
Is There a Case for Skepticism of Psychedelic Therapy? - abhi3
https://slatestarcodex.com/2019/05/09/is-there-a-case-for-skepticism-of-psychedelic-therapy/?
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boomboomsubban
> 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.

~~~
FireBeyond
I tend to disagree. I see as many comments along the lines of "We need to be
using psychedelics, now", how great they are, far more than "we need to be
clinically testing these drugs, now". Many have made up their mind, and the
trials (in their eyes) are only a confirmation / barrier to the adoption.

~~~
boomboomsubban
>Many have made up their mind, and the trials (in their eyes) are only a
confirmation / barrier to the adoption.

Have you asked these people if they feel testing is unnecessary? Proponents
are generally arguing against the ongoing prohibition, and their certainty and
urgency could still involve clinical trials.

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vlthr
I 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.

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empath75
Why 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!

~~~
wbl
Nothing stops people from putting Ornette Colman and Pink Floyd on the radio.
You don't need drugs just effort to appreciate them.

~~~
empath75
I was talking about the people _making_ music.

~~~
mythrwy
Legality (or lack thereof) doesn't appear to have stopped many musicians
before.

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carapace
The 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
\- 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?

~~~
AstralStorm
No, the brain cannot flood itself with serotonin on demand ever.

Dopamine, sort of maybe but only in extreme situations. Norepinephrine, maybe,
likewise.

Endocannabinoids, nope. Ampakines, way no. Glutamate, only in extreme
conditions. Other neuropeptides, likely no.

Do not try to weasel out of this statement without providing actual evidence
that any "mental" treatment comes close to drug effects. Or other unsourced
statements about "scattershot". Research had barely started.

(Not efficacy. Efficacy requires also psychological work, which can be
enhanced or retarded by drugs. Also to be evaluated.)

Experiences are unrelated to efficacy for treatment most of the time, unless
they are. I point you to studies of efficacy of prayer - not very.

~~~
SomeOldThrow
I think a different threads of conversation are conflated here. Both parties
are in an agreement, I suspect, that the LSD itself has no long term effect,
as least as acute psychological treatment. The therapeutic value is in how you
use the time. I think the parent poster who quoted O’Leary was saying that the
drug is not necessary for the therapy to happen in the first place. Without
that already reliable system of therapy in place, the chemical effects of the
drug are not going to give consistently therapeutic results.

~~~
AstralStorm
Do you mean like Prozac? :)

Other ergoloids are used for breaking really hard to treat migraines. They
work exceptionally well at that.

MDMA or analog could be a novel antidepressant.

Ibogaine (also a psychedelic) is already used for smoking cessation sometimes.
Works relatively well, all things considered, but not without risks (cardiac).
Now they're trialing it for alcoholism in Brazil. Maybe a chemical variant
that is safer could be devised if not for the dumb prohibitions.

And don't even start on THC and CBD.

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andy_ppp
Yes, 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?

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coldtea
> _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...

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api
Based 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
Upvoted you FWIW for talking sense.

(A nit: "set" refers in part to the "pre-existing content of your brain and
... biology.")

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scarejunba
Perhaps 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.

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Animats
He has a point. Many new drugs for anything are ineffective or a net lose,
measured by outcomes a few years later.

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anewguy9000
there is always a case for skepticism

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mistermann
This 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.

~~~
wutbrodo
> 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.

Huh, I just realized that for all the years I've been reading about him (and
the adjacent communities) talk about psychedelics, I've been implicitly
holding the assumption that Scott had done psychedelics.

~~~
mistermann
Considering the strangeness of the subject matter, I would think whether one
has personal experiences in the field would factor quite heavily into
interpretation of the writing of others, as well as the level of purely
speculative content in opinions on a forum.

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HillaryBriss
the 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
These 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.

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SomeOldThrow
I don’t think we’ve seen enough clinical trials for skepticism to have much
weight yet.

Edit: field studies → clinical trials

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monieseee
If 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.

~~~
BlueGh0st
I'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.

