What follows is the first chapter in my master’s thesis.
CHAPTER 1
Introduction
As rates of diagnoses of mental illnesses have increased over time, people have sought out new treatments to alleviate the suffering they cause. Psychedelics have been hailed as a wonder drug for the current mental health crisis.[1] As there has been a resurgence of interest in psychedelic drugs, growing numbers of researchers have devoted their time and attention to studying these substances. Most of this research is focused on figuring out the biological mechanisms of action for these substances. In addition to this, there is substantial evidence of these substances providing relief to those distressed by various mental illnesses. How exactly these substances heal mental illnesses is not yet fully understood.
These substances, rather than requiring the daily ingestion of a pill or months of psychotherapy, can work in as few as one or two sessions. One unique, key factor in this treatment approach is the utilization of experience, specifically an altered state of consciousness, in healing. I will argue against the conception that the sole causes of healing are non-psychological but that phenomenological evidence suggests that the psychedelic experience plays a causal role in healing.
To do this, first, I will lay out the role that an individual’s experience plays in their overall health and well-being. I do this by elucidating the biopsychosocial model of medicine and that each aspect affects the other parts of the individual using PTSD and depression as examples.
Then I will present data suggesting that it is the mystical experience itself that is doing at least some healing work in individuals who take psychedelic drugs. These experiences are cases of transformational change—experiences where an individual is transformed and, in some cases, healed. There are two types of this change, gradual and immediate. The psychotherapeutic process could fall under the gradual transformative changes. I will argue that psychedelics work in both gradual and immediate transformational changes.
Before getting into the aspects of the experience that seem to be key in the healing process I give a brief introduction to the physical and mental effects of a psychedelic experience, noting some aspects that are of particular importance to the healing process.
Once the basic experience is understood, I argue that one function of healing that psychedelic experiences can provide is insight into one’s own patterns of behaviors. I utilize Harry Frankfurt’s language regarding desires and volitions. David Velleman has a theory of motivation behind actions which centrally argues for the role unconscious narratives play in driving our actions. I utilize this argument to elucidate how the psychedelic experience provides both the ideal to aim for and the motivation to act out the ideal, which allows people to re-contextualize their lives and make fundamental changes resulting in healing.
I then explore how psychedelic experiences foster feelings of connection to other people and to nature and the central role that this plays in healing people’s relationships. The empathy-altruism hypothesis and in-group/out-group frameworks are utilized as a vehicle for this connection. I then discuss the concept of ego-dissolution and the role of death/rebirth in the psychedelic experience utilizing Evan Thompson’s conception of death as the ultimate transformative experience. This leads to the individual surrendering to death during the experience and to a transformation. Here I utilize L. A. Paul’s conception of personal and epistemic transformation and show how this pertains to healing of individuals.
I then suggest that the traumatic experience is a negative transformational experience that limits possibilities available to an individual and that the psychedelic experience works as a sort of reversal of that process. Part of that is promoting social healing which might be necessary for those with mental illnesses. Finally, I look at the role integration plays in causing lasting change from the psychedelic experience.
Biopsychosocial Model
In parts of medicine, the biopsychosocial model has been utilized to change the way we think about healing. This model views the biological, psychological, and social components as all playing a role in understanding people and their healing. In general, the biological components of pain, sickness, and health are readily accepted as causal. Somewhat less acknowledged are the psychological and social components. These are both experiential components. These other components were of core to one of the biopsychosocial model’s first proponents, George Engel.[2] He strived to elucidate a more holistic approach to health recognizing that patients are situated in a particular world that includes all of their experiences, their thoughts, feelings, and their personal history. Acknowledging this, he argued, gives doctors a more complete understanding of their patients and what is needed to treat them. Engel argued that the body alone doesn’t contribute to an illness. The individual’s psychological and social factors play an important role in both the cause of an illness and in the treatment of an illness.
