Beyond the importance of controlling the placebo effect, I am worried that a lot of the drug-depression research is overlooking an important possibility: that the thing about ketamine/psilocybin/etc that is helping with depression is not some latent property of the molecule, but rather the actual transcendent experience of the trip. In other words, the trip is the point, not the mechanistic neuro-tinkering [0].
Importantly, this tracks with what we know about the protective effects of things like religiosity against depression. As such, the qualitative experience of the drug might not be something we can (or should) do away with. I would even go as far as suggesting that an absence of transcendence in one's life is precisely what causes a large segment of people to become depressed in the first place, and that perhaps drugs are helpful only insofar as they produce a transcendent experience.
This isn't to say we can't take a scientific approach to treating depression, but that has to be balanced with something profoundly metaphysical: the actual qualia of life experience. Wellness isn't the absence of disease; it's the presence of thriving, and that includes within it a component of things like hope, inspiration, and elevation above the ordinary. We used to have various ceremonies designed to turn us towards the numinous, but we've pretty systematically dismantled those in favor of a grounded hyper-rationality [1]. As a scientist, I can't really object to rationality on its own, but it may be worth considering non-rational, transcendent experience as a fundamental psychological need.
[0] If you're a materialist, you might object that neurological machinery is not differentiable from qualia. Fair enough! I even agree! My point is simply that medicine needs to consider qualia as a major parameter in the treatment of depression. Fixing depression is not like fixing a car.
[1] I suspect most people here are familiar with Nietzsche's "God is dead quote". Many people in my entourage are floored to discover that he correctly predicted the dramatic increase in anxiety, depression, neuroticism and nihilism that is present in modern life.
> I am worried that a lot of the drug-depression research is overlooking an important possibility: that the thing about ketamine/psilocybin/etc that is helping with depression is not some latent property of the molecule, but rather the actual transcendent experience of the trip.
Ketamine dosed at levels used in a lot of the original depression studies won’t result in anything resembling a “trip”. Many of the more responsible clinics will carefully administer IV ketamine infusions over 40 minute (IIRC) spans at levels that only result in a little dizziness.
The association between ketamine depression therapy and “tripping” is a more recent development, pushed partially by clinics and influencers seizing on the trend in the most dramatic way possible. Some of the clinics will now dose people with excessively high doses with the goal of inducing trips and overt experiences, even though this isn’t supported by the literature.
I’m actually growing concerned that the pop-culture obsession with tripping and the over zealousness of ketamine providers is going to result in regulatory crackdown on the whole process.
A few months ago I was discussing the topic with a psychiatrist friend. She had tried prescribing ketamine for several patients, optimistically. However, a number of them complained that it wasn’t enough because they weren’t having full on hallucinations like they had read about online or in books. Several of them also started trying to demand higher and very early refills, despite her explaining up front that she was only willing to follow the dosing protocols used in studies.
I am happy to be sorted into the "responsible" category, since I prescribe IV ketamine with the mentioned 40 minute slow IV infusion at 0,5mg per kg of body weight.
I would like to chime in a thought about the choice of words... I think that we might be doing us a disservice when reducing the whole discussion down to "trip" or "no trip". Some patients have mild sensory experiences from the treatment, some have unpleasant dissociative-ish experiences, some done feel much at all. My belief is that the subjective experience, or the phenomenology of the treatment, is of importance even if the experience is far from a "trip". My patient who thus far has had the most convincing response did not "trip", but described a calm feeling of "everything will be alright" during the treatment - a response that none of 20-ish drugs or ECT had given.
This system of scientific gatekeeping and law enforcement is a direct projection of the barriers put in place between individuals and god by the catholic church. For millennia authorities have attempted to prevent people from having meaningful spiritual experiences directly, of their own accord, via access to substances that grow e.g. in their nearest cow fields.
In this way, your psychiatrist friend is simply the next iteration of a priest, and the portrayal of her patients as greedy fools only furthers this divide and pushes ever more people towards the other side of the law. I'll see you in _my_ cow field with a woven basket!
_edit_: think of it this way. An internal urge drives people to your friend in search of a meaningful experience. Your friend consults her good book and returns to them with information: no, you cannot have your meaningful experience.
Only in the last 50 years have humans STOPPED tripping because of "saving the children". Before that, for 10s of thousands of years, humans, and animals, have used phsycoactive substances as a way of coping with and processing, reality.
Its such a dellusion that humanity has been "pure" at any point in time. Drug prohition, and all its tenticles, is a political tool of mass control. Nothing more, nothing less. Today we are seeing the reemergance of the teachings that have been passed down for generations by tribes around the world as this viel is lifted.
So please, this is not a trend. Its a rediscovery of aincent knowledge. I appreciate that low dose is how this remergence started, but there its not a cureall, and its not the only way this sustance provides benifits. 20 years ago, these same people were trapped to tables, eletroshocked until they became cataonic. Heroic doeses have their place in therapy.
Pop culture "obsession" may have been useful for overcoming blanket bans on research, funding, etc. It was obsession that created these bans in the first place, and obsession that triggered them.
Now obsession it's interfering with science and (especially) science communication.
Meanwhile, parent comment (the "trip" is the active substance) is a hypothesis... on the face of it. A reasonable hypothesis that needs to be considered, and if possible tested.
There's probably no getting around obsession here. This is literally the namesake "culture war," dating to 60s counterculture.
> at levels that only result in a little dizziness.
Anecdotal first hand account, I would have to completely disagree with you. I tried intravenous ketamine therapy about a year ago. I’m plenty experienced with psychoactives, having experienced several at varying doses, so I knew what I was in for. My IVKT experience was a full on trip, definitely not just passive dizziness.
Simple size of 1, but you're correct in how a heroic dose psilocybin trip completely cured my existential depression, to the extent I can't even relate to the struggles of my past self.
It certainly FELT to be a property of the transcendent experience and not a biological side effect of the substance.
Being blasted out into the infinite space of all possible chaotic realities but being able to successfully "crawl back" to THIS reality as an oasis / point of stability was a life changing experience. Although it was what you'd otherwise describe as a "bad trip", it flipped a switch in my brain from "existence is pointless" to "existence is a miracle."
If you’d had a crazy life experience that took you to the edge without said product, let’s say a full on mountaineering epic that bought close to the edge, would that remain in your consciousness and alter your being? Perhaps but data would suggest not or it has limited efficacy.
There is something within these molecules that combine experiences and some change to alter awareness.
For sure. In indigenous circles, the perception is often that science’s approach to psychedelics is quite ill-fitted because it seeks to separate the molecules from the non-physical essence of the medicines. What is called “set and setting” in the secular world, is called “sorcery” or “ceremony” for them. They understand the many transcendental layers opened by this medicine in a profound, intimate manner, and many of these traditions have developed, refined and passed down over generations intricate spiritual sciences meant to work with these unseen forces with the most grace possible.
So, naturally when westerns come and want to isolate compounds and get rid of the ceremonial background because it’s “unscientific”, the only possible reaction is to put one’s hand in the face and think “here we go again, THIS too will be colonized.”
This world has far many more dimensions than what modern science is able to address. And many of these plants/compounds open access to these dimensions. It’s really important I think that we have the humility to learn from the people who have worked with these medicines for a very long time.
