Pivotal Mental States (2020)
journals.sagepub.com
journals.sagepub.com
Unfortunately such flowery and offputtingly religious sounding language sounds quaint to our postmodern, secular ears. I think psychedelic, cogsci, and psychological research as explored in this paper offers fruitful avenues for recasting such religious or spiritual language in the vocabulary of science and empiricism.
Some things are improved by formalism, empiricism, and positivist reductionism. Some things are made worse by that kind of thinking.
Science is not always a process of "removing confusion". A mature scientist who can question science itself stops seeing it as a hammer and everything else as a nail.
Secular post-modernity is brilliant at giving us power plants, roads, and medicines. In other regards it's stunted our emotional and social development, bringing us to the brink of total war and social disintegration.
But that doesn't mean anything is made better by mysticism and appealing to some vague idea of transcendence.
If nothing formal can be said about a topic, then perhaps nothing at all can be said about that topic. Which is perfectly fine. It seems to me that so much of the available literature concerning such things is driven by the desperate insistence that it must be possible to investigate it, and if it cannot be done scientifically, there must be some other way.
"Whereof one cannot speak, thereof one must be silent." - Ludwig Wittgenstein
> But that doesn't mean anything is made better by mysticism and appealing to some vague idea of transcendence.
Actually it does. Let's talk about "better". Better for what, for who?
Some of the most powerful forces for positive change are stories. Stories are made-up, vague, hand-waving. metaphorical and allegorical. They occupy a different, parallel communicative realm to science, maths and equations. But they are no less true, particularly with regard to their utility if you want to communicate important ideas to lots of people.
Certainly, mysticism is not an analytical or investigative tool. But it is a powerful communicative, and - since you raise Wittgenstein - a powerful symbolic tool for word-concepts that "stand in for" formalisms.
To be honest I think that the way the younger generations relate to smartphones, the Internet and AI is very much mysticism. The words have changed, but I don't see concepts like "The Cloud" having any more substance than "Ectoplasm" and "ethereal spirits".
Again, that new generation mysticism isn't a bad thing, it's just a way of dealing with unfathomable complexity through stories that we can all share.
By contrast, ectoplasm is a pseudo-scientfic term for something that has never been demonstrated to exist under controlled conditions, and has a long tradition of association with known charlatans. The two aren't comparable at all.
Pile in enough abstractions and yeah, the cloud becomes magic.
Are there many mystical experiences that if you peeled away enough layers you could have rational explanations? Probably. But we don't, and in the meantime the mystical explanations do give us a big picture approach.
Yes, one can point to a specific computer and say that it is part of The Cloud, just as you can point to a neuron or person and say that is part of a brain or a society. But what does that really tell us about societies, brains or clouds? I'm obviously channelling an inner Douglas Hofstadter here.
The Cloud is something mystical not because it's an abstraction but because people don't care. It's more of an abdication than an abstraction. You can read a thousand comments here on HN literally saying stuff like "I don't care how it works".
We positively celebrate it's mystery.
It's not a noble-savage argument to ask, whether there is more intelligence and honour in the hopelessly unscientific, lost person who in their heart knows astrology is nonsense, but cares.... or the well educated scientist who has the capacity to deeply understand the Cloud but chooses not to as a "don't care" coping mechanism for complexity. That is what I mean by modern mysticism .
Postmodernism hasn’t been around long enough for any of that. Perhaps you meant “enlightenment”. It’s the “Age of Reason” that kicked society along this road. Post modernism has given us something else. A set of tools to deconstruct any human concept you can name, until it can be shown as meaningless. Which, I would posit, is the “end of enlightenment”.
Unfortunately the bullshit is useful when building things.
Enlightenment, Modernism and Post-modernism all being distinct things, no-one parodies their confusion better than Monty Python; What have the Romans ever done for us?
Is Post-modernism the end of Enlightenment? Maybe yes, but not in a 'bad way', simply that post-modernism is the last stage of enlightenment, when a developmental stage has attained self-awareness and self-critical capabilities.
First we had to become enlightened in order to see the limits of enlightenment.
I enjoyed reading this pithy summary of post-modernism. As for the parent post:
> it's stunted our emotional and social development, bringing us to the brink of total war and social disintegration.
This was the doing of "modernism", the age of reason, the enlightenment, and the industrial age. Post-modernism is the questioning and subversion of that grand narrative of objectivity, rationality, science, social progress.
From the wasteland of everything deconstructed as meaningless.. Hopefully something new can be born, maybe even a "spiritual language in the vocabulary of science and empiricism".
