Abstract
Letheby’s naturalistic theory of psychedelic therapy argues that the therapeutic power of psychedelics lies in their ability to allow individuals “to discover the contingency, mutability and simulatory nature of their own sense of identity and habitual modes of attention.” The general shape of this project is persuasive; it is hard to see how the claim that successful therapy must involve changes to the self could be objected to, and Letheby sketches a consistent, if speculative, picture of psychedelic experience. But the role of affect in psychedelic therapy is insufficiently explored by Letheby as a comparison to MDMA-assisted therapy indicates. This comparison further suggests that Letheby’s reliance on a particular conceptualization of ego dissolution experiences is in need of further explanation and justification.
References
Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 30(12), 1268–1278. https://doi.org/10.1177/0269881116662634
Carhart-Harris, R. L., Roseman, L., Haijen, E., Erritzoe, D., Watts, R., Branchi, I., & Kaelen, M. (2018). Psychedelics and the essential importance of context. Journal of Psychopharmacology, 32(7), 725–731. https://doi.org/10.1177/0269881118754710
Danforth, A. L., Grob, C. S., Struble, C., Feduccia, A. A., Walker, N., Jerome, L., Yazar-Klosinski, B., & Emerson, A. (2018). Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: A randomized, double-blind, placebo-controlled pilot study. Psychopharmacology, 235(11), 3137–3148. https://doi.org/10.1007/s00213-018-5010-9
Haijen, E. C. H. M., Kaelen, M., Roseman, L., Timmermann, C., Kettner, H., Russ, S., Nutt, D., Daws, R. E., Hampshire, A. D. G., Lorenz, R., & Carhart-Harris, R. L. (2018). Predicting responses to psychedelics: A prospective study. Frontiers in Pharmacology, 9, 897. https://doi.org/10.3389/fphar.2018.00897
Letheby, C. (2021). Philosophy of Psychedelics. Oxford University Press.
Letheby, C., & Gerrans, P. (2017). Self unbound: Ego dissolution in psychedelic experience. Neuroscience of Consciousness, 2017(1), nix016. https://doi.org/10.1093/nc/nix016
Metzinger, T. (2003). Being No One: The Self-Model Theory of Subjectivity. MIT Press.
Mithoefer, M. C., Feduccia, A. A., Jerome, L., Mithoefer, A., Wagner, M., Walsh, Z., Hamilton, S., Yazar-Klosinski, B., Emerson, A., & Doblin, R. (2019). MDMA-assisted psychotherapy for treatment of PTSD: Study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology, 236(9), 2735–2745. https://doi.org/10.1007/s00213-019-05249-5
Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhart-Harris, R. (2019). Emotional breakthrough and psychedelics: Validation of the emotional breakthrough inventory. Journal of Psychopharmacology, 33(9), 1076–1087. https://doi.org/10.1177/0269881119855974
Roseman, L., Nutt, D. J., & Carhart-Harris, R. L. (2017). Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression. Frontiers in Pharmacology, 8, 974–974. https://doi.org/10.3389/fphar.2017.00974
Schmid, Y., Gasser, P., Oehen, P., & Liechti, M. E. (2021). Acute subjective effects in LSD- and MDMA-assisted psychotherapy. Journal of Psychopharmacology, 35(4), 362–374. https://doi.org/10.1177/0269881120959604
Sessa, B. (2018). Why MDMA therapy for alcohol use disorder? And why now? Neuropharmacology, 142, 83–88. https://doi.org/10.1016/j.neuropharm.2017.11.004
Sessa, B., Higbed, L., O’Brien, S., Durant, C., Sakal, C., Titheradge, D., Williams, T. M., Rose-Morris, A., Brew-Girard, E., Burrows, S., Wiseman, C., Wilson, S., Rickard, J., & Nutt, D. J. (2021). First study of safety and tolerability of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder. Journal of Psychopharmacology, 35(4), 375–383. https://doi.org/10.1177/0269881121991792
Sessa, B., Sakal, C., O’Brien, S., & Nutt, D. (2019). First study of safety and tolerability of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in patients with alcohol use disorder: Preliminary data on the first four participants. BMJ Case Reports, 12(7), e230109. https://doi.org/10.1136/bcr-2019-230109
Wolfson, P. E., Andries, J., Feduccia, A. A., Jerome, L., Wang, J. B., Williams, E., Carlin, S. C., Sola, E., Hamilton, S., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R. (2020). MDMA-assisted psychotherapy for treatment of anxiety and other psychological distress related to life-threatening illnesses: A randomized pilot study. Scientific Reports, 10(1), 20442–20442. https://doi.org/10.1038/s41598-020-75706-1
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2022 Sarah Hoffman