Chiara Caporuscio

The literature on psychedelic experiences often highlights their transformative potential. This raises ethical questions about informed consent in psychedelic-assisted therapy: if the altered state of consciousness induced by psychedelic drugs can profoundly alter a person’s value system in ways that are epistemically inaccessible to them beforehand, it is unclear whether their informed consent before the experience can be considered valid. I argue that this view stems from a simplistic understanding of psychedelic-mediated transformation, which overemphasises the power of the psychedelic experience in driving change. In most psychedelic-mediated changes, the experience of an altered state of consciousness is only the beginning of the transformative process: a lasting transformation requires patients to undertake a sober, authentic agential process following the psychedelic experience. I suggest that this two-step view of psychedelic transformation alleviates the pressure on informed consent.

The literature on psychedelic experiences often highlights their transformative potential. This raises ethical questions about informed consent in psychedelic-assisted therapy: if the altered state of consciousness induced by psychedelic drugs can profoundly alter a person’s value system in ways that are epistemically inaccessible to them beforehand, it is unclear whether their informed consent before the experience can be considered valid. I argue that this view stems from a simplistic view of psychedelic-mediated transformation, which overemphasizes the power of the psychedelic experience in driving change. In most psychedelic-mediated changes, the experience of an altered state of consciousness is only the beginning of the transformative process: a lasting transformation requires patients to undertake a sober, authentic agential process following the psychedelic experience. I suggest that this two-step view of psychedelic transformation alleviates the pressure on informed consent.

Delusions are defined by the DSM-IV as false beliefs about external reality. However, it is unclear whether introspective delusions, namely delusional beliefs that are wrong about one’s own experience, are also possible. One reason to doubt this comes from the fact that delusion and hallucinatory experience seem to go hand in hand, suggesting a strong relationship between the two. Empiricist theories argue that delusions arise from endorsing or explaining an anomalous experience. In this chapter, I will review the existing literature on the relationship between experience and delusional belief, and spell out the consequences for the possibility of introspective delusions. I argue that the current understanding of the relationship between experience and delusional belief leaves space for the possibility of introspective delusions; however, as our methods to access experience independently from introspective reports are still imperfect, it is still controversial whether specific candidates like Anton-Babinski Syndrome might be introspective delusions.

Belief change is crucial to therapeutic benefit in psychedelic-assisted therapy as well as in more traditional forms of therapy. However, the use of psychedelics comes with a few unique challenges that urge extra caution. First, drastic belief changes may occur faster than in regular therapy. Facing radical and transformative insights all at once rather than through a gradual process of discovery and integration can lead patients to a volatile, confusing or disorienting epistemic state. Additionally, we know psychedelic substances to generate hallucinatory experiences that come with a high degree of confidence and noetic certainty despite not necessarily being connected with reality. On the other hand, telling a patient which ones of her beliefs are true and which ones are not seems beyond the competence of a psychotherapist, if not an abuse of their authority and power. This is even more dangerous when psychedelics are involved, because power imbalance between patient and therapist is exacerbated by the therapist’s role as a guiding figure throughout an intense altered state of consciousness. Because of this suggestible state, the therapist’s beliefs might have a disproportionate influence, and even well-intentioned nudging might significantly stray the patient’s beliefs. How can a therapist help a patient navigate their epistemic uncertainty around psychedelic insights while preserving the patient’s autonomy? In this chapter, we will review different strategies to mitigate epistemic risks in psychedelic-assisted therapy, and argue that such harm can be significantly reduced.