Context: I have apprenticed and studied very closely under various traditional lineages for the past few years.
Agree. I have heard stories of people who “had one treatment and never smoked/put their elbows on the dinner table ever again.”
My experiences seemed to benefit more from watching David Attenborough and feeling a connection to life.
I’d interpret the dad of a family of mountain lions as an analogue of my dad, etc. Seeing events as taking place in a dissociated context. All that introspection is what I found useful about Ketamine.
Yeah, sounds silly. But it made me a happier person. To my understanding and experience, these function more to temporarily remove neurological filters than really add much new (same with LSD, etc). Maybe that benefit is “subjective,” but what’s the difference to me, years later?
It only sounds silly to our modern sensibilities, which I am increasingly considering regressive on the specific question of "what is a life well-lived".
To a pre-modern society that considers e.g. dreams to be vehicles of important meaning, religiousity to be a good thing in measure, idle time to be a gift and introspection to be one of the major points of existence, it doesn't sound silly at all. It sounds wise.
I'm a scientist by training and an engineer by trade, but as an empiricist, I am forced to admit that my life has gotten better by making room for the irrational, superstitious, obliquely-associative, self-contradictory omginternets to exist. Make of that what you will ;)
> I have heard stories of people who “had one treatment and never smoked/put their elbows on the dinner table ever again.”
Social media selection bias at play. The real world results are very mixed, but usually don’t result in life changing benefits that you read about in selected stories.
There’s also an unhelpful bias toward purely positive stories on the internet. I had a friend get addicted (yes, addicted) to psychedelics who could not stop acquiring and dosing them on a weekly basis for years. It was a huge problem, but strangely when I mention this story people will rush to argue it, deny it, insist I’m lying, or try to downplay it with the old “psychological addiction isn’t physical addiction” gimmick.
That's not silly at all. Like the other guy who posted, connecting back to "life" is pretty important. My family committed to this at a very extreme level in 2020 and we fulfilled it in April 2021. Our lives have been changed for the better in so many ways!
It can also be harmful. I know someone who went through this treatment, they had an out of body/ego death experience, and were convinced that's what death felt like, and they really liked it. They had a suicide attempt just a few days later. It isn't the type of treatment one tries unless they've exhausted all other options. It's saddening to hear a lot of depression treatments seem largely reliant on placebo effect - for someone with decades of dysthmia, it's really disheartening to hear.
That's extremely common with recovery from MDD. The ability to act improves before the low mood, so bam! suicide. In hospitals new patients, particularly younger adults, are put on suicide watch for this exact reason.
So the suicide watch monitoring somehow didn't happen. Not unique to ket or psilo. Not at all.
Sorry, what can be harmful exactly? The experience of drugs? I completely agree.
A corollary of my position is that you should be able to fix a fair bit of depression by providing non-pharmacological access to transcendent experience. The drug is then a (very potent and correspondingly sharp) tool among others.
That sounds terrible. It really sounds like they were already pretty far gone. I was able to get help with my depression from magic mushrooms, but it was at most a moderate case.
>. Beyond the importance of controlling the placebo effect, I am worried that a lot of the drug-depression research is overlooking an important possibility: that the thing about ketamine/psilocybin/etc that is helping with depression is not some latent property of the molecule, but rather the actual transcendent experience of the trip. In other words, the trip is the point, not the mechanistic neuro-tinkering.
I remember the first time I ever tried a benzodiazepine. I then realized I am anxious most times, that that default state is not ""normal" and that you can actually change it. And for brief periods of times I was able to re-create the effects of it at will.
Also just having a xanax pill in my wallet cured my panic attacks.
My hypothesis is that even "temporary" positive psychological experiences can have profound effects on the brain, show it there is a better state and in certain conditions the brain will figure a path.
I don't know when I learnt to move my ears, twist my tongue sideways or when I self learnt "voluntary tubal opening", but without going into mumbo-jumbo, I think there's a lot more we can control about our brains and bodies than we think.
Which brings us to the second most famous statement in all of modern philosophy: Nietzsche's "God is dead." The year was 1882. (The book was Die Frohliche Wissenschaft [ The Gay Science ].) Nietzsche said this was not a declaration of atheism, although he was in fact an atheist, but simply the news of an event. He called the death of God a "tremendous event," the greatest event of modern history. The news was that educated people no longer believed in God, as a result of the rise of rationalism and scientific thought, including Darwinism, over the preceding 250 years. But before you atheists run up your flags of triumph, he said, think of the implications. "The story I have to tell," wrote Nietzsche, "is the history of the next two centuries." He predicted (in Ecce Homo ) that the twentieth century would be a century of "wars such as have never happened on earth," wars catastrophic beyond all imagining. And why? Because human beings would no longer have a god to turn to, to absolve them of their guilt; but they would still be racked by guilt, since guilt is an impulse instilled in children when they are very young, before the age of reason. As a result, people would loathe not only one another but themselves. The blind and reassuring faith they formerly poured into their belief in God, said Nietzsche, they would now pour into a belief in barbaric nationalistic brotherhoods: "If the doctrines...of the lack of any cardinal distinction between man and animal, doctrines I consider true but deadly"--he says in an allusion to Darwinism in Untimely Meditations --"are hurled into the people for another generation...then nobody should be surprised when...brotherhoods with the aim of the robbery and exploitation of the non-brothers...will appear in the arena of the future...
Nietzsche said that mankind would limp on through the twentieth century "on the mere pittance" of the old decaying God-based moral codes. But then, in the twenty-first, would come a period more dreadful than the great wars, a time of "the total eclipse of all values" (in The Will to Power ). This would also be a frantic period of "revaluation," in which people would try to find new systems of values to replace the osteoporotic skeletons of the old. But you will fail, he warned, because you cannot believe in moral codes without simultaneously believing in a god who points at you with his fearsome forefinger and says "Thou shalt" or "Thou shalt not."
Much of the benefit of psychedelics is the introspection, which you can do sober as well (although the depth of the reflection is magnified and qualitatively different while tripping).
This is confirmed by the linked study (which shows that placebo-ketamine is also very effective).
Many psychedelic-era personas expressed this sentiment as well: you don't need psychedelic drugs to reach that state, you could also spend 10 years practicing meditation daily.
This view ignores the major application of these substances. Ketamine-induced self-therapy is accessible instantly and acts as a major reset. When you are experiencing long-term depression and/or anxiety, the advice to "just meditate" or do deep introspection is wildly counter-productive. Depressive state is very frequently accompanied by an unhealthy focus on the internal voice and on over-analyzing own life/motivations/purpose/etc. Having an "introspection session" in this state is a borderline dangerous advice.
There's also reliable studies that it isn't that, and I actually expect it isn't, since antidepressants in general don't work by making you introspect. Actually "rumination" is a symptom of depression, so they would make you do it less, and IME meditation is not about introspection either.
Here's one showing a mechanism ketamine and antidepressants both act on:
>I can't really object to rationality on its own, but it may be worth considering non-rational, transcendent experience as a fundamental psychological need.
I couldn't agree more, you've made really great points that allowed me to reflect on my own approach to my mental wellbeing. I honestly needed to see this comment right now. Thank you!