This model is particularly relevant to health and wellness. The experiences of a person greatly change the way their physiology functions and how they experience it. What is salient to a person is directed or guided by their social and psychological experiences. For example, how tired someone feels can greatly increase the amount of pain they experience compared to when they are well-rested.[3] The more tired they are, the more pain they feel. The amount of stress one is under changes the way pain is felt, generally increasing the severity of the pain in a similar manner to tiredness.[4] The familiarity with a certain type of pain alters the experience of it. Repeated exposure to a specific physical pain lessens the felt pain, despite the levels of pain remaining constant.[5]
Social interaction influences the way our bodies work as well. The general feeling of loneliness is associated with higher blood pressure and risk for heart disease.[6] Additionally, experiencing loneliness for a sustained period of time increases the chance of dying by 26 percent, particularly in elderly people.[7] People of all ages who are lonely are more susceptible to diseases and less able to fight off immediate threats to their body or immune system.[8] Felt pain is decreased by those who feel a sense of social inclusion and greater in those who felt socially isolated. Those with a healthy sense of social inclusion are more able to fight off illness and diseases.[9] Robert Sapolsky, a neuroendocrinologist, found that a “fighting-spirit” as he calls it, and a healthy support system and coping mechanisms greatly increase the body’s capacity to fight cancer and, in almost all cases, increase the life-span of cancer patients.[10] Those without healthy social support are more likely to have worse and more frequent relapses of symptoms in chronic illnesses than those with social support systems.[11]
In a study on depression in patients with rheumatoid arthritis, researchers found that “helplessness and passive coping were significant mediators of the relationship between physical disability and depression and pain.”[12] What was also noted though, was that previous experiences of pain and past and current social support also influenced the participant’s well-being and ratings of pain. Those with less pain reported less intensity of depression and greater social support and those with tried and effective coping mechanisms also reported less pain similarly to the research done by Robert Sapolsky noted above.
Experience is shaped by biological, psychological, and social factors. We are fundamentally embodied and social beings. The way experiences are psychologically or socially perceived shape the way our bodies respond to the world around us. Pathological experience is driven by and leads to problems physically, mentally, and socially. In a similar fashion, the etiology of mental illnesses can be found in not just the biological functions of the body, but in the environment and social context in which an individual is situated. It is well documented that many mental illnesses develop from the environment in which an individual is located. There are infinite situations in which a mental illness can develop. PTSD can occur in soldiers in war, a social conflict. It can occur in individuals who experienced emotional, physical, or sexual abuse at any age of life, a social and psychological conflict. Depression or anxiety can find their cause in any sort of abuse, neglect, or repeated situations in which the individual attempts to adapt to a negative environment. Look at children who were attached and whose needs were being met consistently while young and those whose needs were not. Children who had soothing can auto regulate emotions and the self. They can be healthy functioning adults. Those whose needs weren’t met must calm and regulate through some other method, be it complete dissociation (resulting in severe trauma), partial dissociations, or other coping mechanisms that helped the individual survive the circumstances which later became problematic.[13]
These sorts of examples illustrate the circumstance, the social and psychological environment, playing a role in the development of a disorder, which leads to changes in their physiology and biology. In other words, their experience plays a causal role in the development of their physiology. In cases of trauma, a single moment can lead to lasting physical changes in the brain. Experiences, whether personal or subpersonal, are imprinted on both the mind and the body. Cells imprint and record memories.[14] This information is used in development and growth of new cells. The experience itself, whether positive or negative in nature, alters the physiology.[15] If these negative experiences can have long-lasting negative effects on mental health and physiology, then it is only logical that a positive experience can have long-lasting positive effects on mental health and physiology. If this is true, then just as a single negative experience can transform an individual in an instant, a single experience can facilitate healing and changes in individuals. This is exactly what is occurring in the healing effects of the psychedelic experience. It is not just the physiological effects of the drug that is causing the healing in the individuals, though it probably has a beneficial effect on it. I will argue that it is the experience had under the influence of the drug itself that is doing the work for the individuals in healing. One illness it is particularly potent for is depression.
Depression is an example of this social and psychological context for mental illness. It has been characterized as a sense of disconnection from other people in addition to one’s self.[16] Matthew Ratcliffe has been working on the phenomenology of the experience of depression. He notes that the theme of painful disconnection from other people is a prominent feature of nearly every first-person account of depression, regardless of the source it comes from.[17] Furthermore, he notes that in depression people say their world has been altered. He suggests that the ‘world’ that is altered in depression is a rough comparison to the experiential world that one is immersed in, the one that phenomenology attempts to investigate. And, in depression, the shift in the experienced world can be described in terms of an altered sense of the way one experiences them‘self’, a change in the way one experiences possibility in the world.[18]
On the experiential aspect of depression, David Karp notes,
It was impossible to listen to depressed people without being struck by the frequency with which themes of “isolation,” “withdrawal,” and disconnection” came up. As with all feelings and emotions, isolation is experienced in different degrees and hues. Some individuals feel obligated to withdraw from virtually all arenas of social life. Most people though, unless they become hospitalized, struggle through their daily obligations, sometimes heroically maintaining a façade of “normalcy.” Others may continue to associate with friends and family while nevertheless feeling disengaged, uncomfortable, marginal, and profoundly alone.[19]
What Karp’s observations exhibit is the social and psychological impact of a pathological experience. The way these people experience the world drives them to outward and inward isolation. Despite the proximity of people around them, the possibility of connection does not exist. Their lived world is different than from before.
