Maximiliano Zeller

Psychedelic-assisted psychotherapies (PAPs) pose ethical challenges that existing normative frameworks cannot adequately address. This paper argues that the convergence of belief relaxation (the loosening of high-level predictive priors) and context amplification (the heightened influence of environmental cues on experiential content) generates a condition I call transient epistemic vulnerability: a state in which the individual's fundamental orientations toward meaning, value, and reality become structurally open to revision under heightened sensitivity to the normative dimensions of the therapeutic environment. Drawing on Clifford Geertz's analysis of the fusion of ethos and worldview, I argue that psychedelic experiences replicate a mechanism whereby normative commitments come to appear as descriptive features of reality under asymmetric conditions of interpretive power. I critically examine four leading proposals (Letheby, McGovern et al., Bortolotti, Bublitz) and argue that each remains within an epistemic register when the more fundamental challenge is ethical and contextual: the conditions of power, vulnerability, and interpretive authority under which beliefs and existential orientations form. I introduce normative capture to describe the risk that patients' orientations will be shaped by unexamined features of the therapeutic context, and propose structural reflexivity as a middle position between therapeutic passivity and active epistemic guidance. Five normative principles are outlined.

In January 2026, the American Psychiatric Association published a coordinated series of five programmatic articles outlining a strategy for the next revision of the Diagnostic and Statistical Manual of Mental Disorders. These documents acknowledge limitations of the current classificatory system, including the lack of natural kinds, the absence of zones of rarity, the scarcity of clinically usable biomarkers, and the persistence of diagnostic reification. I offer a textual and philosophical analysis of three of these documents, drawing selectively on a fourth, in order to examine the relation between their empirical admissions and their proposed reforms. The analysis identifies four recurrent patterns: a pragmatic circularity in which institutional arrangements that presuppose diagnostic categories are invoked to justify their retention; a peripheral reform that adds contextual, dimensional, and biological layers while preserving a categorical core; a promissory essentialism that sustains expectations of future biological validation; and an absorption of uncertainty that accommodates classificatory failure through more permissive diagnostic structures. These patterns converge in what is termed bounded reform: a structural constraint that arises when an institution attempts to transform a system on which its own authority and practical functioning depend. I argue that this constraint is sustained by two mutually reinforcing sources: a jurisdictional dependence of psychiatry on categorical diagnosis and a functional dependence on categories as the primary means of translating clinical complexity into action-guiding decisions.

Psychiatric classification has long struggled with a fundamental question: do diagnostic categories like “depression” or “schizophrenia” correspond with distinct diseases with unified biological causes, or are they pragmatic groupings of heterogeneous conditions? Recent reform proposals, exemplified by Steven Hyman’s influential work, reject the idea that current categories in the Diagnostic and Statistical Manual of Mental Disorders are natural kinds while maintaining that future research will eventually reveal the true biological structure of mental disorders. This article identifies a problematic pattern of reasoning in such proposals. I argue that reformist naturalism conflates two distinct requirements: the practical need to identify and track cases of “the same condition” across patients and studies, and the much stronger claim that all such cases share a single underlying biological mechanism. This conflation leads to what I call “promissory essentialism”: the assumption that psychiatric science must ultimately discover unified biological types, even as current evidence points toward heterogeneity. I show how this assumption inverts the appropriate burden of proof: instead of treating biological unity as a hypothesis to be tested, reformist programs treat it as a precondition of scientific legitimacy. Once this conflation is diagnosed, space opens for alternative approaches that take seriously the possibility that psychiatric categories may be irreducibly plural, grounded in overlapping mechanisms rather than unified essences.

Psychiatric classification has long struggled with a fundamental question: do diagnostic categories like “depression” or “schizophrenia” correspond to distinct diseases with unified biological causes, or are they pragmatic groupings of heterogeneous conditions? Recent reform proposals, exemplified by Steven Hyman's influential work, reject the idea that current DSM categories are natural kinds while maintaining that future research will eventually reveal the true biological structure of mental disorders. This article identifies a problematic pattern of reasoning in such proposals. I argue that reformist naturalism conflates two distinct requirements: the practical need to identify and track cases of “the same condition” across patients and studies, and the much stronger claim that all such cases share a single underlying biological mechanism. This conflation leads to what I call “promissory essentialism”: the assumption that psychiatric science must ultimately discover unified biological types, even as current evidence points toward heterogeneity. I show how this assumption inverts the appropriate burden of proof: instead of treating biological unity as a hypothesis to be tested, reformist programs treat it as a precondition of scientific legitimacy. Once this conflation is diagnosed, space opens for alternative approaches that take seriously the possibility that psychiatric categories may be irreducibly plural, grounded in overlapping mechanisms rather than unified essences. Accepted for publication in Philosophy, Psychiatry, & Psychology. Final version forthcoming.

