wellbutrin for three months, argue with their insurance for a while, eventually get permission to drive to a city an hour away that has a government-licensed LSD clinic, and get some weird form of LSD that might or might not work, using a procedure optimized to minimize hallucinations. I don’t know what the optimal set and setting for LSD is, but if it’s anything other than “the inside of a government-licensed LSD clinic, having a government-licensed LSD therapist ask you standard questions”, you won’t get it.

I hope I am wrong about this, I really do. And I think there’s a good chance that I might be. I really want psychedelic research to succeed and I support it wholeheartedly. But there’s been so much hype around so many things before that I want to avoid getting burned again, so I ‘ll stay skeptical for now.

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100 Responses to Is There A Case For Skepticism Of Psychedelic Therapy?

  1. nuttycom says:

    OTOH, Denver just legalized mushrooms, so it’ll be interesting to see how that largish-scale, relatively uncontrolled experiment plays out.

  2. ksvanhorn says:

    Between 10% and 50% of Americans have tried psychedelics. If psychedelics did something shocking, we would already know about it.

    There’s a huge difference between taking psychedelics recreationally and taking them for serious self improvement, in terms of mindset, preparation, and followup. I suggest you read The Secret Chief Revealed, especially Chapter III, to get an idea of the difference. The book discusses the work of Leo Zeff, an underground psychedelic therapist.

    The model of “take this drug and it will make you better” doesn’t really work for psychedelics. They’re more of a catalyst. You still have to supply the reagents for the reaction to happen — that is, you have to do the work. So my expectation is that psychedelics will show striking effectiveness for one particular class of people: those who have struggled with their problem for some time, have put significant effort into it, but have still failed. People who are agentic. I expect psychedelics to be of little use for the person who wants someone else or something else to solve their problems for them.

  3. treatment-resistant patients tend to stay that way

    I suspect this is a very important factor. “Treating treatment-resistant depression” is, partly by definition, a very high bar for a new psychiatric intervention to clear; it amounts to “solving a problem no one can manage to solve, even though everyone really wants to solve it and keeps trying new approaches, which invariably fail.” There’s plenty of room for a new intervention to have distinctive psychiatric utility, in depression and/or in other conditions, while still failing to cross this high bar.

    Relatedly, and more interestingly, I suspect that psychedelics are not a good match for the very notion of a “medical intervention,” and that this will probably cause this line of research to be weird and muddled in a somewhat predictable way. My mental model of psychedelics (derived from both personal experience and observation of other people) says that they can have strong and sometimes lasting effects on people, but that the magnitude and direction of these effects is strongly coupled to personal psychology/circumstances/etc. in a way that will tend to either wash out in the mean, or partly wash out while leaving behind some strong average effects that are nonetheless misleading if taken as a complete description.

    A useful analogy might be romantic relationships. These are clearly important to many people, and (if one wants to view things this way) can have strong psychiatric “effects.” While a relationship may never (?) “cure” or even directly “treat” someone’s mental illness, it is nonetheless the case that many mentally ill people find their relationships very helpful (in one way or another) in dealing with their condition(s). In the most favorable cases — and these are not rare — someone’s romantic partner may be the single most important factor making their illness more bearable, even if they’re also getting medication and/or therapy. But, of course, there are also relationships that interact very badly with mental illness, and relationships that are great but do absolutely nothing to mitigate someone’s depression, and so forth.

    Trying to chase down some sort of standardized “treatment effect” here would probably be frustrating, and one can plausibly imagine a situation where there are lots of studies showing that relationships have strong and generally positive average effects on measures of life satisfaction and life meaningfulness, that mentally ill people regularly rate them as #1 or #2 on the list of the most important and valuable elements of their lives . . . and that they still have small or nonexistent average effects “as antidepressants,” “as anxiolytics,” and so forth. And then there would be a whole discussion about the depressed and anxious people who say their relationships help, and whether this is just so much anecdotal lore that isn’t borne out by the data, or whether we simply aren’t designing the studies correctly to pick these effects up.

    I suspect psychedelics are much like this, and for the same reasons. Psychedelic experiences, like relationships, can play a very important and psychiatrically significant role in a person’s mental landscape, but not everything with this quality can be accurately modeled as a medical intervention and accurately summarized by an estimated treatment effect.

  4. Jonah Sinick says:

    Between 10% and 50% of Americans have tried psychedelics. If psychedelics did something shocking, we would already know about it.

    I agree that the relatively high prevalence of recreational use places an upper bound on the potential benefits within typical settings. But psychedelic use is in fact associated with better mental health within the American population after controlling for covariates. See

    Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population.

    Lifetime classic psychedelic use was associated with a significantly reduced odds of past month psychological distress (weighted odds ratio (OR)=0.81 (0.72–0.91)), past year suicidal thinking (weighted OR=0.86 (0.78–0.94)), past year suicidal planning (weighted OR=0.71 (0.54–0.94)), and past year suicide attempt (weighted OR=0.64 (0.46–0.89)

  5. slipperypig says:

    I am currently taking NSI-189 purchased on the “black market” to treat anhedonia. One thing to note (from Reddit anecdotes) is that it is better at increasing emotionality than mitigating negative emotions. The primary depression scales used in FDA trials tend to focus more on the latter, and NSI actually produced pretty significant improvements on the secondary cognitive measurements in a study done since Scott’s linked post.

    Since starting a month ago, I have started listening to music for the first time in over a year, and began willingly socializing with my peers regularly. Yesterday, I watched an entire movie for the first time in over a year. Because Wellbutrin produced no such results, I am about 80% sure I am experiencing greater-than-placebo benefits. That said, it is quite subtle; my life by no means has completely changed like some people have reported.

    I worry that the questionnaires/scales used in clinical trials like the MADRS are too narrow to properly evaluate the benefits of novel treatments like NSI-189 and psychedelics. Anyway, NSI-189 does seem like it can help some people with some parts of the constellation of symptoms that we group as “depression.”

  6. I have had a long series of severe depressive episodes since 1960. And I started taking acid in 1967 shortly after it became illegal in the spring of 1967, I took a LOT of LSD, maybe 4-500 times over a little less than 2 decades. I also have always had a lot of suicidal ideation over those years. LSD did two things for me. One was the gradual reduction in the emotional tone of my suicidal ideation, so that now, while I still occasionally think of suicide, it has no emotional content, making it more like an earworm than an impulse. The other, which was very important to me in my early use of LSD and other hallucinogens, is hard to describe. After the visuals began to calm down, I had a period of many hours where I experienced what I thought was normal non-depressive emotional tone. After a while, I didn’t find the visual part of the trip enjoyable. or even pleasant. (it was this that got me to give up the experience altogether). But I always enjoyed the reminder that my brain was capable of normal brain chemistry, at least for a while.

  7. Seaweed Shark says:

    I appreciate the skepticism. Regarding the subject of the FDA legalizing something in an over-bureaucratized, inconvenient, nonstandard, unhelpful way, it could be noted that on the other hand, marijuana seems now to be getting just out-and-out legalized, so there’s that. I’m not claiming pot as a cure for depression, though I’m sure there must be anecdotes.

  8. brianmcbee says:

    I took lots of psychedelics back in the and 70’s and 80’s. They were definitely my drug of choice in my teens and 20s. I had plenty of entertaining (and a few pretty uncomfortable) experiences.

    Did they actually do anything useful for me? Hard to say.

    I do remember reading John Lilly warning that psychedelics had a tendency to make you overvalue the experiences and insights you had while on them. That’s just one of their effects.

    It seems like there is something practically useful there simply because the experiences can be so profound. I don’t think we know yet what those practical uses will turn out to be. More research is needed.