> The theory views psychological tension and anxiety as necessary for personal growth.
> These "disintegrative" processes are "positive", whereas people who fail to go through positive disintegration may stop at "primary integration", possessing individuality but nevertheless lacking an autonomous personality and remaining impressionable.
> Entering into disintegration and subsequent higher processes of development occurs through developmental potential, including over-excitability and hypersensitivity.
The same department recently completed a good-quality RCT comparing psilocybin and escitalopram (plausibly the most effective SSRI antidepressant) for the treatment of Major Depressive Disorder. While psilocybin was shown to be marginally more effective than escitalopram, the difference was not statistically significant. A subsequent Bayesian reanalysis did show a statistically significant advantage to psilocybin, but this difference was not clinically significant. Other RCTs investigating classical psychedelics have shown similar results.
There's a lot of excitement about psychedelics, a lot of hype, a lot of people who dearly want them to be a breakthrough (and god knows, we need a breakthrough), but the data we have just doesn't justify that excitement. This article presents a compelling narrative explaining why classical psychedelics might be a radically effective psychiatric treatment, but that amounts to nothing if psychedelics are not in fact radically effective; although it is still far too early to make any firm conclusions, the evidence we do have suggests that psychedelics are, at best, only a modest improvement over the current state-of-the-art.
This does not preclude the possibility that psychedelics could be the best available treatment for a subset of patients, nor does it invalidate the personal experiences of people who believe that they have experienced dramatic benefits from psychedelic therapy, but it is grounds for considerable caution. Pepole enduring the misery of mental illness deserve better than yet another cycle of hype and disappointment.
https://pubmed.ncbi.nlm.nih.gov/33852780/ https://pubmed.ncbi.nlm.nih.gov/37337526/ https://pubmed.ncbi.nlm.nih.gov/36322843/
Anxiety disorders are much better understood and more clearly delineated. And what we see in anxiety land is huge strides being made even just in new forms of therapy. Metacognitive therapy is starting to show real improvement over CBT. Pilot studies with a new form of intensive exposure therapy have shown staggering remission rates of over 70% in severe anxiety disorders like panic disorder(look up the Bergen 4 day treatment). MDMA-assisted therapy for PTSD looks very promising as well.
For depression, dissociatives have looked much more promising than psychedelics for a while now.
https://pubmed.ncbi.nlm.nih.gov/37127598/ https://pubmed.ncbi.nlm.nih.gov/36418989/ https://pubmed.ncbi.nlm.nih.gov/29774005/
I think you're probably right about multiple depressive subtypes that are inadequately differentiated; I think there's a particularly acute problem with the failure to differentiate between short, self-limiting episodes induced by specific life stressors and more durable illness characterised by chronicity and treatment-resistance. The data we've seen regarding elevated inflammatory markers and the associations with severity and chronicity might point towards a meaningful subtype that would benefit from a novel treatment approach, but it's still quite early to say; minocycline has fizzled out as a potential treatment, but the inflammatory pathways are at least worth investigating.
https://pubmed.ncbi.nlm.nih.gov/36103181/
PTSD is a bit of a strange one at the moment, because of the active debate about diagnostic criteria and thresholds; I'm somewhat concerned that an increasingly heterogeneous patient group might muddy the waters in research. I'll elide over the debate regarding cPTSD, because there seems to be far more heat than light. I'm not especially excited about MDMA-assisted psychotherapy for PTSD, but only because we've been seeing comparable effect sizes for specialised psychotherapy without MDMA; again, probably not a breakthrough, but potentially beneficial for a subset of patients.
(Es)ketamine is clearly very useful in the management of acute depressive crises, although I'm somewhat more sceptical about the general applicability for less acute and less severe depressive illness. If I had to wager, I'd say that the next meaningful advance will probably be novel NMDAR antagonists.
What does it mean for something to be statistically significant, but not "clinically significant"?
In this trial, the difference between the psilocybin group and the escitalopram group was, on average, two points on the QIDS-SR-16 scale. Those two points might represent someone reporting that their sleep has slightly improved, or that they feel slightly more energetic and slightly more able to concentrate. We can detect that difference in the analysis of the data and we can be somewhat confident that it's a real difference, but it's not the sort of change that most people would be able to distinguish from normal day-to-day variation.