En esta tesis analizo las implicancias conceptuales, metodológicas y prácticas del resurgimiento de las terapias con psicodélicos para los fundamentos de la psiquiatría contemporánea. A partir de una crítica del modelo biomédico hegemónico, reconstruyo sus supuestos: una nosología objetiva y ateórica, la equiparación entre trastorno mental y disfunción cerebral y la primacía del tratamiento farmacológico. La comorbilidad y heterogeneidad diagnóstica, la falta de biomarcadores específicos, la variabilidad individual y la eficacia limitada de los psicofármacos cuestionan ese marco. En este contexto, la investigación de la psicoterapia asistida por psicodélicos entra en tensión con el modelo biomédico debido a: la mejoría tras pocas sesiones, la centralidad del set y el setting, la integración y la alianza terapéutica, y el rol de la fenomenología (insight, catarsis, experiencias místicas) que desafían el reduccionismo y la separación entre fármaco y placebo. A la luz de esas tensiones analizo los modelos alternativos presentados (biopsicosocial, enfoque de perspectivas, pluralismos metodológico y explicativo, y enfoque enactivo), discutiendo los mecanismos neurobiológicos (incluida la neuroplasticidad y la modulación de la red por defecto) y defiendo una causalidad pluralista multinivel. Finalmente, examino obstáculos para los ensayos controlados y objeciones éticas (daño epistémico, consentimiento, despolitización y viabilidad del cambio de paradigma) proponiendo una psiquiatría centrada en la persona y su contexto con recomendaciones para su implementación clínica responsable. In this thesis, I analyze the conceptual, methodological, and practical implications of the resurgence of psychedelic therapies for the foundations of contemporary psychiatry. Based on a critique of the hegemonic biomedical model, I reconstruct its assumptions: an objective and atheoretical nosology, the equation of mental disorder with brain dysfunction, and the primacy of pharmacological treatment. Comorbidity and diagnostic heterogeneity, the lack of specific biomarkers, individual variability, and the limited efficacy of psychotropic drugs call this framework into question. In this context, research on psychedelic-assisted psychotherapy comes into tension with the biomedical model due to: improvement after few sessions, the centrality of set and setting, integration and therapeutic alliance, and the role of phenomenology (insight, catharsis, mystical experiences) that challenge reductionism and the separation between drug and placebo. In light of these tensions, I analyze the alternative models presented (biopsychosocial, perspective approach, methodological and explanatory pluralisms, and enactive approach), discussing neurobiological mechanisms (including neuroplasticity and default network modulation) and defending a pluralistic, multilevel causality. Finally, I examine obstacles to controlled trials and ethical objections (epistemic harm, consent, depoliticization, and feasibility of paradigm shift), proposing a person-centered and context-centered psychiatry with recommendations for its responsible clinical implementation.

Psychedelic-assisted psychotherapies (PAPs) have shown promise in treating mental health disorders, but concerns persist regarding their potential to elicit “false beliefs” through altered states of consciousness. Some argue that metaphysical or mystical beliefs conflicting with philosophical naturalism could signify “epistemic harm” in patients. We contend that such accusations may conceal a form of epistemic injustice by disqualifying non-naturalistic beliefs under a presumption of epistemic superiority, compromising the validation of pathologized subjective states. We argue that fostering exotic metaphysical beliefs in PAPs could be considered epistemically and medically benign, with the primary focus on generating positive mental health outcomes rather than instilling specific metaphysical convictions. We explore the capacity of PAPs to modify beliefs, examine allegations of epistemic harm and injustice, adresse the “comforting delusion” objection, and discuss the importance of respecting patients’ epistemic agency and cognitive liberty. We contrast philosophical naturalism with epistemic pluralism, advocating for the latter in PAPs. Finally we discuss implications for the future of psychedelic research and therapy, emphasizing the need to prioritize therapeutic outcomes over the specific beliefs elicited.

This work promotes the thesis that humans are naturally transhuman. In order to achieve this, we present in the first two sections some examples of technological devices assembled to human beings, and we critically review the assumptions and dichotomies on which the idea of human enhancement is based according to the ordinary transhumanist vision. Thirdly, we present the thesis of the Extended Mind to support our intuition. Fourthly, we dismantle the most relevant philosophical dichotomies that structure the transhumanist position. Finally, we recapitulate the reasons why we should wake up from the transhumanist dream.