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Is There a Case for Skepticism of Psychedelic Therapy?
- HillaryBriss 7y agothe answer used to be: yes, there's always a case for skepticism and critical analysis of a scientific topic but in today's enlightened discussion climate one must also consider the magnitude of the shit-storm of personal attacks one will face before voicing that skepticism. you even have to consider that before you make a comment like this one.
- hos234 7y agoThese days once a herd has assembled, you just got to cheer them on, in whatever mindless direction they are stampeding in. If they are going to fall off a cliff, the faster it happens, the better for everyone.
- lustysocietyorg 7y agoI do not know if you receive this post because I am shadow banned because I posted unwanted truth. I agree with your first sentence. I have upvoted your post. Unfortunately the second sentence is not always true. We all suffer from the insane democratic majority and the related media.
- api 7y agoBased on past performance there is a strong case for skepticism of <insert psychological theory, psychometric test, or treatment here>. The brain is perhaps the most complex structure in the known universe. In addition psychedelics are a notoriously YMMV thing. It's not like you take LSD and get a deterministic result. Every individual will have an individual experience and some can be quite negative. I have known people who had life changing positive experiences and really negative experiences that left them with PTSD-like symptoms. Set and setting matter a lot but so does the pre-existing content of your brain and I suspect your biology.
- carapace 7y agoUpvoted you FWIW for talking sense. (A nit: "set" refers in part to the "pre-existing content of your brain and ... biology.")
- boomboomsubban 7y ago> But recent discussion has been so overwhelmingly positive that it’s worth reviewing whether there’s a case for skepticism I think people are overwhelmingly positive about the thought of psychedelics facing clinical trials again, less so that they are a clear super drug. Skepticism is fine, but the limited data available was largely positive yet research was basically banned.
- thomascgalvin 7y agoExactly this. People are excited that an entire branch of research has opened up after being prohibited for decades due to ... reasons. Skepticism is the most important tenet of science, so of course there's room for it regarding the value or use of psychedelics. But the blanket ban on ever researching psychedelics was inappropriate, and the fact that there is a good possibility that these substances can significantly help with until-now untreatable conditions is definitely cause for excitement.
- deleted 7y ago[deleted]
- hwillis 7y ago> the limited data available was largely positive yet research was basically banned. Which is prima facie insane; these drugs are named for their ability to affect the brain, and have some of the most diverse and potent effects of known mind-affecting drugs. Especially since some of the most-wanted drugs, treatments for depression, are not that easy to tell from a placebo. When we treat an infection, a cancer, or an autoimmune response, we have a huge range of medicines including incredibly potent scorched-earth stuff. When it comes to the mind, our most powerful drugs are... lithium? Adderall? To be fair, we have very powerful antipsychotics but when it comes to more mundane disease we are just really underpowered. Adderall is a band-aid and even lithium isn't that great. We're crippling ourselves by not investigating more drugs. I don't expect to figure out the core mechanisms underlying the brain in the same way we can figure out, say, antibiotics and antivirals, but there are a huge number of psychoactive drugs and any of them could just be waiting to be weaponized.
