The Ontological Politics of Psychedelic Medicine

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FDA Decision on MDMA Therapy

- FDA Denial of LYKOS/MAPS Application: Matt introduces the surprising FDA decision to deny MAPS (Multidisciplinary Association for Psychedelic Studies) the ability to administer MDMA for PTSD treatment. The decision was unexpected given the promising data on MDMA’s effectiveness for treatment-resistant PTSD.

- Activist Resistance and Confounding Factors: The FDA’s decision was influenced by several factors, including activist resistance to the medicalization pathway for psychedelics. These activists raised concerns about the ethics and efficacy of MAPS' trials, including allegations of sexual misconduct by therapists.

- Implications for the Psychedelic Field: The conversation reflects on how this decision has created uncertainty and has significant implications for the future of psychedelic therapy.

Australia’s Approach to Psychedelic Therapy

- Regulatory Framework: Timothy explains Australia’s regulatory framework for MDMA and psilocybin, where these substances have been moved to a controlled prescription-only status for treatment-resistant PTSD and depression.

- Authorized Prescriber Scheme: The process in Australia requires psychiatrists to become authorized prescribers, involving ethical approvals and strict guidelines, contrasting with the U.S. model where substances like ketamine can be more easily prescribed off label.

- Cultural and Regulatory Differences: They discuss how different cultural and regulatory contexts impact the use and acceptance of psychedelics in therapy.

Mechanisms of Psychedelic Therapy

- Context-Dependent Effects: Timothy emphasizes that there is no such thing as a context-independent effect of any bioactive molecule, highlighting the importance of set and setting in psychedelic experiences.

- REBUS Model: Matt discusses the “Relaxed Beliefs Under Psychedelics” model proposed by Carhart-Harris and Friston, which suggests that psychedelics reduce the activity of the default mode network (DMN), thereby allowing for a loosening of rigid mental frameworks.

- Ego and Default Mode Network: The conversation explores how the ego is tied to the DMN and how psychedelics can disrupt this network, potentially leading to profound therapeutic benefits but also posing risks if not properly managed.

Philosophical and Ontological Considerations

- Non-Neutrality of Language: Timothy points out that terms like “drugs,” “medicine,” or “teachers” are all non-neutral and carry specific connotations that shape our understanding of these substances.

- Spiritual and Religious Framing: Matt and Timothy discuss how psychedelics often invoke spiritual or religious interpretations, a natural outcome given the historical and cultural contexts in which altered states of consciousness have been framed.

- Schelling and Ego Development: Matt references Schelling’s idea that mere reflection can be a spiritual sickness, proposing that the ego, while necessary, can become pathological if not transcended in a larger developmental process.

- Process Philosophy: They touch on process philosophy, where the ego is seen as a functional construct that needs to be integrated and transcended in the human developmental journey.

Challenges and Risks in Psychedelic Therapy

- Overcoming Grasping and Addiction: The conversation delves into the concept of grasping or addiction as a fundamental pathology, whether it be addiction to substances or to a rigid sense of self.

- Risks of Overuse and Dependency: Timothy warns against the risks of frequent psychedelic use, suggesting that repeated use without proper integration could lead to a new form of addiction or a reification of the experience.

- Faith in the Healing Process: Both emphasize the importance of faith in the healing process, where trusting in the reintegration of the ego after a psychedelic experience is crucial to avoiding negative outcomes.

Medicalization and the Role of Faith

- Faith and Placebo: Matt argues that faith in the healing process plays a crucial role in the efficacy of psychedelic therapy, likening it to a placebo effect that is integral to the treatment’s success.

- Challenges for the Medical Model: They discuss how the current medical model, particularly in the context of FDA regulations, struggles to accommodate the role of faith, expectancy, and the subjective and ontologically shocking nature of psychedelic experiences.

- Integration of Experiences: The conversation highlights the importance of integrating psychedelic experiences into everyday life, suggesting that the real work begins after the experience, in how these insights are applied and lived out.

Broader Implications and Future Directions

- Cultural and Spiritual Dimensions: Matt and Timothy reflect on the broader cultural and spiritual implications of psychedelics, questioning whether the current frameworks (both scientific and spiritual) are adequate to fully understand and integrate these experiences.

- The Future of Psychedelic Research: They express cautious optimism about the future of psychedelic research, noting that setbacks like the FDA’s decision might ultimately lead to more rigorous and thoughtful approaches to integrating psychedelics into therapeutic contexts.

- Ongoing Dialogues: The conversation concludes with plans to continue their philosophical exploration, particularly around the ideas of Charles Sanders Peirce, indicating a desire to further delve into metaphysical and epistemological questions related to their discussions.

Conclusion

- Final Thoughts on the Renaissance: Matt and Timothy acknowledge that the psychedelic renaissance is facing challenges, but they view these as opportunities to refine the approach and address legitimate criticisms, ultimately moving the field forward in a more sustainable and informed manner.

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