I couldn't be happier! Do me a favor: help me preach the good word that philosophy is an important and practical subject! :)
If you want me to really tickle your noodle, consider that a lot of modern-day issues stem from a quest for transcendence in a society that has largely dismantled the institutions capable of delivering it. In particular, I am of the (somewhat provocative) opinion that things like radical Islamic terrorism, fringe climate activism, and the more virulent brands of third-wave feminism are all, at their core, performative quests for such transcendence.
But that's all secondary to the fact that I am glad my comment is helpful to you on a personal level :)
I find this... frustrating to read, at the least. This post assumes that all depression is a _lack_ of something external to the body. Or that depression is simply a chemical imbalance. It takes no accounting of physical deficiencies that can _never_ be cured and require a lifetime of maintenance, of which Ketamine can be (literally) lifesaving.
The post is irresponsible. No one should be thinking that some sort of "transcendence" will solve their issue, or that is what their problem is.
I mean, I guess it depends on what the truth is. Clearly the two of you have very different perspectives on what the underlying cause of depression or mental illness is. If your view is incorrect, it could also be equally irresponsible, could it not?
I feel like depression as a term is overloaded because it's a description of a symptom rather than a particular cause.
If you're depressed because you have a chemical imbalance then you're a great candidate for SSRIs and the like. Serotonin? In this economy?
If you're depressed because your life is miserable in some fashion then there's a lot of potential options but this sounds like what you're talking about with K as one treatment.
If you're depressed, you don't respond to SSRIs and "my life is good, why am I still like this?" describes you I think the parent is saying that transcendence is potentially one treatment for this.
Another issue is the variability of depression as a diagnosis itself. An admittedly anecdotal set of my encounters with people who take or have taken anti-depressants is most are on changing set of prescriptions because nothing works continuously and a high percentage of them are ones which no anti-depressant drug worked and were fixed by a different diagnoses for something like adhd.
How does one evaluate if a new drug works vs depression when there isn’t a consistent diagnosis or presentation of the symptoms.
An admittedly anecdotal set of my encounters with people who take or have taken anti-depressants is most are on changing set of prescriptions because nothing works continuously and a high percentage of them are ones which no anti-depressant drug worked and were fixed by a different diagnoses for something like adhd.
An alternative explanation for this is that if you keep giving people different drugs and different diagnoses eventually they will feel better for unrelated reasons and will assume the current diagnosis/drug combo is what “fixed” them.
Yes, agreed! I think I could even formulate a cogent argument for why the diagnostic variability is itself a result of ignoring qualia, but the last comment has drained me of energy for the day ^^
Your comment seems to ignore the main point of the article: that the placebo group did actually have life-changing resolution of their depression symptoms.
I'm not sure I see a contradiction. This is compatible with the established idea that you can have transcendent insight without drugs, and with the equally-established idea of suggestion as one of the principal mechanisms behind placebo effects. A cohort was put in a situation that facilitated reflection upon life in a closed setting; that's exactly what I'm suggesting is helpful.
See also: "you're not anxious; you're distracted."
> but rather the actual transcendent experience of the trip
As a materialist I think it's absurd. But I think that trip is sure sign that the substance actually does something to neurons. And in case of some substances like drugs if you reduce dosage or adjust protocol so that trip doesn't happen means that you also got rid of any significant effect it might have on the brain.
In my opinion saying that experience of the trip healed me is a bit like saying that my experiencing of reduced immobility of walking in a cast made by bones fuse together and heal, mind is so powerful.
Yeah. Seems likely that the subjective experience of the trip is simply what you feel when firing/rewiring the networks that cause the healing. There's no incompatibly between "it's the experience" and "it's the neurology" because they are one in the same.
But there are a lot of different ways to do the healing (e.g. consistent meditation as others mentioned) which will of course be coupled to different feelings/experiences. The "large psychedelic dose" method is just one end of the "works fast + feels strongly" spectrum. Of course as the science/technology develops we will find other points on the spectrum that balance the properties differently -- maybe even through placebo effect alone as suggested here.
>And in case of some substances like drugs if you reduce dosage or adjust protocol so that trip doesn't happen means that you also got rid of any significant effect it might have on the brain.
We agree. My point is that the evidence seems to be going in the direction of:
1. removing transcendence removes part of the benefit; and,
2. to complicate matters, many protocols fail to properly control for transcendent experience because a lot of control groups are placed in a quiet room, free of distraction, and invited to ponder life.
We're both materialists. Mine is a materialist position.
If qualia are not different that our “neurological machinery” (and all available evidence shows this so far, not least the incoherence of definitions of qualia that try to exclude such) then medicine is already considering such as a major parameter.
If they are different (and exist at all) then such needs to be demonstrated before they can be reliably considered.
Given even proponents of qualia can’t reliably agree with each on what they even are defined as (other than using vague circular reasoning)… frankly, I’m not holding my breath.
>If qualia are not different that our “neurological machinery” (and all available evidence shows this so far, not least the incoherence of definitions of qualia that try to exclude such) then medicine is already considering such as a major parameter.
No, they are definitely not. I don't see anything in these studies to the effect of "hey, it's the feeling that they feel that's making them better". They're looking for some mysterious mechanism, usually on the cellular or molecular level, whereas "numen" and "transcendence" are not even on the biological level of analysis.
The way I would rephrase OP is "what is the most useful abstraction for the mechanism of action of these drugs". It might be that limiting yourself to neurological phenomena gives you a much longer, more unwieldy model of what's happening here than an equally predictive model that centers on subjective experience.
I generally agree with you, but I would like to comment on the expression you used: "As a scientist, I can't really object to rationality on its own, but it may be worth considering non-rational, transcendent experience as a fundamental psychological need.".
I think you would agree that if evaluations such as life-meaningfulness are secondary-properties or qualia like you said then arranging it as a debate between rationality vs irrationality is out of the picture. It is customary to consider various forms of mysticisms as opposed to rationality but it doesn't have to be the case as long as we properly define what is entailed by such experience.
I suppose that the reason people might object to such idea is that they are implicitly committed to a form of positivism and they sense that if people can experience evaluations then the fact/value distinction is undermined. Therefore I think that while it is understandable what you mean when you use the term "rationality" as equated with positivism it would be good for the long term debate to separate those two, since I take it that people like us would like to have it both: science and a form of atheistic mysticism [0].
Ultimately the grand-father of rationality, Plato, was anything but a positivist.
[0] I use the term mysticism mostly because I lack any better term. Evaluative intuitionism is probably the most correct technical term but it has historical roots which I dislike because it was constructed around the single intuition of what is Good, and I believe that we need a wider range of evaluative terms to adequately describe our experiences.
Can one be a rationalist and still believe that, “the universe if fucking lit” and marvel at how wonderful it is? I believe being rational allows one to really experience the depth and breadth of the place we are in.
Bleak utilitarianism is why so many reject applying themselves to a deeper understanding of the world, willfully ignorant in a way to manufacture wonder via a lack of comprehension.
It starts early, with the sexist trope of Eve plucking an Apple from the tree of knowledge and getting us kicked out of the garden eden. Bullshit.
I agree with the OP, the trip is the point. Travel, see the universe.
Mysticism with focus on a higher power (deity) has been tried and tested. Why re-invent the wheel? The existence of a higher power does not contradict the more rational modern science, and vice versa. They are both tools that we can use to enrich our lives.
