Ethics and ego dissolution: the case of psilocybin

Summary & key facts

This paper looks at ethical issues from psilocybin experiences. Early clinical trials suggest psychedelics can help with some mental and substance-use problems. Psilocybin trips often include loss of usual self-boundaries, feelings of deep meaning or unity, and can change a person’s personality or worldview. The authors say these unusual effects create new risks and so call for a stronger, more detailed informed consent process in clinical settings. They offer specific topics and questions to cover in consent and discuss ethical concerns as psilocybin moves from research into regular care.

Key facts:

• Psychedelics were removed from medical research about half a century ago but have returned in recent early-phase trials.
• Early-phase trials suggest psychedelics, including psilocybin, may bring benefits for several mental and substance use disorders, but the evidence is still early.
• Psilocybin experiences commonly include loss of self-importance or ‘ego dissolution’.
• Users often report feelings of unity or connection with others during psilocybin experiences.
• People sometimes report encountering ineffable knowledge or a sense of ‘deep’ reality or God during these experiences.
• Psilocybin experiences can lead to significant changes in a patient’s personality and worldview.
• The authors argue these features pose novel risks that justify an enhanced informed consent process beyond what is typical for other psychiatric drugs.
• The paper focuses on psilocybin and offers discussion prompts and topics for clinicians to use in consent conversations, and it responds to potential objections about this approach.

Abstract

Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering 'deep' reality or God. In addition to symptom relief, psychedelic experiences often lead to significant changes in a patient's personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process-one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry.

Topics

Chemical synthesis and alkaloids Complementary and Alternative Medicine Studies Psychedelics and Drug Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Alternative medicine Feeling Hallucinogen Informed consent Law Mainstream Medicine Pathology Political science Psilocybin Psychiatry Psychology Psychotherapist Social psychology

Substances

Psilocybin

Conditions & symptoms

Depression Feeling disconnected from others