This Symposium aims to contribute to the discussion on "Why Delusions Matter" by Lisa Bortolotti (2023), published by Bloomsbury. In her book, Bortolotti attempts to decouple delusions from pathology, and argues that delusions should not be dismissed as meaningless, because engaging with them at an epistemic level fosters a deeper understanding of the speaker’s perspective and agency. The Symposium opens with a précis of the book (Bortolotti, 2024a), followed by four commentaries that critically engage with Bortolotti’s argument. Bacchi (2024) suggests that insights from the authenticity debate in psychiatry could support Bortolotti’s claim that delusions could foster agency. Drawing from the literature and from her own lived experience with delusions, Russel (2024) explores the ways in which some delusions can be epistemically valuable. Williams (2024) challenges the implication that popular, non-clinical delusions deserve a more positive reputation. Vintiadis (2024) links Bortolotti’s work to the discussion on comforting delusions in psychedelic-assisted psychotherapy. The Symposium concludes with a reply from Bortolotti (2024b).

Chiara Caporuscio and Adrian Kind argue that psychedelic-assisted therapy is different from traditional therapy in an ethically fraught way and, as a result, arguably require ethical guidelines beyond those constitutive of traditional therapy. The way in question pertains to the therapist’s role as participatory sense-maker of the patient’s experiences and, with it, the balance of power between the therapist and the patient. In both traditional and psychedelic-assisted therapy, the therapist role as sense-maker can give rise to an imbalance of power between the therapist and the patient, such as when the therapist’s attempt at sense-making totally disregards the patient’s attempt at doing so. But in psychedelic-assisted therapy, the possibility of such a power imbalance is exacerbated. For, given her use of a psychedelic drug, the patient’s conscious experience is altered in such a way as to render her much more vulnerable than she otherwise would be. To give just one example, since the therapist is perceived by the patient to be an authoritative sense-making guide, the former’s attempts at making sense of the latter’s experiences can have much more influence on a psychedelically intoxicated patient’s interpretation of her experiences than they otherwise would have. Hence, Caporuscio and Kind’s conclusion that the ethical guidelines constitutive of traditional therapy are probably not sufficient for psychedelic-assisted therapy.

This special issue focuses on the Philosophy of Psychedelics by Chris Letheby in the form of a book symposium. Introduced by Matthew Johnson, Letheby presents the main claims of this book that explores the apparent conflict between psychedelic therapy and naturalism in a préci​s.​​ Seven contributions criticize, expand or comment on Letheby's arguments, focusing either on his proposed mechanism for psychedelic therapy or on the epistemic implications. The symposium concludes with Letheby’s replies to these commentaries.

Chris Letheby’s defence of psychedelic therapy hinges on the premise that psychedelic-facilitated insights about the self are in a better epistemic position than those about the external world. In this commentary, I argue that such a claim is not sufficiently defended. More precisely, I argue that one element is underexplored in Letheby’s otherwise compelling picture: namely, that unlike new beliefs about the external world, beliefs about oneself have the capacity to turn into self-fulfilling prophecies. Recognising the psychedelic experience and the subsequent integration process as opportunities not only to apprehend certain facts about the self but also to actively shape and redetermine those facts is key to understanding the epistemic differences between insights patients have about themselves and about the external world.

Introspection has traditionally been defined as a privileged way of obtaining beliefs about one’s occurrent mental states, and the idea that it is psychologically and epistemically different from non-introspective belief formation processes has been widely defended. At the same time, philosophers and cognitive scientists alike have pointed out the unreliability of introspective reports in consciousness research. In this paper, I will argue that this dissonance in the literature can be explained by differentiating between infallible and informative introspective beliefs. I will argue that the latter are formed similarly to beliefs about the external world, and are therefore susceptible to similar success and failure conditions. Understanding introspection as belief-like will help to locate possible sources of error in regular as well as in pathological cases, carrying relevant implications for the relationship between experience, belief, and delusion.

In his recent book Bad Beliefs and Why They Happen to Good People, Neil Levy argues that conspiracy theories result from the same rational processes that underlie epistemic success. While we think many of Levy’s points are valuable, like his criticism of the myth of individual cognition and his emphasis on the importance of one’s social epistemic environment, we believe that his account overlooks some important aspects. We argue that social deference is an active process, and as such can be helped or hindered by epistemic virtues and vices. With this in mind, holders of bad beliefs acquire more responsibility than is considered by Levy.