I completely agree with you. The opposition between rationality and life-meaningfulness was just a bit a useful rhetoric to get my my point across. I don't see any fundamental contradiction between the two, either.
> Importantly, this tracks with what we know about the protective effects of things like religiosity against depression
I always took the mechanism to be community, that sort of thing. I guess if you're right we'd expect Pentacostals to be protected more than Lutherans, etc.? Do we have any idea what data is out there that might be able to disentangle this sort of question?
I'm not sure I'd agree, at least not directly. Community is transcendence of self, and both Pentacostals and Lutherans concern themselves with questions of divine order. I'm not sure I see a significant difference between the two (for our purposes, at least).
Do studies commonly take into account a history of trauma? In my experience with medical professionals, trauma is barely considered or outright ignored. Screening processes, when used, are ...generic.
I notice that many transformational psychedelics stories involve some form of previous traumatic experience.
> Importantly, this tracks with what we know about the protective effects of things like religiosity against depression. As such, the qualitative experience of the drug might not be something we can (or should) do away with. I would even go as far as suggesting that an absence of transcendence in one's life is precisely what causes a large segment of people to become depressed in the first place, and that perhaps drugs are helpful only insofar as they produce a transcendent experience.
Fantastic point and so well written. As someone who experimented in my late teens/early 20s, I wholeheartedly agree with this. The experience changed me in a positive way and has helped make me who I am today.
> that the thing about ketamine/psilocybin/etc that is helping with depression is not some latent property of the molecule, but rather the actual transcendent experience
I thought the same thing when reading the article, but then I started to wonder how the fuck would you double blind that?
Well, you wouldn't. It's largely a metaphysical stance rather than a scientific one[0], which I suspect is precisely why modern medicine is struggling to engage with it.
[0] Mostly. Part of it falls under Dennett's notion of an intentional stance, but that requires us to take self-report seriously, and so precludes a number of experimental designs.
You don’t. It’s fundamentally incompatible. But that’s fine.
People are able to acquire knowledge in ways besides randomized, controlled, double-blind trials. Nearly all knowledge is acquired in some other way. I say this as someone who writes A/B testing software for a living.
Could give them a psychoactive that's not reputed to help with depression. As long as they don't know what a trip looks like they won't know you gave them DMT when they're talking to the machine elves.
The simplest metaphysical thing to be amazed at is that we are all conscious and ascribe theory of mind. Be amazed. Also we are all connected evolutionarily as well and we evolved with other organisms so the whole planet is basically connected. That we have paleolific components of our brain and we can use meditation to calm them. All great stuff that doesn’t require the psychedelic. Also recognize that We are social animals so human connection is vitally important. I can regulate your behavior via mirror neurons.
Religion is community at its heart.. but maybe we need an abstract idea of god to foster that community.
Perhaps being able to keep a perspective on hope and of hope for long enough is part of the shift, assisted by ingestion or not.
Placebo as science is learning is relative. The body does literally change based on thought.
A recent Huberman podcast literally stated the brain itself is a pharmacy and creates certain substances as triggered. Not implying it’s the same for everyone, but interesting nonetheless.
If ketamine/shrooms push and hold a different perspective for long enough that it is difficult to unsee, unfeel or unexperience, that’s kind of interesting for sure .
> but rather the actual transcendent experience of the trip
I've seen the results ketamine can give first hand, and the dangers of it, but I'm more convinced it may just be getting proper sleep given the connection between sleep apnea and depression.
I would bet that if they engineer a version that does not cause psychosis it will work just as well for the population it does work on. And we should not be quick to dismiss psychosis, it's a major risk factor for violence, something I have also seen first hand.
To your point, I think that what you describe is also a common cause for depression. As Freud said (paraphrasing): most of my patient's aren't mentally ill, they just haven't learned how to live well. There is much to be said for the idea that psychological needs are (mostly) physiological needs like sleep, food, water and exercise. If we extend that to include social needs like love, security, a healthy sex life, stimulating conversation and adventure, we start to approach a notion of transcendence.
Maybe you don't really have to "fix" depression, I am very nihilistic and I do just fine - I don't kill myself because I don't give a fuck enough to do that. Looks easy to me. We are just on a flying stone in the cosmos, we shouldn't really except anything out of this.
I think you could be right but I wouldn't worry about scientists trying to remove the trip aspect, as doing so in a clinical setting would be a good way to prove/disprove your hypothesis.
The words you're saying aren't materialist so much as they are logical positivist. As it turns out, there are things that are both true but not provable (be it empirically or analytically).
>Though I struggle not to be equally suspect than this is also just hopeful thinking.
I think we all do. Certainly, I struggle with that as well. I think this is an inherent property of undecidable questions (contrary to most well-formed scientific theories, which are valuable precisely because they can distinguish themselves from hopeful thinking).
Here's something to consider: some kind of hopeful thinking may be a fundamental psychological need. When I saw the title of this HN post, I had thought that perhaps this was the question that ketamine researchers were considering, but alas not.
> it may be worth considering non-rational, transcendent experience as a fundamental psychological need.
This speaks to me for sure...
Ever since I was little, I've had trouble identifying with humanity. Even though I was born into this body, I never really identified with it, never really felt like that was "me".
I wanted fantasy instead, I wanted to be a creature instead, something with fur and paws and a tail. It's gone far enough that I have DID and multiple such creatures live in my head with me.
But I can't have it. I don't hallucinate. I don't even dream of creatures, not even daydreams. I only dream of humans. I only dream of reality. My dreams aren't an escape from anything, they are just more of the same. My imagination isn't an escape from anything, because it's not real. It doesn't look real, it doesn't feel real. It's just a tease.
And this hurts. There is some sort of deep, existential pain that I feel whenever I am reminded of this. "Species dysphoria". If anyone had trouble understanding gender dysphoria before, boy do I have a concept for you.
I don't know what is wrong with me. I don't know what caused me to dissociate from the body. It's supposed to be my body, it's supposed to be one with me, it's supposed to be me. I'm supposed to be comfortable in it, and it's supposed to be under my control. But it's not. It's not me, it's not comfortable, and it's not under my control.
I blame some of it on autism and ADHD. Being autistic deprives me of control over the body, and ADHD deprives me of the ability to override that. But I also blame it on the lack of proper fantasy in my dreams. I think, that because my dreams have never truly been an escape from anything... that I'm missing something that I'm not supposed to be missing. In other words... "transcendent experience as a fundamental psychological need". And I haven't had any. I am incapable of it.
I've tried writing stories. I've tried roleplaying. I've tried to make myself more comfortable in the body, through actual physical comfort, or from expression of this "otherkin" identity. But nothing seems to help. Nothing actually feels like it means anything. I'm just not getting it.
I just feel trapped. Trapped in this body. Trapped in this reality. I don't know what to do about it. I don't know what I can do about it. I've tried LSD, tried ketamine. I like LSD, and still use it somewhat regularly. But it still doesn't do what I want, or what I need. It's a recreational activity for me, but it doesn't seem to help with anything deep inside.
Stimulants like dexedrine used to help, but every time I try them after a couple months' break, they either barely help at all, or they help for a few weeks and then my tolerance skyrockets.
The depression is the lack of any hope that this will ever change. The depression is this deep discomfort with myself, my body, my life... and the fear that it will be this way forever. That I will never get what I am seeking, and that I will never be able to fix what is broken inside, either.