  9. jonni says:

    +1 anecdotal evidence for inducing a profound and long lasting (18 months and counting) improvement in someone who suffered from pretty debilitating anxiety and depression for 10 years and tried basically everything else without success.

    There’s a piece on Aeon called Model Hallucinations which speaks to my experience, specifically concerning the sensation of ego dissolution, and how psychedelics help one to soften and reshape negative self-models that were previously firmly stuck in negative-affect local optima / feedback loop.

    Experiencing ego dissolution also felt like a short-cut to the results of spending years meditating: a preview of “Kegan Stage 5” psychological development where emotions, thoughts, and the systems and models of the world that one exists within begin to be perceived as subjects one can choose to interact with, as opposed to objects one inhabits.

    Psychedelics enabled me to take this sort of flexible thinking style for a “test drive”, gave me motivation to study it further, and made it easier to begin thinking in this fashion in sober daily life, as I had memories of the state of mind and sensations that came with it to use as a reference.

  10. Peter Shenkin says:

    But what if the secret of the universe is actually some inane triviality?

  11. HeelBearCub says:

    So, you don’t know if it works, and you don’t think anyone else knows either.

    And you don’t know if it’s safe, and you don’t think anyone else knows either.

    But you are proactively mad at the FDA for being cautious.

    Seriously, the whiplash between this posts take on ketamine and the last posts take on ketamine is amazing. Because last time you said:

    This created a really embarrassing situation for the medical system: everyone secretly knows ketamine is one of the most effective antidepressants, but officially it’s not an antidepressant at all, and mainstream providers won’t give it to you.

    • Sniffnoy says:

      I mean, it’s worth keeping in mind what the FDA being “cautious” actually cashes out to here. Specifically, actively preventing people from trying this even if they’re willing to accept the risk. Normally when we say, hey, who knows what could happen if you do that, you can’t blame people for being cautious, we mean, by “being cautious” we mean “not doing something they believe to be potentially dangerous”. Here the FDA isn’t abstaining from doing something dangerous; it’s actively preventing other people from doing things it judges to be dangerous.

      • HeelBearCub says:

        You are playing games with the definition of cautious.

        Hippocratic oath applies.

        Mind you, action/inaction distinctions matter, and I’m not saying the FDA can’t be improved or improved upon. But Scott consistently downplays the idea that these things are actually complex, with multiple factors that are difficult to manage. And that doctors are not, in fact, all that well informed on the pros and cons of medications. And let’s not get started on patients. Patients are the ones who think vaccines aren’t a good idea, that a low fat diet can be 100% sugar and cigarettes totally don’t cause cancer risk.

        Yes, it’s awful that the world doesn’t have perfect solutions. But that doesn’t mean perfect solutions exist, or are easily available if they do, or that an evil cabal is ruling the FDA.

        • Sniffnoy says:

          You are playing games with the definition of cautious.

          …no? I am attempting to cash out what it actually means in this instance. Tabooing it, more or less. Maybe you should try doing the same. What do you mean by “cautious”, and why do you think it is a good thing in this instance?

          Hippocratic oath applies.

          I am not certain what you mean by this statement, as taken literally it is false or irrelevant in a number of ways.

          And let’s not get started on patients. Patients are the ones who think vaccines aren’t a good idea, that a low fat diet can be 100% sugar and cigarettes totally don’t cause cancer risk.

          Yeah, I don’t really want to bother making a general argument against paternalism here, so I’ll just link Sarah’s post on the matter (most relevant section is the one labeled “Rewarding Those Who Can Win Big”). Suffice it to say I’m of the opinion that by default you should not attempt to save people from themselves, and you should have a very good reason before attempting to do so. I can’t really say that any such reason applies in the case of psychedelics, because, well, among other things, people know about psychedelics. What hidden trap are they going to contain?

          In fact, now that I check again, I’m not seeing where you’re getting your claim that

          And you don’t know if it’s safe, and you don’t think anyone else knows either.

          As a summary of Scott’s post… well, he didn’t say anthing like that. And I rather doubt that it’s true. I mean, people use — and write about the use of — psychedelics all the time, and have been doing for decades; so I think if you read what’s out there you can probably get a pretty good idea what doses are safe. (Not an expert here, but I was under the impression that LSD is generally understood to be very safe at usual doses, outside of maybe the possibility of flashbacks.)

          So, what are you basing that on? Because I don’t think that’s either a good summary of what Scott said, nor factually accurate.

          Yes, it’s awful that the world doesn’t have perfect solutions. But that doesn’t mean perfect solutions exist, or are easily available if they do, or that an evil cabal is ruling the FDA.

          I haven’t claimed any of that?

          • HeelBearCub says:

            You said:

            Normally when we say, hey, who knows what could happen if you do that, you can’t blame people for being cautious, we mean, by “being cautious” we mean “not doing something they believe to be potentially dangerous”.

            In other words, you claimed to be accessing the true “normal” meaning of cautious.

            This isn’t the sole true, normal meaning of cautious. For instance, you might not fire a rifle or other firearm without a suitable, impenetrable background. There is no danger to yourself in firing, but rather danger to others. This is also rightly described as caution.

            From a tabooing perspective, we are getting at the idea that our actions may have effects on people other than ourselves. If we employ a contractor to construct a building based on our plans, they may rightly decide not to build the building despite our protestations that we are willing to take the risk of its inadequate load bearing supports. They are guarding their own reputation, but also do not wish to be responsible for allowing us to architect our own demise, or the demise of anyone who subsequently purchase the building.

            Hence my statement referring to the idea of “first, do no harm”.

            As to claims about safety, Scott references anecdotal data of people becoming more depressed after psychedelics. Scott is also generally coming to the conclusion that he can’t trust published results about psychology (well, accept for that one study that he currently likes, because it agrees with his belief that you can’t trust the other studies). Hence the “no one else knows” statement.

            As to statements about the FDA, you need to put this in the context of Scott’s previous body of work about the FDA (and, frankly, both government and science in general).

            I highlighted the statements about ketamine for a reason. Within the span of a few months he has both said that ketamine is super effective and fiendishly being held back from the public despite this, and now claims that it isn’t really all that effective and we don’t really have much of a good reason to think it works at all. Plus, it’s also commonly available right now.

            There is a failure on his part to recognize the practical effect of this kind of uncertainty. Also, he isn’t recognizing that he is directly contradicting himself to support his previous biases.

          • Sniffnoy says:

            In other words, you claimed to be accessing the true “normal” meaning of cautious.

            No, I just claimed to be referring to the ordinary meaning; and not even the meaning in general, just in that context. Evidently, I didn’t think it through sufficiently and got it wrong. But there’s no need to accuse me of bad faith or philosophical errors when there’s a much more likely error I could be making?

            In this case, as you said, I pretty obviously neglected the possibility of harm to others. OK! But the thing is that accounting for that doesn’t rescue what you’re saying.

            I agree that active/passive is not a very useful distinction. What is a useful distinction here is force/allow. (Typically these go together, but one can imagine situations where the usual association is reversed.)

            That is to say, if you recklessly fire a gun, or build an unsafe house, causing a danger to others, the danger here is that people will be forcefully harmed by it, i.e., they get no choice in the matter. By contrast, allowing someone to choose to shoot themselves, or to walk into a house marked as unsafe, is a very different matter.

            And that’s what the FDA/Congress would be doing. They wouldn’t be forcing psychedelics on anyone, just allowing pscyhedelics. I mean yeah of course if you imagine your alternatives are force no psychedelics vs force pscyhedelics, force no psychedelics is the cautious option. And that’s true even if you imagine they had the resources to make decisions for people individually rather than for the whole population. But those aren’t the alternatives here — the actual alternative to force no psychedelics is not to force anything and allow people to pick for themselves the option that they think is best according to their own risk tolerances! Which is the sort of thing we should generally expect to lead to the best result, etc, I’ve already said this.

