By Manoj Doss
As a psychedelic researcher, I find myself increasingly frustrated by the tendency of the field to make lofty claims about the drugs that stray from the realities and limitations of the data.
For example, psychedelic research that uses neuroimaging employs measures of brain function that are, in fact, quite crude. Typically, one signal in a brain scan can mean many things (amygdala activation can occur when one is scared, happy, observing something salient, etc.).
For this reason, cognitive neuroscientists typically constrain mental activity using behavioral tasks in order to make more educated inferences regarding what is happening in the mind. Yet for some reason, psychedelic scientists believe they can infer mental function from the activity of a few tripping brains under task-free conditions. That is, participants are essentially doing whatever they want in the scanner, making the number of possible inferences one could make nearly infinite. And worse, they base their claims on outdated Freudian theory.
Such studies have led to an empty promise echoed by many psychedelic researchers: the claim that these drugs will teach us about consciousness.
What these studies actually tell us is something about the drug (e.g., psychedelics impair memory), not something about psychology or neuroscience (e.g., memory is stored in two distinct ways). I have yet to read a psychedelic study that has shed light on some underlying principle regarding the mind or brain (i.e., what cognitive neuroscience attempts to do).
It is quite clear that psychedelics produce feelings of insight. But a feeling of insight is not the same thing as an actual insight, and these feelings of insight have led to blind spots. For example, showing that music becomes more emotional under the influence of psychedelics is an interesting finding only if most other stimuli fail to become more emotional, and if other drugs fail to have this effect (yet I am sure that tripping and staring at a brick could be quite an emotional experience, and every drug under the sun is taken at concerts).
But this is not to say psychedelics lack promise. Psychedelics have supposed potential to treat depression, addiction, anxiety, posttraumatic stress disorder, obsessive-compulsive disorder, anorexia nervosa, sexual dysfunction, and more.
Our group did, in fact, find psilocybin’s effect on depression to be nearly three times what would be considered a large effect size and about six times the effect size of typical antidepressant medication. However, our sample size is small, and the study is neither placebo-controlled nor double-blind. Expectancy bias is likely at work here.
Nevertheless, these studies do get something important right. Before psychedelics are administered, patients have several day-long meetings with researchers and clinicians in which they discuss their family, romantic relationships, spirituality, traumas, past drug experiences, and more. After their psychedelic experience, patients return the following day and several times in the following months, with multiple points of phone contact in between. Study personnel are warm and open, and these sessions take place in an environment that I can only describe as a “vibe” (as opposed to the sterile environments typically associated with hospitals).
Although researchers contend that these steps are necessary for psychedelic therapy (despite the lack of research explicitly testing this claim), I would argue that this model should be applied to all of psychiatry. In fact, it might be even more important to build rapport and conduct multiple follow-ups with other medications. Before typical antidepressant medications improve depression, they can increase suicidal ideation – feelings a patient might be more likely to divulge if there were several opportunities to chat with someone who has already heard about their life and listened with compassion.
Perhaps we will one day find out that building rapport and having multiple follow-ups with compassionate personnel is, in fact, more important to potentiating psychedelic therapies than other forms of psychiatric treatment. However, I doubt that compassion is not at least additive to the benefits of other treatments, and this is where other medical fields can learn from psychedelic science. Hopefully, too, psychedelic science will learn from the rest of science how to properly study these drugs with an unbiased lens while being critical of inflated claims.
Manoj Doss, PhD, is a Postdoctoral Research Fellow at the Johns Hopkins Center for Psychedelic and Consciousness Research.