Further characterizing this isolation, Karp continues,
We all necessarily make distinctions among people in terms of their capacity to appreciate our inner life. Thus, the decision to keep the pain of depression private casts others into the status of strangers, persons who are near and distant at the same time. They may be proximate in an immediate physical way, but they are perceived as distant because we do not share with them the perceptions and emotions that most centrally define our experience of the world. Since depression dominates one’s ‘lived world,’ keeping it secret dramatically distances sufferers from everyone, including family and friends with whom they might have a significant volume of daily conversation.[20]
One consequence of the characterization of depression by Karp and Ratcliffe shows that those with depression, distance themselves socially. This distance, social isolation and loneliness, then causes increased risks of diseases and death and decreased ability to fight off infections and illness, which is to say that their experience alters their physiology.
The way one experiences the world plays a role in their health and wellness. Problematic experience can lead to problematic biological functions. If this is the case, then healing or fixing a problematic experience, can help heal the physical. Help a person connect, and their depression will begin to abate. Connection is an experience and it gives rise to other experiences. If so many types of experience can cause a mental illness to occur, it would make sense then that an experience could facilitate the healing of said illness. Likewise, the psychedelic experience helps a person heal themselves.
In psychotherapy, one way to treat pathological experiences, it isn’t any drug that is doing the work. It is the experience and process of therapy that lead to healing. Drugs can and are used in conjunction with therapy, but they aren’t the whole picture. Likewise, the pharmacological part of psychedelics in healing is relevant, but it isn’t the whole picture. The experience is part of the healing picture. According to some researchers, it is a specific type of experience that is doing healing work—a mystical experience.
Psychedelic Healing and Mystical Experiences
It is well-understood that psychedelics are healing. Substances such as psilocybin,[21] LSD,[22] ketamine,[23] ayahuasca,[24] etc. are known to alleviate PTSD, depression and anxiety generally, depression and anxiety in end-of-life cancer patients, obsessive-compulsive disorder, addictions, and other ailments. The biological mechanisms of action behind the beneficial effects is not fully understood as of yet, but progress continues to be made.
Some might argue that the experiences and healing that occur to people who take psychedelics is just an epiphenomenon of the drug’s interaction with the brain. In other words, the experience itself is simply a byproduct that has no causal impact on the healing process. This is not the case. The experience itself does play a causal role in the healing property of psychedelic drugs. This is not to say that the physiological effect of the drug isn’t providing any benefit, but rather to say that the experience is also playing a causal role in the healing. Beyond people simply attributing their healing to the experience they have on psychedelic drugs, there is empirical evidence that the experience itself is correlated with improved outcomes in various patients. For example, the mystical experience has been implicated in studies regarding end-of-life cancer patients, those with depression, anxiety, addictions, and OCD. What these studies show is a correlation between a certain type of experience, a mystical one, and a positive healing outcome after a psychedelic experience. What they don’t explicitly exhibit is a cause or an explanation for what parts of this certain type of experience leads to healing outcomes and why. They explore certain neurological correlates of these outcomes, but what I am interested in here is the specific experiential aspects of healing in the psychedelic experience. This cause or explanation for the parts of the experience that lead to certain healing outcomes will be what I will undertake.
A mystical experience exhibits a few key features. They include internal unity (pure awareness, merging with ultimate reality, loss of internal boundaries within the self or external boundaries between the self and environment), external unity (unity of all things, all things are alive), transcendence of time and space, ineffability and paradoxically (claim of difficulty describing the experience in words), a sense of sacredness (awe), a noetic quality (i.e. sense of direct knowledge of ultimate or higher reality), and a deeply felt positive mood (e.g. joy, peace, love, connection, etc.).[25] The exact characterizations of the experience differ widely from person to person, but these features are common among most mystical experiences.