I've talked to doctors about this, I've talked to therapists about this. I'm getting a neuropsychological evaluation in a few months. I'm trying to help myself, I just don't know if there is anything left to try. The best I can do is get recognized.
Any thoughts or suggestions would be appreciated, of course.
> In other words, the trip is the point, not the mechanistic neuro-tinkering
Are you claiming that there is a soul? Becauae many posit that the brain and thus our experiences are made of matter and energy and as mechanistic as anything else.
Many people have the experience of what could be called a soul, even if what they are experiencing is not some hidden spiritual plane of the universe. Perhaps "soul" could be better defined as something inherent to one's experience, rather than some outside entity that grants life to a vessel.
Related to the psychological vs. physiological discussion: I can say with confidence that the first time I did ecstasy changed how I look at the world. We went for a walk barefoot on warm pavement and it was the most wonderful thing I ever felt. I realized on a visceral level that so much of our personal happiness is based on how we look at things, not what happens to us.
I don't know if I got any chemical benefit from subsequent use, other than fun (with the consistently worsening serotonin crash afterwards). But just being able to step outside my usual angsty 19-year-old brain for a few hours had a profound effect.
Same thing happened to me the first time I tried using molly. I am convinced it was actually a fake of some amphetamines and caffeine or something. But it still had an effect on me: for the first time in my life I was able to have fun while being surrounded by a crowd of people (it was a music festival). It didn't make me feel dumbed down like alcohol used to. I just felt happy, just wanted to have fun and enjoy the moment. After that I realized I had the sparkle in me. I even knew I could do it without drugs. That was the beginning of my healing process. I've remembered that experience many times later and still come back to it sometimes.
Similar experience here. It triggered the thought in my mind of "this feeling exists". It's weird to explain. It's like MDMA created a reference in my mind and, instead of making me to fall into the process of "I need the drug to be happy", it made me to search for things in life that bring me that feeling of happiness and comfort I got as a reference from the experience. I remember vividly the walk to home after the party, with a beautiful girl holding my arm, the hot shower afterwards...it was the first time in my whole existence that I honestly thought "life is beautiful".
Yeah but that serotonin crash afterwards was bleak. At this point in my life I can do E about once a year. Any more than that and I get really depressed afterwards.
Although I do know people who are clinically depressed, and the hangover/crash doesn't bother them as much, because it's their normal state anyway.
Honestly the only thing extasy did for me was let me rave for hours to electronic music at clubs. It also opened the door for other chemical drugs which led to benders and hangovers that were so bad people who only drink alcohol have no idea are even possible.
Granted, I never did it in a quiet "therapeutic" environment, I would have thought of it as a waste because I considered the music and dancing an integral part of the experience, it's a pretty recreational and hedonistic substance after all.
Ecstacy can have great therapeutic and profound effects...
It's not that surprising that if you only use it to "rave for hours" and "open the door for other chemical drugs", then you'll find it a "recreational and hedonistic substance". That's practically a tautology.
It can be great for party setting but I recommend doing it in the safe environment with family, friends at home or in nature. The feeling of deeper connection with people or nature you already have connection with is revealing. I felt love I knew in even more direct and pure way.
From a pretty good essay written by someone who lived through the original "psychedelics will expand your mind" era of the 60s and 70s:
"“Enlightenment in a pill,” many have pointed out, is a quintessentially American concept. Who’s got time for all that prayer and study and meditation and practice when there’s an easier, faster way?
But there isn’t. Therein lies the great danger of LSD and its dopey cousin, marijuana. By offering a simulacrum of spiritual and intellectual growth – a very convincing simulacrum at times – it takes you everywhere except where you need to be, which is doing the long, hard work of learning to live."
I resonate with what he says because, like the author mentions later on, I also have many friends who went deep into the psychedelics journey while claiming it was 'freeing their minds', 'enlightening' them, or whatever other concept they liked to use, only to end up, a decade or two later, in either a regular struggling life like so many others, or a downright bad place. I'm probably wrong to generalize, as I'm sure it can help many, but the drugs still can't substitute the individual's effort and struggle to grow, and overcome, and the learning of how to live a meaningful life.
> only to end up, a decade or two later, in either a regular struggling life like so many others, or a downright bad place
It isn’t like they transform into the ubermensch and transcend the bodily functions of eating and shitting. At the end of the day we all have insecurities
You can be struggling, you can be in a bad place, but that’s orthogonal to feeling connected and spiritually awake
And I’m not saying drugs are how you can (or should) get there, just that the material conditions that someone is living in have nothing to do with being “there”
And by “there”, I mean a sense of abandonment of self to the fabric that you arose out of. Which is not the same thing as conformity, more like a sense of understanding and acceptance of where you belong in the grand scheme of things
It's shocking how much of medicine is just based on trust and word of mouth. Studies made decades ago that turn out completely wrong and not reproducible. We flatter ourselves that we're enlightened and based on science, but the more you dig the more you realize it's all a game of trial and error and fighting cultural wars to get your "remedy" out there and profit.
It's rather shocking to someone who's not familiar with the inner workings of the pharma industry and medicine in general.
In particular in psychiatry, we have working theories about how the various agents work to achieve anti-depressive or anti-psychotic effects, which are taken as the gospel or proven fact. And then those models turn out absolutely wrong. And we have to face the fact we're prescribing drugs to sick people we have no clue how and why they work. And whether they work at all, often.
It's especially the case when a given drug must be taken for months before any effect is seen. It's essentially impossible to control for other variables over MONTHS of someone's life. You can easily convince them they feel slightly better now because they've been months on end taking Zoloft. They may've easily been better if they hadn't taken it.
It is kind of ironic that study hints about hope/placebo. What I experienced were always side effects, no relief and then different drug, rinse and repeat. Left with original problem, worried what the next drug gonna bring as side effect with more and more diminishing hope it will ever help - despair.
Some may criticize me for saying this, but I'll explain my observations. In general I've noticed when a drug works, it immediately gets restricted in use, because it has abuse potential, or a dangerous dose.
There's no vast conspiracy here (well, sort of), but a simple principle: anything that is demonstrable to be USEful, is demonstrable to be abUSEable. No one is restricting homeopathic remedies, they don't have side-effects, or drug interactions, and that's because they don't do anything.
Many antidepressants also don't require too strict of a regime, that's because they actually have very poor therapy effects overall, but even when they do, their effect and side-effects are so stretched out in time, it's very hard to show a hard cause-effect relationship. Despite reading the list you see all sorts of conditions on a drug that may occur as a side-effect, often many of those just occurred during a study, but had little relation to a drug, while other effects were underreported (say often around sexual function as people are embarrassed, or things people can't feel, and aren't tested about, things which doctors don't expect they need to check).
So basically "long-running drugs" are a big question mark, and often turn out to be garbage.
But stimulants like Ritalin, Adderall, Vivanse, Concerta and so on are known to instantly alleviate a number of symptoms of ADHD, depression and so on. Not in months. But within AN HOUR of taking a pill. You can immediately see how it works. But of course you can abuse them, and your body craves them over time, because the body and mind adapts to everything, that's the whole point of homeostasis. So they're restricted and you're told they're not good for you because they can be abused. But this cause-effect relationship is only visible because their effect is also apparent. Not just to medicine, but also to your own body. Your mind makes the cause-effect relationship "this makes dopamine good, circuits work better, take again".