            Hence my statement referring to the idea of “first, do no harm”.

            Yeah, I still don’t know what you’re getting at here. The Hippocratic Oath isn’t the First Law of Robotics. Nor is it clear that “first, do no harm” is a good principle if that means “first, do nothing that risks harm”. That sounds like the path to paralysis.

            As to claims about safety, Scott references anecdotal data of people becoming more depressed after psychedelics.

            Hm, does that count as unsafety? I wouldn’t’ve counted it. I worry I’m getting into an argument over definitions here, but I would’ve just counted that as, well, net harm, but not unsafe, as such. I guess it doesn’t really matter.

            Scott is also generally coming to the conclusion that he can’t trust published results about psychology (well, accept for that one study that he currently likes, because it agrees with his belief that you can’t trust the other studies). Hence the “no one else knows” statement.

            That doesn’t follow. Again: We have decades’ worth of evidence from mass use that psychedelics, or at least particular psychedelics such as LSD, are very safe. If the formal studies of them are untrustworthy, that just means that we have learned nothing from those studies; it doesn’t erase our existing knowledge from other sources. I would assert that we do have pretty good knowledge that these psychedelics are safe.

            I highlighted the statements about ketamine for a reason. Within the span of a few months he has both said that ketamine is super effective and fiendishly being held back from the public despite this, and now claims that it isn’t really all that effective and we don’t really have much of a good reason to think it works at all.

            But that isn’t what he said; what the post says is that we don’t really have much reason to think it works much better than other antidepressants. Then again, that may not be much of a difference for the point you’re making.

            (also, the “fiendishly” bit is unnecessary, we all know the FDA isn’t acting in bad faith)

            Plus, it’s also commonly available right now.

            In a restricted form, if I’m not mistaken?

            In any case, it’s worth pointing out that none of this alters the ultimate decision. Like — switching back to pscyhedelics for a moment — psychedelics are safe, but even if we truly had no idea, so what? The correct decision is still to allow rather than to force (in either direction). Let people make decisions for themselves, pick what they think is best for themselves. Enough with the paternalism-as-default. I mean if there’s some real crazy hidden trap or something, sure, that’s one thing. But I think to the extent that psychedelics or ketamine are dangerous, these dangers are well-known. Someone who takes them probably knows what they’re getting. Let them make that risk assessment for themselves, and hey, maybe by letting the public try things we might actually learn something, find something, that we didn’t know about before. Etc, link Sarah’s essay again, don’t want to make the whole argument against paternalism myself.

  12. danridge says:

    I’m just waiting for the day when dried psilocybin mushrooms are available at the bulk section at the grocery store. Weed would probably go there too. I guess LSD could be with the spices, or wherever vanilla extract goes. And the MDMA? At the sample station, of course!

    I wonder whether it is possible that the correct venue for any kind of psychological growth may simply be as far as possible from anything the FDA would like the look of. I take the point that as of the present moment, this is what legal, medical ketamine looks like, and it looks bad. There’s also the recent story of the city of Denver decriminalizing psilocybin mushrooms. I’m wondering, if you take the view that these drugs should be decriminalized and normalized, the way marijuana is now in many places, such that they become easy and legal to acquire, what’s the route forward? Maybe glowing studies are important to drive public opinion; however, I think your wary attitude towards these studies seems sensible, so maybe having such studies enter the medical and scientific mainstream to get a reality check is something that you’d want to delay (again, if your only goal is getting psychedelics decriminalized). And I wonder how things will play out with ketamine; maybe because of this clinical avenue being opened, availability of the ketamine everyone actually wants will be massively or even permanently delayed, or maybe we will end up with a situation like that in California several years ago, when it was merely a formality to see a doctor and make up some vague ailment in order to be given a medical marijuana card (as a complete aside, a possibly telling anecdote; the only person I ever knew to have their medical request turned down by a doctor had asked for it because of menstrual pain). Perhaps psilocybin is the best candidate to be the next drug to be decriminalized, because of the legal grey area with spores in many places. In any case, it will be interesting to compare its progress to that of ketamine in the coming months.

  13. doris says:

    I’ll give my two cents for what it’s worth.
    Before I present my thoughts though, I’d like to say my hope is that in the future there will be real dialogue between scientists and people that have had (or claimed to, at least) profound experiences with either meditation of psychedelic drugs. I consider myself in both of those groups (I’m in the later part of my PhD studying the brain – my research topic though is pretty mundane, vision, so it has nothing to do with transformative conscious experiences -and I have also had quite profound transformative experiences through meditation, but not psychedelics which I have not tried). This puts me at an odd position, because I understand both viewpoints and I think a productive dialogue may be established.

    Psychedelics pave the way toward a conscious experience where you perceive yourself as an observer outside the mental models (thoughts, emotions, beliefs etc) that normally populate your mind. Let me unpack this statement. First off, not all people that take psychedelics reach this point, and there is a diversity of experiences that people have, with hallucinations, fancy feelings of insight and bliss obscuring this philosophically profound finding: that the mental world we had been living our whole life is just that, a mental projection, a world of ideas that we can step outside of if only for brief periods of time. I claim that this is the true value of meditation and true healing and insight potential of psychedelics. When depressed people find that they can have access to a state of consciousness that is outside their mental world (which can be awful, terrible, suicidal), they can find a way out.

    Personal anecdote time:
    I know this because this has been my experience. When I was in my early 20s I suffered from suicidal depression and anxiety and having access to this state of consciousness that we don’t normally experience has saved my life. How?, because suddenly you see that sometimes you can be an observer of your thoughts, outside of the mental model. And when I say “different consciousness state”, I mean exactly that: not just sitting on a meditation cushion watching your thoughts thinking how beautiful and giving the Universe is. I want to emphasize that this is a different conscious experience in which you feel in a very real sense you are not your mind (by mind here I mean the collection of thoughts and ideas and emotions that make “you” who you think you are). Every person that I talked to that has had a profound transformative experience with meditation or any experienced spiritual teacher that’s worth its salt will recognize that this is the true GOAL, the insight etc.

    Importantly, this is not something that is contradicted by science. Merely claiming that such conscious experience can be achieved doesnt’t mean: the Universe is good, we are all interconnected, there is a God/Spirit/Invisible Pink Unicorn and other such claims. The only novel thing that can be said here is that quite astoundingly, there exists such a different state of mind that can have true healing potential. From my personal experience, having access to this state then permitted me to tweak my beliefs and re-learn habits that were conducive to my high-anxiety states and to reach a state where I (think I am, at least) a high-functioning adult, with pretty high tolerance to stress.

    Again, this basic insight is obscured by a plethora of misunderstandings, embellishments with no scientific or ethical value. I believe though that scientists need to let go of their perceived intellectual superiority (sorry, can’t help it I had to insert that here) and lend an ear to people that have had truly transformative experiences. Spiritual people (or I don’t know how to call them) need to chill, and understand that whatever perceptions they have are subjective and listen to scientists too, because there is a lot of learn. So I think both sides need to make an effort to listen to each other for any productive conversation to ensue.

    Potentially, I think that if we play our cards right, we can change the way we see ourselves and heal from our mental maladies. Skepticism be damned.