In end-of-life cancer patients, high doses of psilocybin, which are more likely to induce mystical experiences, significantly improve depression and anxiety compared to those given lower doses which are less likely to induce mystical experiences. The analysis done suggested that it was the mystical experience produced by the high dose of psilocybin that caused the positive therapeutic outcomes in patients.[26] In two studies, researchers found that the mystical experience was the mediator between the psilocybin experience and the healing of depression and anxiety.[27] Participants were either given a large or a small dose of psilocybin in two sessions. All were placed in a similar aesthetic environment with the same music. After the session, participants were given four questionnaires to answer regarding the session: Hallucinogen Rating Scale, 5-Dimension Altered States of Consciousness, Mysticism Scale (Experience-specific 9-point scale), and the States of Consciousness Questionnaire. Additionally, therapeutically relevant measures were given prior to the session, at their baseline level, 5 weeks after each session, and 6 months after the last session. What they found was a strong correlation between the reduction of symptoms of those with depression and anxiety and the strength of the mystical experience had during the psilocybin session. Without that type of experience present during a session, healing occurs with substantially less frequency.
It appears that the LSD experience provides the same mystical experience/healing effect as psilocybin when given at higher doses. In a study done using 20 micrograms of LSD as the placebo (not enough to induce strong experiences) with 200 micrograms of LSD as the effective dose (150 micrograms is typically a “blast-off” dose), the group that received 200 micrograms of LSD reported significant reductions in anxiety at a 2-month follow-up exam, while those who received 20 micrograms actually reported increased anxiety over the same period at the follow-up.[28]
In patients suffering from depression and anxiety, higher ratings of the mystical experience were significantly related to lower depression scores 5 weeks after the psilocybin treatment.[29] In another study using ayahuasca in non-patients, individuals who participated in the ceremony had significantly decreased ratings of depression and anxiety in the days and months after the ayahuasca ceremony compared to before the ceremony occurred.[30] Further, the size of the ratings of decreased depression and anxiety after the ceremony were significantly related to the extent of the mystical experience or ego dissolution that occurred in the experience.[31]
Additionally, in the case of addictions, the mystical experience plays a factor in the ability to quit and continually abstain from the substance of choice. One study focusing on smoking addictions found that the participants with stronger mystical experiences in psilocybin sessions were more likely to be successful in quitting smoking than those with weaker ones.[32] In another study, which focused on alcohol addiction, found a significant relation between higher mystical-type experience scores in the first psilocybin session and decreased alcohol use.[33] It is important to note that it is not just the intensity of the psychedelic experience in general that is key factor in producing positive outcomes; it is the intensity of the mystical experience within the psychedelic experience that is correlated with positive outcomes in those who are addicted.[34] A study done with ketamine focused explicitly on whether the mystical experience or dissociative effects were relevant to the therapeutic benefits.[35] They created two separate measures, one for mystical experience effects and another to measure dissociative experience effects (feelings of detachment from self or environment or loss of sense of reality). They found that scores higher on the mystical experience factor regardless of the dissociative level or dosage was correlated with increased motivation to quit cocaine usage. This was not the case with a higher score of dissociative experiences. The mystical experience, not the dissociative effect, was the key factor in motivation to quit cocaine.
It is already well established in the psychedelic literature and community that set and setting play an important role in the psychedelic experience and efficacy of the drugs. The environment in which one does the drugs impacts the healing efficacy of the drugs. Drugs taken in an unsafe space, around unfamiliar people have a greater chance of inducing a so-called “bad trip” while drugs taken in a safe environment, with trusted individuals, and with support are more likely to have a positive trip and have increased healing effects.[36] That is, the environment one takes the drug in alters and shapes the nature of the experience the individual has which in turn influences the healing efficacy of the drug. If the environment plays such an important role in the healing effects, then it would seem that the biological and physiological effects of the drug cannot be solely responsible for the healing that occurs.
As the above studies show, the specific physical effects of the drug alone can’t account for the lasting therapeutic benefits.[37] For any substance to change behavior for extended periods of time after a single use would need to permanently alter brain physiology. These changes would be considered biological, but the psychological response to the experiences had under the effects of the drug could potentially play a role in changing the physiology as well. This would be similar to the biological brain changes that are induced by psychologically traumatic experiences. And, while it is vital to understand the biological mechanisms of action behind these drugs, a closer look at the experience itself and how it plays a role in healing can shed light into the nature of the healing process more generally. One major player in the healing process is that of transformational change.