But the fact of the matter with drugs is they're all poison, and the therapeutic effect is in the right dose and application. There's no way around it. If it was nice and fun at any quantity, it's at best just sugar, or at worst some random chemical that few bad studies pushed through, which doesn't at all act like it's supposed to.
This doesn't apply just to stimulants. I have issues with my circadian rhythm so I found a brand of melatonin of Jamieson that is 10mg, slow release. I notice on the first night it works. Other smaller doses from random supplement companies did nothing, heck who knows if they even had the active ingredient.
So I'm in EU. And lo and behold, the EU notices melatonin is USEful at dose over 3mg. Therefore also abUSEable, and has side-effects in some. Very minor I might add.
But it was immediately pulled from shelves, so a long and tedious registration can begin for it as a medication rather than a supplement, and until then, EU people who need it are screwed I guess. It's absurd, but it follows the principle that if it works, it becomes controlled. So the irony in all this is that we have easiest access to garbage that doesn't help, and the drugs that do help, have high prices and restricted access due to over-regulation.
Alternative explanation: ketamine isn’t better than placebo for treating depression when given to someone who’s under anesthesia. You have to be awake.
Similarly, I bet that if you gave psilocybin to someone under anesthesia, they wouldn’t get the same benefits as someone who took it while awake.
Another alternative explanation: general anesthesia's disassociation alone combined with an expectation of transformative psychological change results in transformative psychological change similar to ketamine's disassociation combined with such an expectation.
Ruling out the general anesthesia as having an effect because general anesthesia without expectation of depression improvement doesn't improve depression seems like it toys with a false negative in ignoring the possibility of combined factors (specifically psychological disassociation plus expectations of change).
I broke my leg skydiving a few months ago. The EMTs gave me ketamine and fentanyl before they loaded me up in the ambulance. That stuff sent me to another dimension! I never want to go back there. Was pretty terrifying to be honest. Maybe a low dose could help with depression? I think a high dose would probably scare people and they wouldn't want to do it again.
A friend of mine needed a bunch of morphine before a major surgery. Right before the doctor administered it he said "don't worry, people pay a lot of money for this"
Yeah that's one of the worst possible combinations (maybe apart from tripping sky high in actual war zone) - drugs and bad traumatic experience, while being loudly transported by strangers to hospital. You can't make up much worse set for trip.
No wonder you had a bad trip, although I have absolutely 0 idea about those drugs or their combined effect on one's mind.
The paramedics/doctors I used to work with would administer ketamine from time to time, but they would always pair it with this other drug (maybe midazolam? I don’t quite remember), for the sole purpose of preventing hallucinations.
They made it very clear that the only reason for this mix was that ketamine hallucinations of that dose are often violent or sexual or both, and you don’t want to deal with those kind of allegations.
I personally tried low dose pure ketamine (intramuscular) and it was quite pleasant.
This is not the first trial of ketamine used under clinical anaesthesia to disguise its effects. A previous study using similar methods in 2018 found the usual effects of surgery: a transient increase in depressive symptoms. I'm no expert but my inclination is to blame this on postoperative pain.
The confidence interval in the new study includes zero, although the average beneficial effect is still surprising when considering the usual expected negative effects. I suspect that the real effect may simply be that general anaesthesia causes a susceptibility to suggestion.
It's not clear if ketamine — or anything else — should be expected to work normally when it is administered to patients under general anesthesia. General anesthesia has profound effects on the functioning of the nervous system.
> It's not clear if ketamine — or anything else — should be expected to work normally when it is administered to patients under general anesthesia. General anesthesia has profound effects on the functioning of the nervous system.
Very much this! Additionally when discussing ketmaine it's method of action (NMDA receptor antagonist) specifically could be disrupted by the effects of another anesthetic compound.
Ketamine IV or compound medication without any other drugs is so profoundly different from Ketamine as part of a procedure where you’re otherwise unconscious.
Ketamine treatment is something I've seriously considered for my depression. It's hard not to be lured in by all the miraculous claims by folks who have been down the same path and found relief. I've been through the rounds with traditional ADHD and depression treatment with side effects that rival the underlying symptoms and have tried a few different prescriptions. I'm just so tired. Doing simple things like paying your electric bill or getting out of bed when you don't have external demands shouldn't be so damn hard.
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Importantly, this tracks with what we know about the protective effects of things like religiosity against depression. As such, the qualitative experience of the drug might not be something we can (or should) do away with. I would even go as far as suggesting that an absence of transcendence in one's life is precisely what causes a large segment of people to become depressed in the first place, and that perhaps drugs are helpful only insofar as they produce a transcendent experience.
This isn't to say we can't take a scientific approach to treating depression, but that has to be balanced with something profoundly metaphysical: the actual qualia of life experience. Wellness isn't the absence of disease; it's the presence of thriving, and that includes within it a component of things like hope, inspiration, and elevation above the ordinary. We used to have various ceremonies designed to turn us towards the numinous, but we've pretty systematically dismantled those in favor of a grounded hyper-rationality [1]. As a scientist, I can't really object to rationality on its own, but it may be worth considering non-rational, transcendent experience as a fundamental psychological need.
[0] If you're a materialist, you might object that neurological machinery is not differentiable from qualia. Fair enough! I even agree! My point is simply that medicine needs to consider qualia as a major parameter in the treatment of depression. Fixing depression is not like fixing a car.
[1] I suspect most people here are familiar with Nietzsche's "God is dead quote". Many people in my entourage are floored to discover that he correctly predicted the dramatic increase in anxiety, depression, neuroticism and nihilism that is present in modern life.
Ketamine dosed at levels used in a lot of the original depression studies won’t result in anything resembling a “trip”. Many of the more responsible clinics will carefully administer IV ketamine infusions over 40 minute (IIRC) spans at levels that only result in a little dizziness.
The association between ketamine depression therapy and “tripping” is a more recent development, pushed partially by clinics and influencers seizing on the trend in the most dramatic way possible. Some of the clinics will now dose people with excessively high doses with the goal of inducing trips and overt experiences, even though this isn’t supported by the literature.
I’m actually growing concerned that the pop-culture obsession with tripping and the over zealousness of ketamine providers is going to result in regulatory crackdown on the whole process.
A few months ago I was discussing the topic with a psychiatrist friend. She had tried prescribing ketamine for several patients, optimistically. However, a number of them complained that it wasn’t enough because they weren’t having full on hallucinations like they had read about online or in books. Several of them also started trying to demand higher and very early refills, despite her explaining up front that she was only willing to follow the dosing protocols used in studies.
I would like to chime in a thought about the choice of words... I think that we might be doing us a disservice when reducing the whole discussion down to "trip" or "no trip". Some patients have mild sensory experiences from the treatment, some have unpleasant dissociative-ish experiences, some done feel much at all. My belief is that the subjective experience, or the phenomenology of the treatment, is of importance even if the experience is far from a "trip". My patient who thus far has had the most convincing response did not "trip", but described a calm feeling of "everything will be alright" during the treatment - a response that none of 20-ish drugs or ECT had given.
In this way, your psychiatrist friend is simply the next iteration of a priest, and the portrayal of her patients as greedy fools only furthers this divide and pushes ever more people towards the other side of the law. I'll see you in _my_ cow field with a woven basket!