Of course those very subtle differences might aggregate to a meaningful benefit across a whole patient population, but we also have to consider the cost-benefit tradeoff. A tiny benefit might be highly significant if the treatments were very similar in cost, but they aren't - escitalopram is a very cheap generic drug that can be safely prescribed by family doctors and nurse prescribers with minimal follow-up, while psilocybin currently requires a full day in a specialised clinic with significant preparation and follow-up.
https://alnursing.org/wp-content/uploads/2020/03/Depression-...
I'm afraid that the public interest in legalisation of psychedelics, motivated by positive experiences in recreational use, leads to a skewed narrative around their health benefits, as a means to open the door for their gradual acceptance and legalisation. This happened to marijuana as well, where health benefits of marijuana were grossly exaggerated to open the door to its legalisation, with medical marijuana as a segway. Marijuana can be harmful and abused, so even though I'm all for legalisation, people should have a balanced view of the benefits and risks to make more informed decisions. Luckily the risk and abuse profile of psychedelics is (much) lower than that of marijuana.
Sorry. Truly.
Is this measured in terms of efficacy alone, or are you also counting both literal $$ cost, and "cost" in things like side effects? Genuine question - apologies if the tone comes across as harsh at all - you seem like you know this stuff pretty well, and AFAIK those are the other major claims that psychedelics make against pharmaceuticals.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9760680/
We don't yet know enough about the safety profile of psychedelics to draw any firm conclusions regarding side-effects, because of the very small number of patients who have participated in clinical trials. If even a very small proportion of patients treated with psychedelics experience serious harms - and it's very plausible that they could, given the subjective intensity of the experience and the vulnerability of the patient cohort - then that could outweigh the more common but less dangerous side-effects of SSRIs. There are also potential risks that might not be apparent in carefully controlled clinical trials but might materialise in real clinical practice, for example the risk of patients with undiagnosed psychotic traits being prescribed psychedelics.
Truly dubious researchers will just tinker with the analysis to get the result they want without telling anyone what they've done, which absolutely was not the case here. These researchers followed the accepted best practice of publishing their intended outcomes and analysis methods before starting the trial, which is laudable.
The original paper used standard frequentist methods that are generally accepted by clinical journals, while their follow-up used more esoteric (and arguably more advanced) Bayesian methods. The decision to publish the re-analysis was justified, they were completely transparent about it, it doesn't reflect badly on their professionalism or integrity in any way whatsoever, but it does slightly smack of desperation.
Similarly, some of the authors of that paper subsequently published a paper criticising the validity of the main outcome measure they used, the QIDS-SR-16. The points they make are perfectly reasonable, the paper is informative, it's entirely plausible that they only lost confidence in the instrument because of what they learned from the trial, but it does seem a tiny bit desperate to be making those arguments after the fact.
https://pubmed.ncbi.nlm.nih.gov/37122239/
To be absolutely clear, the team at the Centre for Psychedelic Research at ICL are good guys. They're serious, they do all the right things in terms of research integrity and they clearly care deeply about patients. They worked through a dreadful mire of legal and bureaucratic barriers to get psychedelic research done on a meaningful scale. Nutt and Carhart-Harris and others are absolutely passionate about this area of research, and I just hope that they can find a way through if this disappointing finding proves to be the beginning of a dead-end.
I'd argue this is one of the very few fields where religion, specifically Buddhism, is more advanced than modern science. I'm not joking either, Buddhists have been concerned with this exact thing for over 2,000 years.
When studied, I think scientists will find that certain mystical practices induce these pivotal mental states, at least in a percentage of the population.
That's not to say people in the past have necessarily understood it. They experienced it and recorded it though, and the evidence of these collective experiences throughout time and space have turned out to be remarkably consistent.
My favourite thread throughout eastern and western philosophies, as well as modern psychedelic research, is how crucial dissolution of the ego is to attain clear perception (at least what we consider to be clear) and ultimately, more virtuous action in the world. Buddhists did it, Taoism, Hinduism, Stoicism... I'm sure there are others, but I'm not that well-educated, just interested in this stuff.
Many people will be strict about what qualifies as a science and exclude anything that appears to be religion or philosophy. I think it's worth taking seriously, though. I certainly wouldn't have 10 years ago.
Much of his writing proposes a few experiments you can try for yourself; the first line of "Liber E vel Exercitiorum" reads, "It is absolutely necessary that all experiments should be recorded in detail during, or immediately after, their performance."
Crowley was interesting in that he tried to bring an empirical, albeit subjective (since the target of study is the mind, psychology, subjective experience itself) and non-objective, non-quantitative approach to techniques of mysticism - meditation, breath work, and ritual, in particular.
