Christopher Kochevar

Psychedelics are being investigated as therapies for major depression and other mood disorders, but the “tripping” experience remains poorly understood. This paper argues that the epistemic dimensions of psychedelic experience should be considered more carefully, both to characterize better the psychedelic state and to develop and explain therapeutic approaches. I propose a tripartite framework for three phenomenological regularities in psychedelic experience—fascination, revelation, and improvisation—and I relate them to everyday epistemic phenomena like curiosity, insight, and intellectual playfulness. I illustrate these regularities with first-person accounts of tripping, and I impact my discussion with a broader model of adaptive cognition, arguing that psychedelic experience, while extraordinary, is best understood as a modification of familiar processes. I conclude with recommendations for new approaches to clinical measurement in psychotherapeutic settings.

This paper attempts to integrate ongoing conversations about the nature and ethics of psychedelic-assisted psychotherapy (PAP) in order to clarify some outstanding ethical questions. First, I address a debate about whether informed consent is possible for “transformative” therapies like PAP, and I conclude that reasonable approaches to informed consent should not be considered especially difficult for PAP. Next, I argue that a focus on potential barriers to information about PAP has obscured a more central risk for the therapy – that posed by a PAP patient’s radical susceptibility to environmental influence, or what I call epistemic vulnerability. After expanding on this concept, I conclude that warnings about epistemic vulnerability should be a part of informed consent to PAP in all cases. Finally, I discuss more broadly the complexities of informed consent in PAP, drawing on analogous concerns for regular psychotherapy that may be addressed by a “process view” of consent. I propose that a “nondirective” approach to PAP may be more ethically supportable than other approaches, in part because of the theoretical benefit to patients from managing their own experience, prioritizing the potential for autonomous transformation.

In this paper, I explore scientific attempts to articulate a unified theory of the serotonin system and to explain the effects of psychedelic substances. I consider how certain accounts of psychedelic action have focused primarily on cognitive states, and I propose some phenomenological insights to supplement these models and inform work on psychedelics as therapeutic agents. Specifically, I argue that considering “psychological transformation” to be a core desideratum of psychedelic therapy should lead us to investigate the role of affect in guiding significant psychological change. The phenomenological tradition offers resources for describing the relationship between knowledge and affect, and I argue that epistemically significant affective states such as fascination and revelation are more central to psychedelic experience than is commonly acknowledged. I propose that understanding the role of affect in psychedelic experiences is critical to developing a plausible account of the potential for using these substances therapeutically.