Transformational Change
Transformational change has been associated with positive therapeutic and healing outcomes in various mental illnesses and disorders. What I will argue is that psychedelic experiences aid in and produce transformational change, both gradual and instantaneous. Psychedelics produce noetic moments, or moments of insight, which lead to healing and/or change. They also take an individual through the therapeutic process which results in a healing outcome.
There are two major types of healing or change therapeutically, there is a gradual process of transformation and there is an immediate healing or transformation. Most are familiar with the gradual processes of types of healing, but the immediate healing is less well-known.
Psychiatrist Richard Miller has done research and what he calls quantum change, but also is known as transformational change, building on the work of William James’ The Varieties of Religious Experience. William James and Edwin Starbuck distinguished two types of transformational change: “a volitional type in which the change is gradual and consciously directed, and a self-surrender type, which is rapidly climactic and whose direction seems to come from outside the self. [38] In his clinical field, focusing on additions, Miller notes that “it is common to encounter reports of sudden and permanent transformations, frequently of a profoundly spiritual character,”[39] especially in the context of Alcoholics Anonymous meetings. Miller broke down the immediate transformations into two different types: an insightful type (consisting in a breakthrough of internal awareness) and a mystical type (having a sense of being acting upon by some outside force).
Miller notes that the mystical type of transformative experience are distinctly different from normal consciousness. They are
experienced passively, not a product of personal will or control, and has a difficult time expressing the experience in words. They usually are intensely positive, joyful experiences, and often the person senses the presence of an awe-inspiring transcendent Other. Often there is a noetic element of revelation, a sudden knowing of a new truth. An experience of unity is common; for example, an ineffable oneness with all of humankind, with nature, or the universe.[40]
In other words, they can be categorized as mystical experiences, containing most of the requirements developed by Stace and Pahnke for categorizing mystical experiences.
The second kind of quantum or transformational change Miller argues, which centers on insight, lies more in the world of psychotherapy.[41] Stories of this type lack the characterizations of the mystical experience—all but one—the noetic moment. The noetic moment is a moment of insight—a sudden realization or knowing. Miller notes that these types of insights are different from traditional “a-ha” moments that can occur in ordinary consciousness. He explains, “These [noetic] awakenings break upon the person with great and sudden force, and in the moment of seeing, the person recognizes them for authentic truth (or Truth). Their effect tends to be a reorganization of one’s perceptions of self and reality, usually accompanied by intense emotion and a cathartic, even ecstatic, sense of relief and release.”[42]
The question “so what changed?” naturally arises after this sort of experience. The standard response Miller cites as being given (and the standard response after a psychedelic experience) is “Everything has changed.”[43] So what is changing? Miller notes that the common areas of transformation in the narratives were a sudden release from chronic negative affectivity (e.g., fear, resentment, depression, anger), that was replaced with a complete sense of well-being, safety, joy in living, and peacefulness that he found endured for decades afterwards.[44] They feel as though they have passed through a one-way door and are essentially new people.
These type of transformational change experiences are a critical detonation point of an individual’s past experience. They are built on one’s personal history, the narratives of their life.[45] In this type of change, it is as though therapy was fast-tracked. In all cases of transformative experiences, both gradual and immediate, there is a critical point, a turn, a realization of the need to change or alter one’s behavior.
White lays out two previous models of the stages of transformative experiences. The first described three stages of the entire transformative process: unrest and conflict (feelings of unworthiness, shame, and incompleteness), the “conversion crisis” (sudden breakthrough of illumination), and a sense of “peace, release, and inner harmony.” The second has five similar stages which were called the “logic of transformation.” These stages were: conflict (a dissonance in the soul), interlude for scanning (search for a resolution), intuitive insight (breakthrough experience of truth), release and openness for new patterns of thinking and being, and interpretation and verification (experience is filtered through significant others for validation).[46]
Likewise, in the traditional therapeutic process or relationship there exists stages. There is the initial commitment to therapy and the therapist or to bettering oneself. This is based on a motivation which could be internal (a desire to get better) or external (forced by an outside party).