Buddhism also contains some experimentation of its own - I am quite fond of Daniel M. Ingram's work with the "fire kasina" technique, in which clear steps for reproducing the result are given, and falsifiable claims are made about what (note: subjective!) phenomena will occur as a consequence of the experimental procedure. It is possible to reproduce such claims for one's self, given sufficient time and practice.
In the sense that some spiritual traditions and philosophies have as their subject of study the mind, and employ empirical techniques to gain insights into it, yes, I would say they are arguably sciences of mind.
That's useless if those "mystical practices" don't consist of precise, actionable instructions, whose outcome can be measured in a way that eliminates expectation bias.
The standard approach seems to be to give relatively vague guidelines for what to do, then if following those doesn't lead to any positive result, claim that the student either misapplied them, or didn't try hard enough, or tried too hard, or it wasn't their time, etc. etc.
Which is factually indistinguishable from "there's nothing to it but smoke and mirrors".
> That's useless if those "mystical practices" don't consist of precise, actionable instructions, whose outcome can be measured in a way that eliminates expectation bias.
They do and they can.
Instructions:
1. Sit on a cushion in a specific posture.
2. Think the thought of not thinking.
3. Do it every day.
I harm people around me when I don’t do this. I am being asshole.
When I do it, I’m less of an asshole. I am being not-asshole.
People say so. Even when I start practicing and don’t tell anyone (I’m a serial relapser when it comes to the cushion).
My expectation of “being not asshole” is always wildly different to the reality of it too.
That’s also part of the exercise/work. Learning to not pay attention to my own expectations.
Usually they’re wrong.
> The standard approach seems to be to give relatively vague guidelines for what to do, then if following those doesn't lead to any positive result, claim that the student either misapplied them, or didn't try hard enough, or tried too hard, or it wasn't their time, etc. etc.
Yeah. The vague guidelines are the point. It is part of the practice.
It’s not the student’s fault. Sometimes people just need to practice longer than others.
So teachers say things like: that’s just the content of your zazen.
Which basically means: Keep sitting on the cushion. Keep doing the work.
The work is never finished. Phrases like that are meant to be a form of encouragement or reminder.
> Which is factually indistinguishable from "there's nothing to it but smoke and mirrors".
“Magic” is just stuff people don't understand yet.
Whether that’s a good or a bad thing depends on individual perspective.
They're saying that with the use of psychedelics you can create super states in your mind.
> _Inspired by_ research with serotonin 2A receptor agonist psychedelics, we highlight how activity at this particular receptor can robustly and reliably induce pivotal mental states, but we argue that _the capacity for pivotal mental states is an inherent property of the human brain itself._
My experience with psychedelics in my youth was reckless recreation, and in my not-youth I'm fascinated by how it can be a tool to be a better me. I have a healthy enough respect for the medicine now to not just jump in willy nilly and it would be wonderful to learn if there are "new tricks" that the properly prepared psychonaut can put in play.
The Matrix has obviously become a cliche, but it's modern telling of Plato's cave allegory is handy.
Imagine if I could give you a "healing" pill. But I'll warn you, in my best Laurence Fishburne voice, that when you wake up you will see the world exactly as it really is, no more, no less. And even if you go back in the cave you won't be able to unsee it or relate to other cave-dwelling people.
There's a reason 99 percent of us take that blue pill every day. We like to have friends, go to dinner parties, wear acceptable clothes and say acceptable things.
Trauma sets you apart. That's the best way I can put it.
PTG is a 20 or 30 year process of adapting to so-called "super powers".
A movie they never made is "What ever happened to Will Hunting?" After Matt Damon hugged Robin Williams and drove off into the sunset... what came next? Drug abuse, alcoholism? A 20 year gambling spree in Las Vegas? Or just endless fun with Minnie Driver?
I'm not against recreational psychedelics, indeed I take the Bill Hicks view that they should be mandatory for some :) But to use them as a "pivotal" therapeutic shortcut to "wellness" doesn't seem to add up in my view. You'll still have to do "the work", sooner or later.
But I'd hate to encourage anyone to climb on, only to see them freeze in fear, and get stuck when the only way is up.
I think there are three things one should always bring to psychedelics or potentially life changing traumatic experiences
- some experience
- a question
- a friendPavlov's research with the salivating dog was part of an larger experiment to learn how to brainwash people. Not surprisingly, physical and psychological stress were found to put people into a highly receptive state where they could be taught new beliefs and behaviors.
This paper claims that some psychedelics can mimic that stress to put people into a similarly receptive state. Further, it says that the same underlying brain chemistry comes into play.
(At least that is how I understood it)