Prescribing meaning: hedonistic perspectives on the therapeutic use of psychedelic-assisted meaning enhancement

Journal of Medical Ethics - Tập 47 Số 10 - Trang 701-705 - 2021
Riccardo Miceli McMillan1
1Doctorate of Medicine: Student, The University of Queensland Faculty of Medicine, Brisbane, QLD 4072, Australia

Tóm tắt

The recent renaissance in research on psychedelic-assisted psychotherapy is showing great promise for the treatment of many psychiatric conditions. Interestingly, therapeutic outcomes for patients undergoing these treatments are predicted by the occurrence of a mystical experience—an experience characterised in part by a sense of profound meaning. This has led to hypotheses that psychedelic-assisted psychotherapy is therapeutic because it enhances perception of meaning, and consequently leads to a meaning response (a therapeutic mechanism that has been well described in the philosophical literature on the placebo effect). The putative mechanism of action of psychedelics as meaning enhancers raises normative ethical questions as to whether it can be justified to pharmacologically increase the perception of meaning in order to heal patients. Using the perspectives of hedonistic moral theories, this paper argues that if psychedelics operate as meaning enhancers, psychedelic-assisted psychotherapy can be ethically justified. An anti-hedonistic objection is presented by applying Robert Nozick’s Experience Machine thought experiment to the case of psychedelic-assisted psychotherapy. However, it is argued that this objection falls short for two reasons. First, even if pleasure and pain are not the only consequences which have moral value they are not morally irrelevant, therefore, therapeutic meaning enhancement can still be justified in cases of extreme suffering. Second, it is possible that psychedelic states of consciousness do not represent a false reality, hence their therapeutic meaning enhancement is not problematic according to Nozick’s standards.

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Tài liệu tham khảo

Schenberg, 2018, Psychedelic-assisted psychotherapy: a paradigm shift in psychiatric research and development, Front Pharmacol, 9, 10.3389/fphar.2018.00733

Majić, 2015, Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences?, J Psychopharmacol, 29, 241, 10.1177/0269881114568040

Barrett FS , Griffiths RR . Classic hallucinogens and mystical experiences: phenomenology and neural correlates. In: Behavioral neurobiology of psychedelic drugs. Berlin: Springer, 2017: p.393–430.

Meaning MD . Medicine and the “Placebo Effect”. Cambridge; New York, NY: Cambridge University Press, 2002.

Hartogsohn, 2018, The meaning-enhancing properties of psychedelics and their mediator role in psychedelic therapy, spirituality, and creativity, Front Neurosci, 12, 10.3389/fnins.2018.00129

Sinnott-Armstrong W . The Stanford encyclopedia of philosophy: Consequentialism. Available: https://plato.stanford.edu/entries/consequentialism/

Shaver R . The Stanford encyclopedia of philosophy: Egoism, 2019. Available: https://plato.stanford.edu/entries/egoism/

Moore A . The Stanford encyclopedia of philosophy: Hedonism, 2019. Available: https://plato.stanford.edu/entries/hedonism/

Driver J . The Stanford encyclopedia of philosophy: the history of Utilitarianism, 2014. Available: https://plato.stanford.edu/entries/utilitarianism- history/

Crimmins J . The Stanford encyclopedia of philosophy: Jeremy Bentham, 2019. Available: https://plato.stanford.edu/entries/bentham/

Weijers D . The Internet encyclopedia of philosophy: Hedonism. Available: https://www.iep.utm.edu/hedonism/

Reiff, 2020, Psychedelics and Psychedelic-Assisted psychotherapy, Am J Psychiatry, 177, 391, 10.1176/appi.ajp.2019.19010035

Carhart-Harris, 2018, Psilocybin with psychological support for treatment-resistant depression: six-month follow-up, Psychopharmacology, 235, 399, 10.1007/s00213-017-4771-x

Hengartner, 2018, Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that the drugs work: effect size and method bias matter!, Front Psychiatry, 9, 10.3389/fpsyt.2018.00517

The Productivity Commission . Mental health productivity Commission draft report: overview and recommendations Australian Government: Productivity Commission; 2019. https://www.pc.gov.au/inquiries/current/mental-health/draft/mental-health- draft-overview.pdf

LifeLine Australia . Statistics on suicide in Australia. Available: https://www.lifeline.org.au/about- lifeline/lifeline-information/statistics-on-suicide-in-australia

Ampalam, 2012, A comparative study of caregiver burden in psychiatric illness and chronic medical illness, Indian J Psychiatry, 54, 10.4103/0019-5545.102423

Griffiths, 2006, Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance, Psychopharmacology, 187, 268, 10.1007/s00213-006-0457-5

Johnson, 2017, Long-Term follow-up of psilocybin-facilitated smoking cessation, Am J Drug Alcohol Abuse, 43, 55, 10.3109/00952990.2016.1170135

Corrigan, 2002, Understanding the impact of stigma on people with mental illness, World Psychiatry, 1

Letheby, 2016, The epistemic innocence of psychedelic states, Conscious Cogn, 39, 28, 10.1016/j.concog.2015.11.012

Nozick R . Anarchy, state, and utopia. New York: Basic Books, 1974.

Thoricatha W . What is the meaning of psychedelic? different terms for Entheogens and what they mean. psychedelic times, 2015. Available: https://psychedelictimes.com/what-is-the-meaning- of-psychedelic-the-difference-between-psychedelics-hallucinogens-and- entheogens/

Letheby, 2017, NATURALIZING psychedelic spirituality, Zygon®, 52, 623, 10.1111/zygo.12353

Fischman, 2019, Seeing without self: discovering new meaning with psychedelic-assisted psychotherapy, Neuropsychoanalysis, 21, 53, 10.1080/15294145.2019.1689528

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Journal of Medical Ethics

Tập 47 Số 10

701-705

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