Abstract
Psychedelic-assisted Psychotherapy (PAP) combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder (MDD), and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (1) illness suffering, which relates to embodiment; (2) existential suffering, which relates to self-narratives, and (3) political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting.
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We have chosen to focus on these three authors to highlight complementarities between their work and, more broadly, between phenomenological and bio-psycho-social models of health and illness. Our analysis entails a degree of selectivity and simplification: we have set aside other valuable contributions to phenomenological literature, and we have glossed over some important disagreements within that literature. Nevertheless, we believe this analysis will add to an ongoing conversation between philosophy and medicine about how phenomenological accounts of illness, psychopathology, and altered experiences more broadly can explain the therapeutic effects of psychedelic experiences and inform ongoing research into their use in the treatment of mental illness.
Ratcliffe differentiates existential feelings from Heidegger’s concept of moods, but since this distinction is not relevant to our arguments here, we use all of these terms interchangeably and prefer the term ‘pre-intentional state’ as defined by Ratcliffe (2015).
This observation is consistent with qualitative research into the experience of life-threatening malignant disease (see, e.g., Little et al. 1998).
Interestingly a similar phenomenon seems to be observed in patients who experience temporary global amnesia (Hales 2020) – a parallel which perhaps warrants further investigation.
I.e., causal relationships between them are bi-directional: just as neurobiological dysfunctions can cause psychological symptoms that disrupt social experience, traumatic social experiences can impact on neurobiological development and behavioural responses to normal stimuli.
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Miceli McMillan, R., Jordens, C. Psychedelic-assisted psychotherapy for the treatment of major depression: a synthesis of phenomenological explanations. Med Health Care and Philos 25, 225–237 (2022). https://doi.org/10.1007/s11019-022-10070-7
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DOI: https://doi.org/10.1007/s11019-022-10070-7