Psychedelic therapy as reality transformation: A phenomenological approach

AbstractCoinciding with and responding to a growing crisis in the diagnostic, explanatory and treatment systems of psychiatry, the last couple of decades have seen a growing amount of evidence regarding the therapeutic potential of psychedelic drugs to treat a variety of mental health conditions. Broadly, this crisis can be construed as that of “indivi/dualist” approaches which aim to treat patients who are construed as separated from their social and material contexts, which are taken as given. The implicit premise: the self, but not the world, is the site of therapeutic intervention. By contrast, researchers insist that psychedelic therapy functions by on producing an experience of “connectedness” to self, world, and others, which is heavily influenced by context. However, by remaining in an indivi/dualist thoughtspace, neurological and psychological perspectives betray these recurring themes. In this essay, I approach psychedelic therapy for depression through the lens of phenomenological psychiatry to take these themes seriously–a task which passes by considering experience as embodied, and therefore embedded. Starting off from an analysis of depression as a bodily detunement (disconnection), I argue that, through a process of “immersive reflection”, psychedelic therapy transforms not only the self, but patients’ sense of reality. This will allow me to answer several questions pertaining to psychedelic therapy regarding its therapeutic mechanism, why it transforms reality and not only the self, why it transforms and not merely amplifies experience, why its effects last beyond the drugs’ psychoactive duration, and in what their paradigm-shifting potential for mental health consists of.