    EDIT: Re-reading this I feel my argument is lacking an important part. Some people may counter-argue that, well, heroin or other drugs are arguably conducive to “different consciousness states”. So why would we bother particular with this “observer conscious experience” that I have just described. First off, I’ve never taken psychedelics in my life and these different consciousness states that I’ve achieved were through my meditation practice. Therefore, there is no need for drugs. It just so happens that when I talked to my friends who were trying either LSD or mushrooms, we found commonality… Through all our conversations we found that this consciousness state I’ve been describing had particular philosophical/moral value (of course this is subjective). Second… only after you’ve achieved it can you understand what I mean. When I try to describe it to people that have not experienced it, I often feel like I’m explaining what the color red is to someone who has never seen red. There is a language barrier that can never be crossed, because, well, you can’t explain what “red” is to someone that’s never seen it. The best antidote therefore is to keep an open mind (not belief or acceptance, simply openness to the possibility) that what me and other smart people are saying (Sam Harris is one of them) is not non-sense. We have been so disillusioned as a species to disbelieve that anything is truly transformative, so much so that when an opportunity comes to find that truly transformative thing, we may miss it!

    • cuke says:

      I also consider myself in both of these groups and have experienced the kind of big shift in consciousness you describe both in meditation and on psychedelics.

      This captures it well: “that the mental world we had been living our whole life is just that, a mental projection, a world of ideas that we can step outside of if only for brief periods of time. I claim that this is the true value of meditation and true healing and insight potential of psychedelics. When depressed people find that they can have access to a state of consciousness that is outside their mental world (which can be awful, terrible, suicidal), they can find a way out.”

      Cognitive behavioral therapy tries to convey to people that their feelings, while “real” in the sense that they are indeed arising, are not “real” in the sense that they reflect some reality about things. A handful of people can find some relief in using their intellect to attack the distortion field created by one’s projections. But it’s impossible I think to fully see the distortion field while you’re in it, and there’s no way to grasp that there’s a place outside of it (and we might quibble with the word “outside” but whatever) without inhabiting that outside space and feeling its freedom.

      When we come out of a bad depression we can look back and go, “yeah, wow, my thinking was distorted in all these ways I can identify now and that totally affected my feelings, but it felt so real at the time.” So that’s everyday consciousness being able to recognize a past distortion field in a way that might be useful for the future. But that lesson seems to be far too intellectual to make the kind of deeper shift that most of us need to keep us from falling into the same hole over and over again.

    • Q says:

      Deeply appreciate Doris’ comment. Juvenile psychedelic experimentation probably triggered or accelerated a severe depressive tendency in me, but also most certainly paved the way for the lessons of meditation, years later. The ecstatic part of each trip was the initial burst of liberation, the freedom from the straightjacket of the self … which would, slowly, over the long hours, return in a warped and even more neurotic form, with no afterglow but a gray brittleness that could last for days. (These were ‘heroic’ doses, I suppose, and possibly impure. It was said at the time that the acid we got was ‘speedy’.)
      The descriptions offered of the central insights of meditation are pithy and apt. Finding a version of that extremely forceful liberation in stillness — calm & solid & if not exactly durable then repeatable — has been a lightning-in-a-bottle-like gift.

  14. Mendalrass says:

    This leads to all those stories where people feel like they discovered the secret of the universe, but when they recover their faculties, they find it was only some inane triviality.

    That 1996 Atlantic article article linked to on William James is worth a read.

    He seemed in his 20s to have soberly philosophized himself into a pretty deep depression concerning determinism. Beginning of his lowest period here:

    One night, walking into a darkened room, James had a sudden hallucinatory vision: a young man he had once seen, a patient at a mental hospital, black-haired, with “greenish” skin, sitting on a bench against the wall, his legs pressed up against his chest, moving only his eyes. “That shape am I,” James wrote: a powerless waif, observing a world he could not change. After this, he said, “the universe changed entirely.” He began to wake up each morning with dread in his stomach. For months he was afraid to go into the dark alone. Concealing his condition from the people around him, James quietly contemplated suicide.

    He got out of this by, like Rush, choosing free will, but it didn’t stop there:

    What began as a simple, almost physical necessity–a personal need to believe in free will in order to escape crushing moral paralysis–blossomed into a full-fledged philosophical doctrine. Beliefs, James eventually decided, were adaptations, like the giraffe’s long neck or the tiger’s claws: they were justifiable only insofar as they helped people to get around in the world. To believe what one needed to believe was no mere sign of weakness, as some of James’s contemporaries contended. Rather, it showed a healthy understanding of what the process of believing was all about.

    Beliefs as adaptations seems 2019 culture relevant, but also circles back to how hallucinogens might help some people — perhaps a trip can expand the toolbox of beliefs they might draw on to muddle through?

    • Uribe says:

      perhaps a trip can expand the toolbox of beliefs they might draw on to muddle through?

      This could explain why so many longtime acid users believe, e.g., they have been contacted by aliens. (What was Scott’s post “Why were the early psychedelicists so weird?”?)

    • cuke says:

      Oh this is well said, and thank you for the reminder about that article.

      This is a lovely line: “Beliefs, James eventually decided, were adaptations, like the giraffe’s long neck or the tiger’s claws: they were justifiable only insofar as they helped people to get around in the world.”

  15. Moorlock says:

    “If psychedelics did something shocking, we would already know about it.” Don’t they, and don’t we?

    I do hear your suspicion about psychedelics operating by putting the “I just had a remarkable insight” alert on hair-trigger. It’s been a long while since I’ve done any of those drugs, but I do remember the frustration of having such an insight and then trying to pull it out from where I found it into the space of articulable concepts only to have it disintegrate into clichés or nonsense.

    But this could be explained also by the difficulty of translation of insights that do not first appear in the form of articulable concepts. I think this may explain some of the overlap between psychedelics enthusiasts and Zen enthusiasts: there’s a similar thing that goes on in Zen where there are all of these stories that seem superficially ridiculous or not-on-point but are examples of people who have Seen The Thing trying to translate their insight into language or some other form of communication, where the end result cannot be taken literally but only as a sort of signal that encourages you to look in a certain direction so you can See it too.

    When William James comes down from nitrous and furiously scribbles down “wicker baskets don’t hold water” or something like that, it may be something that worked as a profound metaphor for him in that moment but is pretty worthless to the rest of us, or even to him anymore. That doesn’t mean it isn’t really the residue of a profound insight, just that the words don’t have the hoped-for power to cage it and convey it to anyone else. Some insights are essentially ephemeral because their subject matter is the strange autophagous dream of human consciousness; others, though more lasting, require extraordinary poetic talent to convey usefully, of a sort that’s hard to rally even when you’re not totally high.

    And if I remember right, of 95 insights that came back down to earth a mush of muddled stoner tropes that I would have been embarrassed to repeat, 5 others shone out golden, beautiful, lighting the way on the trajectory of a more flourishing life that I might not have noticed otherwise. YMMV.

  16. the verbiage ecstatic says:

    “. I think of psychotherapy as a domain where people can get as many amazing success stories as they want whether or not they’re really doing anything right, for unclear reasons.”

    I think this is exactly what you would expect to see if psychotherapy was a real but high-skill thing. Brilliant psychotherapist spends decades getting really good at helping people have life-changing insights. They acquire disciples, to whom they pass on some but not all of their skill. They write books about their mental models, which may or may not reflect reality at all (I remember reading an anecdote about an Olympic sharpshooter who imagines pulling the trigger as allowing the bullet to fall out of the gun down towards the target. Not at all reflective of reality, but helped the world champion manage their muscles in a way that was effective). People read those books, start going out and treating patients. But the verbal description of the mental models only carries some small fraction of the original therapist’s skill, so the new psychotherapists aren’t as good, and there results revert to mean.

    • Douglas Knight says:

      The hypothesis that a field has some identifiable high-skill practitioners is a testable hypothesis. It is rarely tested, either in medicine (eg, psychotherapy) or on the fringe of medicine (eg, acupuncture).

