Classic psychedelics, such as psilocybin and LSD, are currently being studied for their potential therapeutic impact—primarily in conjunction with some form of psychotherapy—on a variety of conditions. Within such a clinical frame, the potential value of psychedelic-assisted therapy is largely assumed to rest on empirical questions about whether, to what extent, or under what conditions such therapy is successful in alleviating the relevant symptoms of a condition as defined within psychiatry or allied medical fields (for example, major depressive disorder). Outside of the clinical framework, or in studies with so-called “healthy normals” (i.e., participants who do not meet diagnostic criteria for relevant psychiatric conditions), other positive effects, such as a durable, felt increase in overall well-being or a sense of meaningfulness, are also sometimes discussed. Whether clinical or non-clinical, such positive outcomes, if achieved, are often characterized as “persisting beneficial effects.”
However, anecdotally, many individuals have reported finding value in psychedelic-induced experiences without reference to such long-term effects. Rather, they seem to regard the experience itself as being of considerable value. Aldous Huxley, for example, in The Doors of Perception, includes significant detail on his subjective experience of viewing the beauty of a rose, the colors of the books around him, and the textures of fabrics, but does not mention reduced psychiatric distress or enhanced mood. Similarly, one clinical trial participant reported finding value in “the visuals that I got when the effect of the drug started. It was the diamond sparkling-like colors and they were so, so enjoyable.” Such descriptions, along with others, bring to the forefront the question: (How) can we make sense of the psychedelic experience being seen as intrinsically valuable (i.e., in its own right) for some people? And could it still be valuable for some, even if there were no persisting beneficial effects?
This question has arisen in other contexts, most notably in discussions around ongoing attempts to develop nonsubjective, or non-hallucinogenic, psychedelics—named as such for their lack of a characteristic “trip.” The idea is that these nonsubjective psychedelics—if successfully developed along the lines some have proposed—would work by increasing the brain’s neuroplasticity but without inducing acute changes to subjective consciousness, potentially with a similar therapeutic impact as has been reported for their subjective counterparts.
At present, there is a live debate (one to which we have contributed) about whether the acute subjective experience associated with classical psychedelics is, in fact, necessary for bringing about the sorts of persisting positive effects we described above (our view is yes). But let’s set that debate to one side. In a hypothetical scenario in which both subjective and nonsubjective psychedelics did turn out to have the same therapeutic or other long-term impact, might there still be some value to the subjective form of psychedelics, over and above any persisting effects?
In our opinion, one reason to answer this question affirmatively has to do with aesthetics. Consider the fact that classical, subjective psychedelic experiences may often qualify as an aesthetic experience, defined by Levinson as “involving aesthetic perception of some object, grounded in aesthetic attention to the object, and in which there is a positive hedonic, active, or evaluative response to the perception itself or the content of that perception.” Individuals typically enjoy, savor, or are moved by the perceptions of objects or stimuli with aesthetic qualities, which may often occur during a psychedelic experience. Huxley, again, writes of being “completely absorbed in looking, so thunderstruck by what I actually saw, that I could not be aware of anything else.” Another clinical trial participant described his perceptions of a park as being “so green, a type of green I’d never experienced before. Being among the trees was incredible, like experiencing them for the first time, so vibrant, so alive.” Such aesthetic experiences, we suggest, can be valuable in their own right, irrespective of therapeutic consequences.
Another way to understand the potential value of psychedelic experiences comes from a framework borrowed from the enhancement literature. Goodman, in his examination of the ethics of enhancement, makes a distinction between process goods and outcome goods: process goods are found in activities that are characterized by excellence in their performance, while outcome goods are the benefits that an activity creates (with many activities having both). Consider the example of a person who has trekked to the top of Mount Everest whilst another has simply taken a helicopter. Both enjoy the beautiful view and crisp air at the top, but it may seem that the person who took the helicopter has missed something crucial about the process of summiting Mount Everest, which may be valuable in its own right.
How might this distinction apply to our discussion of “subjective” versus “nonsubjective” psychedelics?
Both, we are supposing, might one day produce the same outcome goods (e.g., increased well-being, alleviation of symptoms, or other persisting positive effects). Still, there may also be some process goods that can only be attained during the “subjective” psychedelic experience that help point to its value. These might include the reflection on one’s life and values that is sometimes carried out or the experience of seeing ourselves, our relationships, or the world generally “from a different angle.” Looking at these as process goods might help us conceptualize the potential value of the acute subjective psychedelic experience, even apart from possible long-term effects. To complete the Mount Everest analogy, suppose that neither hypothetical mountaineer reaches the summit of the mountain: the one turns back two-thirds of the climb up, and the other’s helicopter is grounded due to inclement weather. Thus, the intended beneficial outcome (seeing the view from the top of Mount Everest) is not achieved in either case. Even so, it might seem that the climber’s journey would have had some value that the helicopter passenger would not share.
Finally, we might consider whether a life richly imbued with a diversity of interesting experiences—of which the experienced changes to consciousness associated with some psychedelics is a striking example—could be valuable in a way that would not be reflected in an otherwise similar life with a relative lack of such experiences. Consider the following thought experiment: the “Dream Pill”. There are two hypothetical sleeping pills, both of which are extremely effective at addressing insomnia. However, pill X takes away one’s ability to dream, whilst pill Y leaves dreams intact and unaffected (or even more vivid). It is plausible to imagine that some people would opt for pill Y, and have reason to do so, even if we assume that the ability to dream makes no difference to one’s waking life (perhaps one always forgets one’s dreams immediately upon waking up). If that is correct, it might be that a diversity of interesting experiences can be a valuable part of life independent of their persisting effects.
This would be consistent with the view of Besser and Oishi, who argue that a psychologically rich life is one kind of good life. They describe their concept as “a life characterized by complexity, in which people experience a variety of interesting things, and feel and appreciate a variety of deep emotions via firsthand experiences or vicarious experiences.” Characteristic psychedelic experiences, we suggest, with their range of felt emotions and often quite interesting content (which may be positive or negative), help to contribute to a psychologically rich life. If we agree with Besser and Oishi that psychological richness can be valued per se, this provides an additional reason for valuing certain psychedelic experiences.
To sum up, although it remains to be empirically determined whether or not “nonsubjective” psychedelics will have the same therapeutic impact as subjective ones (one company is currently conducting its Phase 1 trials), we hope to have highlighted several ways in which the subjective experience associated with classic psychedelics might still be valuable, even if the persisting therapeutic effects are the same as non-subjective psychedelics––and perhaps even if no persisting beneficial effects are attained.
Works referred to:
Katherine Cheung
Katherine Cheung is a PhD student in Bioethics and Health Policy at Johns Hopkins University and holds an M.A. in Bioethics from New York University. She currently focuses on bioethical issues related to psychedelics, such as the value of the psychedelic experience and the place of meaningfulness in medicine.
David B. Yaden
David B. Yaden, PhD, is the Roland R. Griffiths Professor of Psychedelic Research at Johns Hopkins University School of Medicine. His research interests include characterizing the acute subjective effects of psychedelics, investigating their capacity to impact well-being and worldview, as well as investigating their benefits and risks.
Brian D. Earp
Brian D. Earp is an incoming Associate Professor of Biomedical Ethics (and Philosophy, by courtesy) at the National University of Singapore, and is director of both the international Oxford-NUS Centre for Neuroethics and Society and the Hub at Oxford for Psychedelic Ethics (HOPE). With Julian Savulescu, Brian is co-author of Love Drugs: The Chemical Future of Relationships (Stanford University Press, 2020).