The second stage of therapy consists of the process, the various therapeutic techniques utilized. Within this stage there are sub stages at work. The first is the searching for patterns of psychological phenomena and behavioral manifestations. These patterns might consist of repetitions of behavior, triggers to the repetitions, vicious circles, of a trigger leading to a repetition of behavior which leads again to the trigger and so on.
The second sub stage consists of the acquisition of new information on the part of the patient. This could take the form of a therapist identifying the patterns to a patient, a subsequent realization of the patterns on the part of the patient, and ways to avoid or escape the patterns. Both of these sub stages produce an insight, information that was not known to the patient prior to the revelation.[47] Insight into one’s predicament plays a substantial role in the therapeutic process. The extent to which a patient realizes their experiences are due to their illness or mal adaption, or in other words, how much insight a patient has, affects the patient’s chances of recovering. It is one of the foundations that the third stage, change, builds on and uses to make progress.
The third stage is the change, which represents conclusion and a success of outcome. de Rivera notes that there are three important aspects to this stage required to ensure permanent therapeutic results. The first is the complete repudiation of the illness and all related elements. This includes the getting over any positive reasons for remaining ill and realizing that the new, healthy function is better in every way. The second is the implication of voluntary patterns of action replacing old pathological behaviors and third, the sustaining of these patterns requiring the creation of mental structures that can detect, interrupt, and neutralize any pathological mechanisms that could reappear.[48]
The last stage is the “graduation” of the individual as an expert in the functioning of their own mind. This stage is where the individual becomes aware of their own responsibility for their life and behavior.[49] Psychotherapy is meant to be an educational experience where patients learn something new about themselves whether that be patterns of thought, connections between experiences, the best coping mechanisms, etc.[50]
The goal of therapy is to heal, to change the experience of the individual(s) who comes to therapy. This constitutes a gradual transformative change. As noted prior, transformative changes are just that, transformative in every respect. The person who existed before the experience, their subjective affects, personality, and world view, might not be the person who comes out of the experience. This is a scary thought. One doesn’t know what life is without the mental disorder or what this “new” life might look like. This is the benefit of the psychedelic experience. It serves as both the transformative experience and gives a glimpse at what life after the transformative experience might be like. The difference between therapeutic approaches and the transformative experience that occurs via the psychedelic experience is the direct, experiential encounter with the new realm. Psychedelics, and the proper integration, exhibit the properties of these sorts of both processes—therapy and transformative experiences. Now we’ll start to look at how this sort of thing occurs.
Part two can be found here.
[1] For examples of claims such as this see Michael Pollan’s book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (Penguin Press, 2018).
[2] George Engel, “The need for a new medical model: a challenge for biomedicine,” Science 196 no. 4286 (1977): 129-136.
[3] Marie Hoeger Bement, et al., “Fatiguing exercise attenuates pain-induced corticomotor excitability,” Neuroscience Letters 452 no. 2 (2009): 209-213.
[4] Marie Hoeger Bement, et al., “Anxiety and stress can predict pain perception following a cognitive stress,” Physiology and Behavior 101 no. 1 (2010): 87-92.
[5] A. O’Melia, et al., “Repeated Exposure to Conditioned Pain Modulation Reduces Situational Pain Catastrophizing to the Conditioning Stimulus,” The Journal of Pain 20 no. 4 (2019): 87-92.
[6] L. Hawkley, et al., “Loneliness is a unique predictor of age-related differences in systolic blood pressure,” Psychology and Aging 21 no. 1 (2006): 152–164.; R. Thurston, L. D. Kubzansky, “Women, loneliness, and incident coronary heart disease.” Psychosomatic Medicine 71 no. 8 (2009): 836–842.
[7] J. Holt-Lunstad, et al., “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review,” Perspectives on Psychological Science 10 no. 2 (2015): 227–237.
[8] Steven Cole, et al., “Loneliness, eudaimonia, and the human conserved transcriptional response to adversity,” Psychoneuroendocrinology 62 (2015): 11-17.
[9] Nicholas V Karayannis, et al., “The Impact of Social Isolation on Pain Interference: A Longitudinal Study,” Annals of Behavioral Medicine 53 no. 1 (2019): 65–74.
[10] Robert M. Sapolsky, Behave: The Biology of Humans at our Best and Worst (Penguin Press, 2017).; Robert M. Sapolsky, Why Zebras Don’t Get Ulcers: A Guide to Stress, Stress-Related Diseases, and Coping (New York: W. H. Freeman and Company, 1998).