      • cuke says:

        My memory of the research done on this is that effective outcomes in therapy are not highly correlated to years of experience of the therapist. It is also not correlated to how closely a therapist follows any particular technique. And it’s not correlated to any particular technique over any other.

        Good outcomes in therapy are correlated to how well the patient and therapist form a strong therapeutic bond (this has been specified more — how much they are on the same page about what they’re doing, how much the patient trusts the therapist, etc) and how motivated the patient is to change.

        So most of the “skill” that resides in a therapist is about how well they create this therapeutic bond, how good they are at not rupturing that bond, and how good they are at repairing the bond when they do rupture it. There’s a lot that goes into that, but “high skill” doesn’t largely have to do with the things we might think it does — it’s not about brilliant interpretations or using some fabulous technique or having been the disciple of some amazing master.

        It also means it’s pretty individual what works from one patient to another. A fairly new and young clinician can be just as successful as a very seasoned older one, but there may be some variation in terms of what kind of patient they are each successful with.

        • Douglas Knight says:

          Right, the problem is not that people are failing to test the hypothesis; the terrible problem is they’re pretending that they are testing it.

  17. P. George Stewart says:

    Trivialities are nonetheless true, and may be worth reinforcing; it could be that the psychedelic experience enables you to retrace the steps that have made such ideas common wisdom. Now you know in a kind of intimate detail why the truism is a truism.

  18. Jaskologist says:

    Wasn’t all this done back in the 60s and 70s with Timothy Leary? What’s different this time?

    That’s the basis of my skepticism. We already had a movement based around how revolutionary LSD was. It didn’t seem to stand the test of time.

    • genocidebunnies says:

      The True Believer answer to that is that Nixon’s drug policy, the Cold War and the zany CIA experiments killed off the movement before it managed to blossom into anything particularly fruitful. Timothy Leary himself did a lot to harm the movement when he went off the rails and, in true 60s fashion, tried to turn it into a religion.

      • Douglas Knight says:

        Yeah, why is Jaskologist more skeptical than Nixon?

      • Jaskologist says:

        That’s a plausible argument. Trying to turn it into a religion sounds like a pretty common failure mode for a substance which is supposed to induce a deep sense of meaning, though.

      • Said Achmiz says:

        Timothy Leary himself did a lot to harm the movement when he went off the rails and, in true 60s fashion, tried to turn it into a religion.

        Why did he do that? Could it have something to do with all the drugs he took…?

  19. Walter says:

    I’m a normie, never done any drugs, never drank alcohol, but the one drug I’ve imagined myself trying, if it were legal, would be the ‘sees hallucinations and believes that all is one with the universe one’.

    Like, LSD is the central case of the whole ‘taking drugs’ idea. You do it, and then you are a weird druggie for a bit, and later on you swear it was the best. I can’t help but be curious what is going on inside of the mind of that person.

    • my2cents says:

      That’s not quite what LSD does. That said, if legality is the main barrier for you, then go to a jurisdiction where psychedelics are legal and openly sold. Amsterdam is a good destination – psilocybin mushrooms (in the form of ‘truffles’) and mescaline cactuses are legal there.

      • acymetric says:

        I don’t think its a bad synopsis…over-simplified and assumes a good experience, but as far as short one-sentence descriptions go it isn’t all that far off.

        • my2cents says:

          I agree that it is not too far off. I originally intended to clarify my first sentence with “but it is not a bad description either”. I should’ve left it there, I guess.

          Feeling one with the universe is not uncommon on psychedelics, but it is not a given even with a good experience.

    • broblawsky says:

      I did have some interesting insights while using psychedelics, which I think are still relevant even after coming down.

    • Nornagest says:

      From everything I hear, you need to take heroic amounts of LSD or mushrooms or whatever to get a “saw Ganesha and felt the shape of the universe” kind of experience. Heroic enough that it’s not really a very good idea for someone that hasn’t been doing it for a while. Odd but not hyper-profound mental states and maybe the occasional melting wall are more what you should expect from normie doses.

  20. my2cents says:

    I tried ketamine, psychedelics (a few different ones, including LSD) and MDMA. None in therapy setting.

    1. I think (1) is not surprising, given widespread skepticism against psychedelics. If you are a researcher, you don’t get bonus points for studying schedule I substances, and, in fact, you experience a lot of hurdles. So, of course people who study psychedelics are going to be strong believers.

    2. Do you count MDMA as psychedelic here? In one of your previous posts, you called it “a strong 2A agonist” in one of your previous post. Is it really a strong 5HT2A agonist? I don’t know much about neuropharmacology, but I always assumed that MDMA works primarily as a releaser of serotonin. Also, subjectively, there are some similarities between psychedelics and MDMA, but it is pretty different, and insights tend to be different (and more practical for me).

    Based on my own experience, I am VERY optimistic about MDMA chances of being a successful PTSD treatment, and only cautiously optimistic about e.g. LSD being a successful depression treatment.

    3. I wouldn’t compare Ketamine and MDMA (again, I am not sure if you count MDMA as psychedelic in your post). I think comparing psychedelics and ketamine is ok – the experience is similar to some degree. However, with ketamine I just… feel better for at least a few days, and it seems to be ‘just normal’ which doesn’t ‘feel’ related to the actual experience that much. Whereas with LSD there is a nice afterglow which passes in a few, and then anything that helps with depression is tied to the actual experience I had.

    I am not so optimistic about LSD for depression on its own, but LSD and other psychedelics are so weird that I can’t really guess what it’s like to be in therapy on LSD, so I just _have_ to be somewhat optimistic here.

    6. I am somewhat with you here. I love psychedelics, and they tend to produce meaningful insights for me, but my insights tend to be in the area of “holy shit, consciousness is weird, the universe is weird”. And yeah everything feels weirder, like some sort of a puzzle that you are about to solve, so perhaps you’re right about insight system being stimulated.

    Psychedelics also give you an afterglow for a few days – you feel ‘better’ but it is also ‘different’ from ‘normal better’, if this makes sense. You also feel ‘different’. It’s not surprising that some people might start hoping for a lasting change.

    That said, it is strange that you link an atlantic story about nitrous oxide (which is subjectively much more similar to ketamine than LSD).

    (Scott, I think you mentioned that you haven’t tried psychedelics. Do you think that if you try psychedelics you would get a false insight into how insight system works, or you would get a true insight? I mean, you tend to believe that people get false insights, would your own insight be different?)

    Overall, I feel like people should make a better distinction between psychedelics (LSD, psilocybin and similar ones), entactogens (MDMA) and dissociatives (ketamine).

    • acymetric says:

      1. I think (1) is not surprising, given widespread skepticism against psychedelics. If you are a researcher, you don’t get bonus points for studying schedule I substances, and, in fact, you experience a lot of hurdles. So, of course people who study psychedelics are going to be strong believers.

      Yeah. I mean, there is definitely a case to be made for skepticism about psychedelics as therapy, but I’m not sure we are wanting for it in any way. Skepticism about psychedelics is the default position. Acceptance of psychedelics for recreation or therapy is gaining traction, but is still a relatively fringe position to hold.

  21. Freddie deBoer says:

    I think partly it’s the fact that we live under a violent and inhumane system of total prohibition and medical uses seem like an encouraging means to change that fact.

    Probably the best I’ve ever felt was lying in the surf at sunset with three friends while coming down from shrooms. And the absurdity and cruelty of denying people that experience leaves me willing to pursue any means to change things

    • Lodore says:

      And the absurdity and cruelty of denying people that experience leaves me willing to pursue any means to change things

      Agreed. It sometimes makes me sick with despair to think that, for no cogent reason whatsoever, some impossibly stupid dullard has decided that this experience should be illegal. Just fuck off; this is none of your business.

