On Conceptualizing Psychedelics as Therapeutics
PART I. Introduction: Psychedelics as a New Paradigm in Psychiatric Pharmacotherapy
In his lovely and important book Psychedelic Healing: The Promise of Entheogens for Psychotherapy and Spiritual Development, Dr. Neal Goldsmith (due disclosure: a friend of mine), points out repeatedly an important distinction between psychedelic drugs and "traditional" pharmacotherapeutic agents: the putative therapeutic or spiritual benefit derived from the therapy is not so much one directly exerted by the pharmacological actions of the drug in question, but rather, a function of a "peak" or "mystical" experience. This is a recurring trope in psychedelic research on topics as divergent as smoking cessation and end of life anxiety, and has approached the level of conventional wisdom in the psychedelic community. Interestingly, however, it is in complete opposition to the prevailing paradigm of pharmacotherapy in psychiatry, which, operating from the perspective of the disease model, in essence is occupied with the search for "magic bullets" to treat various psychiatric disorders. This is apparent in the very nomenclature used for psychiatric medications: anti-psychotics, anti-depressants, mood stabilizers, etc. (ibid.). The presupposition therein is that there is a one-to-one correspondence between psychiatric complaints as discrete neurochemical phenomena and the neurochemical actions of psychiatric drugs ...
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