- mistermann 7y agoThis is by far the weakest article of Scott's I've ever read. Granted, these were only "reasons for skepticism", but there's always reason for skepticism, this list as written seems more like advocacy for not even bothering to try, although perhaps I'm reading it more critically than the spirit in which he wrote it. 1. "...for example, a study two years ago found that psilocybin did not permanently increase the Openness personality trait. This was one of the most exciting studies and had shaped a lot of my thinking around the issue. Now it’s gone." Increases in openness were not permanent, therefore nothing of interest remains (for example, medium term increases, that can potentially be reinstated)? 2, 3, 4: Eventual disappointing outcomes of other over-hyped approaches. 5. Between 10% and 50% of Americans have tried psychedelics. If psychedelics did something shocking, we would already know about it. Largely depends on what he means by "did something shocking" I suppose. Regardless, they do indeed, and I'd wager that less than 10% of the population (despite his statistics seemingly indicating otherwise) has a remote clue about what they can do. Set and setting are not just important, they are crucial - doing psychedelics at a party at college and laughing it up with your friends is one thing, doing them while sitting alone in a quiet room with your eyes closed for several hours is something else entirely. 6. In my model of psychedelics, they artificially stimulate your insight system the same way heroin artificially stimulates your happiness system. This leads to all those stories where people feel like they discovered the secret of the universe, but when they recover their faculties, they find it was only some inane triviality. Well sure, many people say very silly things after using psychedelics (which is why people always say integration is so important). I suspect this would strongly correlate to intelligence or styles of thinking (say, high correlation with a lack of critical thinking, which is often found in spiritual communities in my experience). But this in no way implies there's nothing valuable among all the nonsense. 7. Even if all of the above are wrong and psychedelics work very well, the FDA could kill them with a thousand paper cuts. Again, look at ketamine: the new FDA approval ensures people will be getting the slightly different esketamine, through a weird route of administration, while paying $600 a pop, in specialized clinics that will probably be hard to find. This is a problem with the FDA, not psychedelics. -------------- If I was able to choose one person on Earth to do psychedelics and write about it afterwards, Scott Alexander would be my #1 pick by far. EDIT: I'm extremely curious about the reason behind downvotes, any explanations would be appreciated.
- scarejunba 7y agoPerhaps the studies are weak because we can’t study it easily. In any case, the drugs aren’t that harmful so we might as well give it a good shit to see if they work. I’d prefer them being legal even for the short term effects.
- monieseee 7y agoIf you watch Joe Rogan you'll often hear something like "if only more people took psychedelics, the world would be a much better place". There are places, like Peru, where psychedelics were in widespread usage for a thousand years. Yet Peru is not associated with an utopia, the best place to be on Earth, or anything of that sort.
- mistermann 7y agoThis is somewhat suggestive, but due to a massive amount of other variables involved, for it to be more conclusive you'd want to compare to another extremely similar country with minimal usage (or, spawn an alternate universe).
- BlueGh0st 7y agoI'm not sure if it's constructive to dispel super vague opinions with logical fallacies. In fact, I'm not sure what the point of the comment was at all, in retrospect.
- newnewpdro 7y agoThe world can be a much better place while still being nowhere near a utopia. There's a lot of ground to cover between the status quo and such an ideal.
- wutbrodo 7y agoSure, and claims that socialized healthcare systems don't wreck the economy are definitively falsified by the existence of Cuba. Or....the counterfactual isn't "arbitrary country without socialized healthcare (or history of psychedelic use)" , it's a hypothetical Cuba minus socialized healthcare (or a hypothetical Peru minus psychedelic use). Your conclusion is not remotely how basic logic works.
- empath75 7y agoWhy can’t we just be happy they’re thinking of legalizing psychedelics because they’re a lot of fun and fairly safe compared to alcohol? Think of how good pop music will be again!
- appleshore 7y agoAlso regular life is fairly traumatic and alternating. Doing therapeutic fun things with friends is rejuvenating and helpful for everyone not just those facing serious issues.
- wbl 7y agoNothing stops people from putting Ornette Colman and Pink Floyd on the radio. You don't need drugs just effort to appreciate them.
- drngdds 7y ago"fairly safe compared to alcohol" is a pretty low bar
- yahyaheee 7y agoHaha I’ve often wondered if in the future things like medical marijuana will mostly be a joke, folks just wanna felt high and have fun
- Animats 7y agoHe has a point. Many new drugs for anything are ineffective or a net lose, measured by outcomes a few years later.