      Probably the best I’ve ever felt was lying in the surf at sunset with three friends while coming down from shrooms.

      I consistently experienced this blissful come-down with the liberty cap (psilocybae semilanceata), but never with any other species of mushroom. I wonder is this just me?

    • AlesZiegler says:

      I am on board with legalization of psychedelics, on usual grounds that things should not be forbidden without very good reasons. I highly doubt that gross societal harm from legal psychedelics will be higher than or comparable with gross harm from legal alcohol, yet I am totally against alcohol prohibition.

      Moreover, even if I am wrong about this and psychedelics are significantly more harmful than expected, we could ban them again after we find out. This happened before with other drugs.

      But I am also doubtful that shoddy medical research which will be later debunked is a good way to promote legalization.

      • Douglas Knight says:

        This happened before with other drugs.

        Has it? What are you thinking of?

        • Paper Rat says:

          Wasn’t cocaine legal (or just not strictly regulated) in the past?

        • AlesZiegler says:

          I am reluctant to hunt for sources on this topic, because, you know, Big Brother, but here is some information about cocaine in Britain, which was legal until 1920 and available over the counter until WWI.

    • RKN says:

      That sentiment aligns well with one of the conclusions Micheal Pollan reaches in his recent book on psychedelics, which I can recommend.

  22. rlms says:

    Between 10% and 50% of Americans have tried psychedelics.

    That sounds like a very high range. If the figure is 50%, that’s higher than cannabis. Cocaine (I think including crack) is apparently 16%; I’d expect psychedelics to be lower than that.

    • Mendalrass says:

      Trying mushrooms was a pretty mainstream thing to do in the 80s and 90s, especially on campus, but 50% still seems pretty tall…. cannabis is also a psychadelic perhaps its being captured in some of the numbers?

      • Well... says:

        cannabis is also a psychedelic perhaps its being captured in some of the numbers?

        That has to be it. There’s no way one out of even ten Americans has tried mushrooms/LSD/DMT/salvia/etc. Even if you narrow it to Americans over age 18, I’d still guess the number is closer to 5% on the high end.

  23. Lodore says:

    Perhaps looking at psychedelics as ‘medicine’ is not the best way to evaluate them. My experience with them is more analogous to my experience with something like music. That is, a life-long exposure that has very profoundly shaped my engagement with the world–but which for any given exposure, produces transitory effects. And just as different people will engage with different forms of music in different ways, it’s equally plausible that the cognitive styles associated with different psychedelics will be selectively appealing for specific traits of interpersonal variation.

    On this view, it the issue is less to do with the clinical efficacy of psychedelics than it is to do with the efficacy of clinical models as they apply to human well-being.

  24. Jonluw says:

    […] and get some weird form of LSD that might or might not work, using a procedure optimized to minimize hallucinations.

    I actually have some hope that this might not be the case. From what I’ve been reading, the studies so far have been careful to point out that the effect of psychedelics on depression, say, are not merely caused by the presence of a molecule in the patient’s system, but are in fact mediated by the experience induced by the psychedelic.
    Supposedly patients who, for whatever reason, did not have a mystical experience during the treatment did not receive the same benefits as those who did.
    If this is replicated going forward it might be hard for the regulatory agencies to get away with swapping the psychedelics for versions that don’t properly induce a psychedelic experience.

  25. J. Mensch says:

    Psychedelics have mostly been investigated in small studies run by true believers.

    I don’t think this can be overstated. Especially since true believers in (say) 5-HTTLPR just want a successful research program, whereas true believers in psychedelics have already melted their brain with reams of LSD and tend to have grand visions of a society liberated by pouring it into the water supply. I took part in a small clinical trial on effects of LSD and the people running it were all nuts.

    • Freddie deBoer says:

      I know a lot of people who have taken a lot of LSD who are immensely successful in conventional terms, in addition to very present and compassionate.

  26. Candide III says:

    1. Psychedelics have mostly been investigated in small studies run by true believers

    And administered to true believers, or at least people similar to those who run the study. How likely that random people off the street would agree to take trip-worthy doses of psychedelics for a study? Look at the original Griffith(2006/2008) participants – 97% college degrees, 53% postgraduate degrees, apparently recruited just by leafleting around John Hopkins. That’s bound to lead to non-representative results. I’d even say this is a straightforward extension of your principle of social science studies: if a result of a psychological study can be explained by selection (including self-selection) effects, it is explained by selection effects.

    a study two years ago found that psilocybin did not permanently increase the Openness personality trait

    Especially since “openness personality trait” as usually measured is just a proxy variable for support of socially progressive positions. There is no inherent reason why a pop of psilocybin should make someone like anal sex or unrestricted immigration.

  27. Steve Sailer says:

    How rigorously do experiments with psychedelics record drug-induced disasters? For example, I once knew somebody who decided to give a well-known psychedelic a try … and two hours later his street was full of smashed garden gnomes, angry neighbors, and police officers with drawn guns.

    Or do these incidents go in the “Let Us Never Speak of This Again” file?

    • Squirrel of Doom says:

      The therapy procedures take place in an office with a therapist that you talk to through the whole “trip”. The local gnomes should be safe.

      • Well... says:

        How long are these therapists willing to trip-sit in their offices? A friend of mine did mushrooms half a dozen times in his early 20s, and the very shortest of his trips lasted 5 hours. It was also very difficult for him to stay in one place, he had a real urge to get out and walk somewhere each time.

    • ksvanhorn says:

      Sounds like he didn’t have a sitter and didn’t pay attention to set and setting. Never trip without a sitter. Basically, you need someone trusted to whom you can outsource your judgment for the duration.

  28. Ashley Yakeley says:

    (one exception to this might be microdosing, which is a pretty new idea and might work differently from regular trips.)

    Worth mentioning (since he tends not to be wrong about anything): Gwern is skeptical.

    In my model of psychedelics, they artificially stimulate your insight system the same way heroin artificially stimulates your happiness system.

    Is this from your own experience of psychedelics? It seems like the wrong model to me.

  29. wearsshoes says:

    Two of the ways LSD could affect insight are (1) directly messing with the insight system, and (2) by messing with the input signal to that system. Scott argues the first in his point (6), but my personal experience leads me to prefer the latter.

    I think LSD looks a lot like causing one’s perception to experience feedback through signal delay. For a very simple toy example, say the sober pattern is for a neurons to receive for 100 ns and simultaneously transmit for 100 ns. If a neuron instead receives for 100 ns but delays the signal 10% [impossibly high value provided for clarity of demonstration] and transmits over 110 ns, but also begins transmitting the next packet on time, the next neuron down will receive a lossy copy of the packet with an afterimage from the previous packet laid on top of it. When that second neuron node transmits these packets to a third (I am making an additional assumption here that the afterimaged 10% becomes evenly distributed across the resultant new signal) and so on, the degradation and delay will increase again.

    This seems to be a plausible explanation for the trailing and colorshifting visual effects of LSD and why they get reset when you blink or change focus. Likewise the same putative phenomenon can explain how LSD characteristically distorts thoughts into extreme mood spirals (a feedback loop).

    As the signal becomes progressively worse, the insight system is increasingly fooled, even if its detection threshold has not changed. In summary, I think the hypothesis “LSD would make false insights more accessible despite not directly acting on the insight system” matches the evidence at least as well as Scott’s claim. This hypothesis also only requires positing a single mechanism, whereas if LSD did act directly on the insight system, a second mechanism might be required to explain the sensory and mental changes not directly attributable to a shift in insight formation.

    • Berna says:

      LSD characteristically distorts thoughts into extreme mood spirals

      That sounds scary! Looks like I was right not to take it, that one time when I had the chance.

