Abstract

In this presentation I will explore multiple big-picture domains relevant to understanding psychedelic therapy ensuring its safe adoption into mainstream clinical practice and science. It is not uncommon for high dose psychedelic experiences to involve what I call the “big questions,” for example: What is the meaning of life? What is the nature of reality? Does God exist?  I will argue that it is critical in clinical practice to let the patient determine her or his own metaphysical meaning, if any, from psychedelic experiences, rather than to impose or introduce the clinician’s own metaphysical beliefs, even ones that may seem innocuous to the clinician or scientist such as the “perennial philosophy.” Clinicians and scientists must avoid falling into the roles of guru or religious leader, and only introduce concepts grounded in their professional or empirically informed expertise.

Psychedelic experiences are also believed to increase suggestibility and to occasion highly personal and meaningful experiences for patients. For this reason, a common but dangerous tendency for clinicians and scientists is to assume that psychedelic therapy constitutes an exception to many accepted clinical and ethical norms. I will argue, however, that the intensity and meaningfulness of psychedelic effects call for even greater attention and adherence to the wisdom of clinical boundaries and norms. I will argue that scientists should do a better job with phenomenology regarding psychedelics, meaning that we need to be judicious in distinguishing insights that people claim to have, from what we can objectively claim to have learned from psychedelic research. Finally, I will argue that it is critical for psychedelic scientists to conduct research more honestly and not purposefully avoid data collection that they view as a societal threat to psychedelic medicine. This includes assessing the credibility of the blind, reporting on subsequent psychedelic use outside of trials, and more clearly describing adverse reactions. Following these suggestions will help minimize the cult-like atmosphere that will surround psychedelic medicine, minimize abuse of patients, and provide full warnings of adverse consequences when psychedelics are medically approved and available to many thousands of clinicians and patients.