- carapace 7y agoThe context of the trip is more important than the chemical. "Set and setting". I'm copying Dr. Leary's quote from the Wikipedia page https://en.wikipedia.org/wiki/Set_and_setting https://en.wikipedia.org/wiki/Set_and_setting > > Of course, the drug dose does not produce the transcendent experience. It merely acts as a chemical key — it opens the mind, frees the nervous system of its ordinary patterns and structures. The nature of the experience depends almost entirely on set and setting. Set denotes the preparation of the individual, including his personality structure and his mood at the time. Setting is physical — the weather, the room's atmosphere; social — feelings of persons present towards one another; and cultural — prevailing views as to what is real. It is for this reason that manuals or guide-books are necessary. Their purpose is to enable a person to understand the new realities of the expanded consciousness, to serve as road maps for new interior territories which modern science has made accessible. — Timothy Leary, The Psychedelic Experience: A Manual Based on the Tibetan Book of the Dead You can have a transcendent experience without any drugs at all. Your brain can perform all the chemical manipulations required in a much safer manner than e.g. flooding your system with synthetic LSD. If you have a therapeutic system that works in the first place then drugs would be a sideshow at best. Adding LSD to ineffective scattershot therapies will just amplify random aspects of the subject's psychology.
- mistermann 7y ago- You can have a transcendent experience without any drugs at all. - Your brain can perform [all] the chemical manipulations required in a much safer manner than e.g. flooding your system with synthetic LSD. - If you have a therapeutic system that works in the first place then [drugs would be a sideshow [at best]]. - Adding LSD to ineffective scattershot therapies will just amplify random aspects of the subject's psychology. The first point seems consistent with anything I've read on the subject, but the rest don't seem backed by anything I've read, if not contrary. (I've added brackets for emphasis on specific parts where applicable). If you could point me in any direction to some reading I've missed it would be appreciated. EDIT: I assume the reply below ("Do not try to weasel out of this statement...") is directed at the parent to my post?
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- SomeOldThrow 7y agoI don’t think we’ve seen enough clinical trials for skepticism to have much weight yet. Edit: field studies → clinical trials
- anewguy9000 7y agothere is always a case for skepticism
- vlthr 7y agoI don't know if psychedelics will turn out to have any medical value in the end, but I wouldn't be surprised if much of its failure stems from the way we try to fit it into the existing structures of medicine. Psychedelics amplify the perceived significance of many experiences, but what experience are you likely to be getting at a hospital or psychiatric facility? Every encounter I have had with modern medicine has been uncomfortable or even slightly demeaning. The way we practice medicine today has bought us repeatability and accountability of treatment, but with it comes an overwhelming air of impersonality. That's not an issue if you needed surgery, but if you're prescribed a transformative experience I'd say that might be a show stopper.
- andy_ppp 7y agoYes, it’s good to be skeptical when big claims are made. I have had one (heroic) experience of LSD and while it was one of the most peak experiences of my life I cannot say if it was positive or negative just that it was extreme. Fixes for some will come at a price for others in my opinion. As my friend said while looking me deep into the eyes at the end of our trip together “It’s not exactly what you would call recreational is it?”. Also I’d add that older minds find these experiences much more difficult to process/deal with. I believe research is good but can it be used if 5% of people have very negative reactions?
- coldtea 7y ago>Psychedelics have mostly been investigated in small studies run by true believers. This looks like ascertaining what it should prove. How do we know they were "true believers"? Because they did psychedelic studies? >Back when psychoanalysis was new, the whole world was full of people telling their amazing success stories about how Dr. Freud helped them obtain true insight and get real closure. I think of psychotherapy as a domain where people can get as many amazing success stories as they want whether or not they’re really doing anything right, for unclear reasons. Not an argument. >Between 10% and 50% of Americans have tried psychedelics. If psychedelics did something shocking, we would already know about it. Which psychedelics, under what conditions, how often? Also, I seriously doubt anywhere close to 25% has taken psychedelics, for example (a number halfway between the 10 and 50%). I don't have the numbers, but I'd say 50% was not even true in 1967 San Francisco...