_edit_: think of it this way. An internal urge drives people to your friend in search of a meaningful experience. Your friend consults her good book and returns to them with information: no, you cannot have your meaningful experience.
Its such a dellusion that humanity has been "pure" at any point in time. Drug prohition, and all its tenticles, is a political tool of mass control. Nothing more, nothing less. Today we are seeing the reemergance of the teachings that have been passed down for generations by tribes around the world as this viel is lifted.
So please, this is not a trend. Its a rediscovery of aincent knowledge. I appreciate that low dose is how this remergence started, but there its not a cureall, and its not the only way this sustance provides benifits. 20 years ago, these same people were trapped to tables, eletroshocked until they became cataonic. Heroic doeses have their place in therapy.
Pop culture "obsession" may have been useful for overcoming blanket bans on research, funding, etc. It was obsession that created these bans in the first place, and obsession that triggered them.
Now obsession it's interfering with science and (especially) science communication.
Meanwhile, parent comment (the "trip" is the active substance) is a hypothesis... on the face of it. A reasonable hypothesis that needs to be considered, and if possible tested.
There's probably no getting around obsession here. This is literally the namesake "culture war," dating to 60s counterculture.
Anecdotal first hand account, I would have to completely disagree with you. I tried intravenous ketamine therapy about a year ago. I’m plenty experienced with psychoactives, having experienced several at varying doses, so I knew what I was in for. My IVKT experience was a full on trip, definitely not just passive dizziness.
It certainly FELT to be a property of the transcendent experience and not a biological side effect of the substance.
Being blasted out into the infinite space of all possible chaotic realities but being able to successfully "crawl back" to THIS reality as an oasis / point of stability was a life changing experience. Although it was what you'd otherwise describe as a "bad trip", it flipped a switch in my brain from "existence is pointless" to "existence is a miracle."
Haven't felt existential dread since.
And you don’t need to mountaineer
So, naturally when westerns come and want to isolate compounds and get rid of the ceremonial background because it’s “unscientific”, the only possible reaction is to put one’s hand in the face and think “here we go again, THIS too will be colonized.”
This world has far many more dimensions than what modern science is able to address. And many of these plants/compounds open access to these dimensions. It’s really important I think that we have the humility to learn from the people who have worked with these medicines for a very long time.
Context: I have apprenticed and studied very closely under various traditional lineages for the past few years.
My experiences seemed to benefit more from watching David Attenborough and feeling a connection to life.
I’d interpret the dad of a family of mountain lions as an analogue of my dad, etc. Seeing events as taking place in a dissociated context. All that introspection is what I found useful about Ketamine.
Yeah, sounds silly. But it made me a happier person. To my understanding and experience, these function more to temporarily remove neurological filters than really add much new (same with LSD, etc). Maybe that benefit is “subjective,” but what’s the difference to me, years later?
It only sounds silly to our modern sensibilities, which I am increasingly considering regressive on the specific question of "what is a life well-lived".
To a pre-modern society that considers e.g. dreams to be vehicles of important meaning, religiousity to be a good thing in measure, idle time to be a gift and introspection to be one of the major points of existence, it doesn't sound silly at all. It sounds wise.
I'm a scientist by training and an engineer by trade, but as an empiricist, I am forced to admit that my life has gotten better by making room for the irrational, superstitious, obliquely-associative, self-contradictory omginternets to exist. Make of that what you will ;)
Social media selection bias at play. The real world results are very mixed, but usually don’t result in life changing benefits that you read about in selected stories.
There’s also an unhelpful bias toward purely positive stories on the internet. I had a friend get addicted (yes, addicted) to psychedelics who could not stop acquiring and dosing them on a weekly basis for years. It was a huge problem, but strangely when I mention this story people will rush to argue it, deny it, insist I’m lying, or try to downplay it with the old “psychological addiction isn’t physical addiction” gimmick.
So the suicide watch monitoring somehow didn't happen. Not unique to ket or psilo. Not at all.
A corollary of my position is that you should be able to fix a fair bit of depression by providing non-pharmacological access to transcendent experience. The drug is then a (very potent and correspondingly sharp) tool among others.
I remember the first time I ever tried a benzodiazepine. I then realized I am anxious most times, that that default state is not ""normal" and that you can actually change it. And for brief periods of times I was able to re-create the effects of it at will. Also just having a xanax pill in my wallet cured my panic attacks.
My hypothesis is that even "temporary" positive psychological experiences can have profound effects on the brain, show it there is a better state and in certain conditions the brain will figure a path.
I don't know when I learnt to move my ears, twist my tongue sideways or when I self learnt "voluntary tubal opening", but without going into mumbo-jumbo, I think there's a lot more we can control about our brains and bodies than we think.
Which brings us to the second most famous statement in all of modern philosophy: Nietzsche's "God is dead." The year was 1882. (The book was Die Frohliche Wissenschaft [ The Gay Science ].) Nietzsche said this was not a declaration of atheism, although he was in fact an atheist, but simply the news of an event. He called the death of God a "tremendous event," the greatest event of modern history. The news was that educated people no longer believed in God, as a result of the rise of rationalism and scientific thought, including Darwinism, over the preceding 250 years. But before you atheists run up your flags of triumph, he said, think of the implications. "The story I have to tell," wrote Nietzsche, "is the history of the next two centuries." He predicted (in Ecce Homo ) that the twentieth century would be a century of "wars such as have never happened on earth," wars catastrophic beyond all imagining. And why? Because human beings would no longer have a god to turn to, to absolve them of their guilt; but they would still be racked by guilt, since guilt is an impulse instilled in children when they are very young, before the age of reason. As a result, people would loathe not only one another but themselves. The blind and reassuring faith they formerly poured into their belief in God, said Nietzsche, they would now pour into a belief in barbaric nationalistic brotherhoods: "If the doctrines...of the lack of any cardinal distinction between man and animal, doctrines I consider true but deadly"--he says in an allusion to Darwinism in Untimely Meditations --"are hurled into the people for another generation...then nobody should be surprised when...brotherhoods with the aim of the robbery and exploitation of the non-brothers...will appear in the arena of the future...
Nietzsche said that mankind would limp on through the twentieth century "on the mere pittance" of the old decaying God-based moral codes. But then, in the twenty-first, would come a period more dreadful than the great wars, a time of "the total eclipse of all values" (in The Will to Power ). This would also be a frantic period of "revaluation," in which people would try to find new systems of values to replace the osteoporotic skeletons of the old. But you will fail, he warned, because you cannot believe in moral codes without simultaneously believing in a god who points at you with his fearsome forefinger and says "Thou shalt" or "Thou shalt not."
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This is confirmed by the linked study (which shows that placebo-ketamine is also very effective).
This view ignores the major application of these substances. Ketamine-induced self-therapy is accessible instantly and acts as a major reset. When you are experiencing long-term depression and/or anxiety, the advice to "just meditate" or do deep introspection is wildly counter-productive. Depressive state is very frequently accompanied by an unhealthy focus on the internal voice and on over-analyzing own life/motivations/purpose/etc. Having an "introspection session" in this state is a borderline dangerous advice.
Here's one showing a mechanism ketamine and antidepressants both act on:
https://www.science.org/content/blog-post/how-antidepressant...