[11] Sheldon Cohen, “Psychosocial models of the role of social support in the etiology of physical disease,” Health Psychology 7:3 (1998), 268-297.; Peter Franks, et al. “Social relationships and health: The relative roles of family functioning and social support” Social Science and Medicine 34:7 (April 1992), 779-788.
[12] T. Covic, B. Adamson, D. Spencer, G. Howe, “A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study,” Rheumatology, 42:11 (November 2003): 1287–1294.
[13] Gabor Mate, When the Body Says No: Understanding the Stress-Disease Connection (Wiley, 2011).
[14] Eric R. Kandel, Yadin Dudai, Mark R. Mayford. “The Molecular and Systems Biology of Memory,” Cell 157 no. 1 (2014): 163-186,
[15] For a specific example of how emotional stress changes the brain see Bender, Christian Luis, et al., “Emotional stress induces structural plasticity in Bergmann glial cells via an AC5-CPEB3-GluA1 pathway,” Journal of Neuroscience (2020): DOI: 10.1523/JNEUROSCI.0013-19.2020.
[16] David A. Karp, Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness (Oxford: Oxford University Press, 2016).
[17] Matthew Ratcliffe, “The Interpersonal Structure of Depression,” Psychoanalytic Psychotherapy 32 no. 2 (2018): 2.
[18] Ratcliffe, “The Interpersonal Structure of Depression,” 6-7.
[19] Karp, Speaking of Sadness, 34.
[20] Karp, Speaking of Sadness, 37-38.
[21] Albert Garcia-Romeu, Roland Griffiths, M. Johnson, “Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction,” Current Drug Abuse Review 7 no. 3 (2015): 157–164.
[22] Stanislav Grof, LSD Psychotherapy (Hunter House, 1980).
[23] Phil Wolfson, Glenn Hartelius eds., The Ketamine Papers: Science, Therapy, and Transformation (Multidisciplinary Association for Psychedelic Studies, 2016).; Stephen J. Hyde, Ketamine for Depression (Xlibris, 2015).; Sanjay Matthew, Carlos Zarate Jr., eds. Ketamine for Treatment-Resistant Depression: The First Decade of Progress (Adis, 2016).; Karl Jansen, Ketamine: Dreams and Realities (Multidisciplinary Association for Psychedelic Studies, 2004).
[24] Joseph Tafur, The Fellowship of the River: A Medical Doctor’s Exploration into Traditional Amazonian Plant Medicine (Independently Published, 2017).; Fde L. Osorio, R. Sanches, L. Macedo, et al., “Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report,” Brazilian Journal of Psychiatry 37 no. 1 (2015): 13-20.
[25] Roland Griffiths, et al., “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance,” Psychopharmacology 187 no. 3 (2006): 268–292.; Garcia-Romeu, Griffiths, Johnson, “Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction,” 162. See also W. Pahnke, Drugs and Mysticism: An analysis of the relationship between psychedelic drugs and the mystical consciousness (Cambridge, MA: Harvard University Press, 1963).; W. T. Stace. Mysticism and Philosophy (Macmillan, 1960).
[26] M. W. Johnson, et al., “Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function,” Pharmacology & Therapeutics 197 (2019): 83-102.; Roland Griffiths, et al., “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial,” Journal of Psychopharmacology 30 no. 12 (2016): 1181–1197.
[27] Griffeths et al., “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial,” 2016.; Stephen Ross, et al., “Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial,” Journal of Psychopharmacology 30 no. 12 (2016): 1165-1180.
[28] Johnson, et al., “Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function,” 2019.; Peter Gasser, et al., “Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases,” The Journal of Nervous and Mental Disease 202 no. 7 (2014): 513–520.
[29] Robin Carhart-Harris, et al., “Psilocybin with psychological support for treatment-resistant depression: six-month follow-up,” Psychopharmacology 235 no. 2 (2018): 399–408.; Robin Carhart-Harris, et al., “Psilocybin with psychological support for treatment-resistant depression: An open-label feasibility study,” The Lancet Psychiatry 3 no. 7 (2016): 619–627.
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[47] I am not using this in a technical sense, this is not to say that the patient didn’t know it unconsciously or that has to be unknown knowledge on the patient’s part. Discussion of that is beyond the scope of this paper.
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