      • Freddie deBoer says:

        Millions of people have taken acid without any such negative effects.

        • Conrad Honcho says:

          Sure, but one of my friends took it and saw spiders everywhere. I politely declined.

          • Nornagest says:

            What kind of spider? Some of them are pretty cute.

          • Doctor Mist says:

            Aughh! No thank you!

          • Psycicle says:

            I disbelieve this. The sort of hallucinations that LSD produces are more like perceptual warpings or distortions, not seeing something non-present. In general, the popular perception of psychedelics as making you see stuff that just straight-up isn’t there is wrong (with DMT as a notable exception).

            Interestingly enough, however, there is a class of drugs that just makes you see stuff that isn’t there. The exceptionally unpleasant, unadvisable, and unsafe class of drugs known as deliriants. Even more interestingly, there happens to be a commonly available one which consistently induces spider hallucinations! Diphenhydramine, aka Benadryl. The dose to hallucinate spiders is around 600 mg, though, and it’s a pretty terrible idea to take that much.

          • Conrad Honcho says:

            That’s what he said. Maybe he was lying, but I don’t know why he would.

        • John Schilling says:

          Millions of people have driven drunk without any accidents. Millions of people have chain-smoked cigarettes without getting cancer. I think that rationalists ought to be able to reason better than that.

          • Razorback says:

            About a million people die every year from car accidents. Do you avoid getting in cars?

          • Watchman says:

            That’s a seriously out of context statistic: if a million people die out of two million people taking car journeys then rationally you don’t drive. If its out of billions then perhaps rationally choosing not to drive because of the risk is an over-reaction. Anyway, you then have to consider the safety of the alternatives to driving whereas the alternative to taking psychedelics is generally not taking psychedelics so making that equation a lot easier.

      • wearsshoes says:

        The depressive mood spirals suck and you should ideally have someone you trust nearby to help talk you out of them. The uplifting ones are super great!

    • bzik says:

      I get a strong feeling this is close to the mainstream (but possibly somewhat outdated position). If I were to ask myself (specifically, the part that completed a neurobiology degree a few years ago) about how psychedelics work I get “something-something disruption of multimodal processing, alterations in sensory inputs, excessive activation of locus coereleus”. Haven’t checked on the subject in a while though.

    • zzzzort says:

      I feel like those two systems aren’t super distinct in reality. The process of perceiving something involves a bit of sensory input, and then a whole lot of post processing/interpretation at various levels. You can get perceptual effects by changing what features are considered important, and the strength of feedback in processing, ala Deep Dream. My guess would be that since psychedelics seem to have generally consistent, particular mental effects from person to person and drug to drug, it’s probably affecting something fairly high level.

  30. elusivepastry says:

    I tend to agree with the skepticism and at very least look to temper the fervor with which the new treatments are being embraced.

    As you said, you can absolutely get profound, permanent, depression-squashing or paradigm shifting experiences from the use of psychedelics… but you can often get the same from a really good talk with a close friend or therapist, a near death experience, a religious awakening, etc.

    As for whether it will effectively treat depression, I’m of the opinion that maybe we should be focusing on producing fewer depressed people rather than jumping at every treatment that seems like it may work.

    Instead of blasting our depressed brains with every new chemical combo that crosses our desks, how about meaningful exploration of the systemic and cultural causes of this depression epidemic to begin with? A more complex path than giving your cortex an acid bath for sure, but maybe a real fix exists.

    Is the fact that depression treatment is much more lucrative than depression prevention a coincidence? With the rise of psychedelic use among citizens, was it just a matter of time before the medical powers that be figured out how to effectively market and control the stuff?

    Your point on set and setting and how “government lab run by underpaid civil servants who just want to go home” is almost definitely NOT the ideal I’m with. I’d much rather kids do acid with their friends in the woods than in some clinic being monitored for weird behavior.

    Friends in the psychedelic space, through MAPS and other orgs, are excited for the developments. They see it as destigmatization and the opening of access to powerful tools for mental exploration and treatment. But I find it difficult to share their excitement.

    Saying that the legalization of gov sanctioned psylocibin treatment is opening access to powerful tools for mental exploration to me is like saying that Marlboro gives us access to the powerful spiritual experiences of a Peruvian tobacco ceremony.

    It’s never just been about the substances, but about the intentional and reverent use of such in meaningful ways to create lasting change for people.

    Without a meaningful culture of psychedelic use, grounded in open dialog and tradition around responsible use and respect for the power of the substances, I think we may be in for more harm than healing from the transition into an era of psychedelic medicine.

    • jasmith79 says:

      That’s a valid and important perspective, but the systemic causes you mention tend to be that way because they’re not particularly solvable, or contain tradeoffs, etc. Even in utopia some people will have bad things happen to them and still need to be able to function in society.

      As for the dangers of psychedelics, if they ever become mainstream there will be a transition period where some early adopters become collateral damage. This is an acceptable process cost if they help a bunch of people, which is why e.g. the FDA is fairly conservative about approval.

      • belvarine says:

        the systemic causes you mention tend to be that way because they’re not particularly solvable, or contain tradeoffs, etc.

        Unsolvable, or yet to be solved? Unacceptable tradeoffs, or unaccepted tradeoffs?

    • ksvanhorn says:

      you can often get the same from a really good talk with a close friend or therapist, a near death experience, a religious awakening, etc.

      I don’t think so. The problem is that a good talk may convince me intellectually, but not at a gut level. With psychedelics I can really feel things that I previously would have agreed with on an intellectual level, but that my hindbrain wasn’t buying into.

      For a specific example, until very recently I had never succeeded in talking myself out of a black, depressive mood. I could try to tell myself that, really, I had a lot of things to be happy and grateful about, but that never helped. The best I achieved was to remind myself that, based on past experience, the mood would eventually pass, so this was survivable if I just grit my teeth and hung in there.

      Five months ago I had a psychedelic experience that can only be described as feeling intensely OK. I wasn’t seeing the world through rose-colored glasses, I was entirely aware of all the things wrong with my own life and the world as a whole, but I felt that, nonetheless, life was on balance beautiful and good, and I could be content with what I had.

      Then recently I had a very bad day, feeling like shit both physically and emotionally. As bedtime approached I was still in a deep, black mood. I sat down, and tried to recall the feelings I had experienced under psychedelic influence. I repeated to myself the insights I took away from that experience. And… hot damn, it worked, better than I could have hoped! I felt again what I felt then. It was a very positive emotional experience that brought tears to my eyes. The black mood was gone, and in its place was a feeling of gratitude for the privilege of existing, for even having existed. I felt that if I were to die the next day, I could still die happy to have experienced the life I had already lived.

      • cuke says:

        This is a remarkable story, thank you for sharing it.

        I think we can have profound, life-changing experiences from conversations, books, dreams, all kinds of places. For it to be profound, it does need to register at a level beyond intellect, as you say. It’s not common and it’s not an experience we can summon in the same way we can take a psychedelic trip and produce a shift in experience or perspective. A meditation retreat can do it with maybe the same kind of reliability as a psychedelic experience.

        I have found that wherever the perspective-shifting experience came from, that the feeling of okay-ness in the big picture that it produces, the sense of lightening up about things, can last across years. We may lose track of it in the press of things, but having had it, it’s still available to return to, as you describe. It may not always dispel a very dark mood as it did for you, but it still has power to shift our perspective. This, to me, is what wisdom is.

