A Philosophical Phenomenology of Psychedelic Therapy

Clinical evidence suggests that psychedelic therapy is effective in treating various psychiatric disorders, and that undergoing the psychedelic experience is the crucial mediating factor of the therapeutic effect. Despite the clinical evidence, qualitative investigations remain rare. Interdisciplinary dialogue between philosophical phenomenology and clinical science can provide a valuable method to address this gap.

My proposed research would undertake the neglected task of clarifying the structures and defining features of psychedelic experience, as understood by patients, to better understand how psychedelic therapy works. By producing a phenomenological taxonomy of the kinds of experience that define the psychedelic-therapeutic process, my research will enrich the exclusively clinical view of psychedelic experience currently dominant.

And by understanding patients on their own terms, we can build a bridge between patient advocacy, clinical research, and philosophical inquiry. Introduction

In light of evidence from clinical trials, psychedelic substances have been championed as offering a therapeutic "revolution" for psychiatric treatment (Heal et al., 2023). There is considerable governmental investment in the future of psychedelic therapies: a £2.4 million clinical trial funded by the UK's Medical Research Council and National Institute for Health and Care Research (NIHR, 2022), a $27 million research grant from the USA's Department of Defence (Yakowitz, 2021).

Australia has re-classified certain psychedelic substances as prescriptible medicines (Australian Government, 2023). For advocates, psychedelic therapy is a key to understanding andachieving recovery from psychiatric disorders. Critics suggest that more research is needed. While scientific research is advancing, research in the humanities is lagging behind.

Advocates argue that psychedelic therapies work differently from approved psychiatric medications in that an experience or set of experiences is central to their effect (Roseman et al., 2018) rather than changes in specific neurotransmitters. Thus, the use of phenomenological methods to clarify these experiences has been called for by both scientists (Turton et al., 2014) and philosophers (Miceli McMillan and Fernandez, 2022).

What's more, the applicability of the same psychedelics to several disorders (transdiagnostic efficacy) also challenges the validity of current diagnostic categories, which is another area of inquiry where phenomenology has made important contributions (Fernandez, 2019). By following these research avenues, a phenomenological project can shed important light on the experientially-mediated benefits of psychedelic therapy.

Background

The clinical procedure of psychedelic therapy itself highlights the centrality of lived experience. The procedure consists of three stages: preparation, the session, and integration. Preparation involves meetings between the patient and study staff to develop "rapport and trust" (Griffiths et al., 2006).

In the session, the drug is administered, and the patient is monitored for eight hours in a comfortable environment. The patient is encouraged to lie down, wear an eye mask, and listen to a curated music playlist. The patient is instructed to focus attention inward and "trust, let go, and be open" to their experiences (Noorani et al., 2018).

After the session, the patient is guided to integrate their experiences into a meaningful narrative (ibid.). At each stage, the experience and its meaning for the patient is central and carefully cultivated.

In a smoking cessation trial, this procedure led to abstinence for 80% of participants 6 months post treatment and 67% at 12 months; the success rate of the most effective pharmacotherapies at 6 months and beyond is less than 35%(ibid.). A depression treatment trial reported antidepressant effect sizes "more than 4 times greater" than thosefound in standard antidepressant treatment studies (Davis et al., 2021).