        I think there is some conflation in how we talk about the content of psychedelic trips versus the awareness/feeling residue they leave. Like we may have “insights” while tripping that don’t hold up to the light of day — I still remember ones I had 30 years ago and how silly they sounded after I came down. The literal content of the “insights” no longer made sense. But the shift in perspective, the felt sense of a larger perspective and the okay-ness of one’s self in that light, that part seems lasting. So I think there’s a distinction between the kind of grand content-based “insight” that evaporates and the felt sense of a wider perspective and existential at-homeness in one’s skin. Trips can produce both of those things but they are different and of different importance.

    • Nornagest says:

      Instead of blasting our depressed brains with every new chemical combo that crosses our desks, how about meaningful exploration of the systemic and cultural causes of this depression epidemic to begin with? A more complex path than giving your cortex an acid bath for sure, but maybe a real fix exists.

      You know, I would be sympathetic, but every time I entertain a line of argument like this, the “systemic and cultural causes of the depression epidemic” turn out to be synonymous with “everything my professor/pastor/Jon Stewart is complaining about all the time”, and “meaningful exploration” turns out to mean “sit down, shut up, and listen”. Yet deep Blue and deep Red spaces both exist, and people are still depressed in them. So I’m getting pretty skeptical about our prospects for finding depression cures that way.

      • cuke says:

        I guess the one friendly amendment I’d offer to this — because I generally agree with you — is that some folks seem trapped in chronic depression because of having been raised without love or care. And they’ve gone on to live in environments that continue to deprive them of love or care because they don’t know how to hope for something else or to give themselves the kind of love and care that might lead them into environments where people know how to love and care.

        I see this a lot in my therapy practice. And then I go read about mental illness treatments in say Sweden where some people are sent to live with families. A family is ideally a unit of love and care. And in those environments, there seems to be evidence that people with chronic mental illness often get better. Like that there are families with love and care to spare and there are people for whom receiving it for the first time in their lives makes a huge huge difference.

    • ARabbiAndAFrog says:

      I am inclined to think that depression epidemic can not be fixed by anything short of apocalypse. My personal armchair theory is that delayed gratification became too delayed. A few centuries earlier I would already have a family with several kids some of whom might even have survived, be at peak of my career – or would have died in war. Now my life is only starting. The world is littered with people who expected gratification that never came because they did something wrong – how would I know I’m not one of them?

      Either this, or people were just better at dying.

  31. corticalcircuitry says:

    I highly suggest watching Woodstock: Three Days That Defined a Generation.

    Specifically the bit about how the Hog Farm was the security force.

    It’s people like that who will be able to design a productive environment for personal growth/treatment on psychedelics.

  32. badspeler says:

    If nothing else, psychedelics help expose people to an altered state of consciousness which gives you an experience with different habits of mind. If we think that depression and mental illness is related to habits of mind, generally, I’d expect psychedelics to be a useful tool, but I wouldn’t consider it as a wholesale “treatment” anymore than I’d consider a bicycle a treatment for obesity.

    In my experience with psilocybin, I get to experience life like I might expect a low-neuroticism person to experience able to approach facets of life without a towering ego. Over time, my high-neuroticism mental habits reassert themselves and I’m back to normal more-or-less.

  33. deluks917 says:

    I feel like I have gotten a lot of personal growth from LSD/psilocybin. In particular, I think I am much nicer, happier and mellower. LSD also sparked my interest in Buddhism which I practice daily. Just experiencing ego death is a very useful proof of concept. I also think psychedelics are useful for obtaining other hard to reach mental states and for integrating different parts of your mind. But mostly for the reasons in (7), I am not terribly excited.

    • deciusbrutus says:

      Do people who knew you over that period agree with each other about how much nicer, happier, and mellower you are now?

      Personal feelings are unreliable indicators.

      • dunkinsailor says:

        If you say you’re happier but a research scientist measures your brain and concludes “No you are not” – who is right?

        although for being nicer, there should definitely be a measurable effect, if present.

        • Kindly says:

          It’s hard but not impossible to be wrong about how happy you are.

          For example, there’s the usual peak-end heuristic; if you think about how happy you’ve been over the past year, your impression is not likely to be influenced by the “average” moment. This suggests, for example, that a job that’s constantly moderately stressful but occasionally very rewarding might make you think you’re happy, when in fact you’re usually happier at a job that’s reasonably enjoyable all the time.

      • deluks917 says:

        Yes. They definitely agree the change is real. The harder question is whether the cause is LSD or something like ‘getting older’. On the otherhand, the causal link between LSD and practicing Buddhism seems very direct.

        • Dragor says:

          And the causal link between practicing Buddhism and being nicer is pretty strong.

          Though this requires some defining of what Buddhism is along lines that yield niceness.

    • nameless1 says:

      I used to be into Buddhism for the same reasons, but got disillusioned. In a certain way, not the usual way, it is anti-intellectual. It is saying that much of thinking and rules of logic and all that are not of much value, because reality is an intellectually, verbally ungraspable “thusness”.

      It’s a seductive idea. Because yes I felt like so under acid. But it is weakening the most important tool we have for solving problems, our thinking, often verbally thinking, yes, often far too rigidly categorically verbally thinking minds. You don’t find a cure for cancer in zazen.

      How to even know that that blissful feeling is a sign of something really true? Barbiturates feel very blissful too. How to even know if that truly deep feeling wisdom merely feels deep?

      It is all about turning off parts of the brain so that we are able to listen to other parts. But if those parts had important things to say, surely there was a ore obvious way to listen to them?

      • dyfed says:

        My experience is that ‘truly deep-feeling wisdom’ is usually useless. ‘Personal insight’ often feels profound, but often doesn’t survive contact with others. Actual wisdom often disturbs what you would like to believe, is eminently practical, often cannot be told to others not because it doesn’t make sense but because they won’t believe you, feels stupid in practice, and requires humility to submit to. The difference is that actual wisdom works.

      • Hoopyfreud says:

        If those parts had important things to say, surely there was a ore obvious way to listen to them?

        This is straight-up the naturalistic fallacy. The importance of those things (which isn’t the same as their relevance) is decided entirely by you.

      • Radu Floricica says:

        Buddhism … varies. The dogma part might be of use, I don’t know. Religion generally is correlated with some pretty positive stuff, and buddhism in particular might also be designed to work complementary with meditation.

        But meditation by itself, I still think it’s very useful. Not in a drug-related, become one with the universe, feel the bliss way, but as a way to debug and improve parts of yourself.

        The way you’re expressing yourself suggest the premise that rationality and whatever buddism offers are incompatible – no, that they work in the same plane. I don’t think that’s true at all, even from a strictly system architecture PoV.

        Are you familiar with the Society of Mind ideas? We are more or less colonies of subsystems, not all active at the same time. The rational you is a certain collection of subsystems that includes lots of critics/checks, like a strong executive function and mostly system 2 stuff. The you that’s driving the car is a different collection of subsystems – same with eating, having sex and so on.

        If (and take this if as a given for now), if zazen is improving the function of some of those subsystems, there is nothing to say that 1. the executive function/system 2 stuff needs to be active while you’re doing it, and 2. that it has anything negative to do with how the rational you is functioning. So it’s perfectly ok to sit with your legs crossed and put your mind in non-rational states as an exercise, then get up and get on with your life.

        Now, dogma is a different thing. Dogma, especially taken literally, is influencing your day-to-day actions and may very well be anti-rational, and/or harmful. I have nothing to say on that – it depends on the specific content, context and how you’re interpreting it. What I’m saying is that plain meditation is in no way inherently anti-rational.

        • Dragor says:

          @radu The “society of mind” notion, or at least something similar to it is pretty common, at least among western Thai Forest monks. Often it’s called the “inner committee” and used to discuss different “I”s.

      • raemon777 says:

        > I used to be into Buddhism for the same reasons, but got disillusioned

        Is… is this not what is *supposed* to happen if you do Buddhism?