I couldn't agree more, you've made really great points that allowed me to reflect on my own approach to my mental wellbeing. I honestly needed to see this comment right now. Thank you!
If you want me to really tickle your noodle, consider that a lot of modern-day issues stem from a quest for transcendence in a society that has largely dismantled the institutions capable of delivering it. In particular, I am of the (somewhat provocative) opinion that things like radical Islamic terrorism, fringe climate activism, and the more virulent brands of third-wave feminism are all, at their core, performative quests for such transcendence.
But that's all secondary to the fact that I am glad my comment is helpful to you on a personal level :)
The post is irresponsible. No one should be thinking that some sort of "transcendence" will solve their issue, or that is what their problem is.
Always discuss treatment with a psychiatrist.
If you're depressed because you have a chemical imbalance then you're a great candidate for SSRIs and the like. Serotonin? In this economy?
If you're depressed because your life is miserable in some fashion then there's a lot of potential options but this sounds like what you're talking about with K as one treatment.
If you're depressed, you don't respond to SSRIs and "my life is good, why am I still like this?" describes you I think the parent is saying that transcendence is potentially one treatment for this.
How does one evaluate if a new drug works vs depression when there isn’t a consistent diagnosis or presentation of the symptoms.
An alternative explanation for this is that if you keep giving people different drugs and different diagnoses eventually they will feel better for unrelated reasons and will assume the current diagnosis/drug combo is what “fixed” them.
See also: "you're not anxious; you're distracted."
As a materialist I think it's absurd. But I think that trip is sure sign that the substance actually does something to neurons. And in case of some substances like drugs if you reduce dosage or adjust protocol so that trip doesn't happen means that you also got rid of any significant effect it might have on the brain.
In my opinion saying that experience of the trip healed me is a bit like saying that my experiencing of reduced immobility of walking in a cast made by bones fuse together and heal, mind is so powerful.
But there are a lot of different ways to do the healing (e.g. consistent meditation as others mentioned) which will of course be coupled to different feelings/experiences. The "large psychedelic dose" method is just one end of the "works fast + feels strongly" spectrum. Of course as the science/technology develops we will find other points on the spectrum that balance the properties differently -- maybe even through placebo effect alone as suggested here.
We agree. My point is that the evidence seems to be going in the direction of:
1. removing transcendence removes part of the benefit; and,
2. to complicate matters, many protocols fail to properly control for transcendent experience because a lot of control groups are placed in a quiet room, free of distraction, and invited to ponder life.
We're both materialists. Mine is a materialist position.
If they are different (and exist at all) then such needs to be demonstrated before they can be reliably considered.
Given even proponents of qualia can’t reliably agree with each on what they even are defined as (other than using vague circular reasoning)… frankly, I’m not holding my breath.
No, they are definitely not. I don't see anything in these studies to the effect of "hey, it's the feeling that they feel that's making them better". They're looking for some mysterious mechanism, usually on the cellular or molecular level, whereas "numen" and "transcendence" are not even on the biological level of analysis.
I suppose that the reason people might object to such idea is that they are implicitly committed to a form of positivism and they sense that if people can experience evaluations then the fact/value distinction is undermined. Therefore I think that while it is understandable what you mean when you use the term "rationality" as equated with positivism it would be good for the long term debate to separate those two, since I take it that people like us would like to have it both: science and a form of atheistic mysticism [0].
Ultimately the grand-father of rationality, Plato, was anything but a positivist.
[0] I use the term mysticism mostly because I lack any better term. Evaluative intuitionism is probably the most correct technical term but it has historical roots which I dislike because it was constructed around the single intuition of what is Good, and I believe that we need a wider range of evaluative terms to adequately describe our experiences.
Bleak utilitarianism is why so many reject applying themselves to a deeper understanding of the world, willfully ignorant in a way to manufacture wonder via a lack of comprehension.
It starts early, with the sexist trope of Eve plucking an Apple from the tree of knowledge and getting us kicked out of the garden eden. Bullshit.
I agree with the OP, the trip is the point. Travel, see the universe.
I always took the mechanism to be community, that sort of thing. I guess if you're right we'd expect Pentacostals to be protected more than Lutherans, etc.? Do we have any idea what data is out there that might be able to disentangle this sort of question?
I notice that many transformational psychedelics stories involve some form of previous traumatic experience.
> Importantly, this tracks with what we know about the protective effects of things like religiosity against depression. As such, the qualitative experience of the drug might not be something we can (or should) do away with. I would even go as far as suggesting that an absence of transcendence in one's life is precisely what causes a large segment of people to become depressed in the first place, and that perhaps drugs are helpful only insofar as they produce a transcendent experience.
Fantastic point and so well written. As someone who experimented in my late teens/early 20s, I wholeheartedly agree with this. The experience changed me in a positive way and has helped make me who I am today.
I thought the same thing when reading the article, but then I started to wonder how the fuck would you double blind that?
[0] Mostly. Part of it falls under Dennett's notion of an intentional stance, but that requires us to take self-report seriously, and so precludes a number of experimental designs.
People are able to acquire knowledge in ways besides randomized, controlled, double-blind trials. Nearly all knowledge is acquired in some other way. I say this as someone who writes A/B testing software for a living.
It's bizarre that people would think any different of it?
It's like therapy on steroids.
It's an equivalent of scientist saying that eating an invoice for therapy doesn't get you "cured". Doh?
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Religion is community at its heart.. but maybe we need an abstract idea of god to foster that community.
Perhaps being able to keep a perspective on hope and of hope for long enough is part of the shift, assisted by ingestion or not.
Placebo as science is learning is relative. The body does literally change based on thought.
A recent Huberman podcast literally stated the brain itself is a pharmacy and creates certain substances as triggered. Not implying it’s the same for everyone, but interesting nonetheless.
If ketamine/shrooms push and hold a different perspective for long enough that it is difficult to unsee, unfeel or unexperience, that’s kind of interesting for sure .
I've seen the results ketamine can give first hand, and the dangers of it, but I'm more convinced it may just be getting proper sleep given the connection between sleep apnea and depression.
I would bet that if they engineer a version that does not cause psychosis it will work just as well for the population it does work on. And we should not be quick to dismiss psychosis, it's a major risk factor for violence, something I have also seen first hand.
I think we all do. Certainly, I struggle with that as well. I think this is an inherent property of undecidable questions (contrary to most well-formed scientific theories, which are valuable precisely because they can distinguish themselves from hopeful thinking).
Here's something to consider: some kind of hopeful thinking may be a fundamental psychological need. When I saw the title of this HN post, I had thought that perhaps this was the question that ketamine researchers were considering, but alas not.
Or, I could have just as well answered "both, but medicine is ignoring one".
it's like fixing the way you drive your car
See the notion that suicide is illegal/bad.
Also most old people I know are religios and still are depressed.
Religion overall has very little effect on people. How many are religios and still break all rules. Alone hating on other people, being racists etc.
This speaks to me for sure...
Ever since I was little, I've had trouble identifying with humanity. Even though I was born into this body, I never really identified with it, never really felt like that was "me".
I wanted fantasy instead, I wanted to be a creature instead, something with fur and paws and a tail. It's gone far enough that I have DID and multiple such creatures live in my head with me.
But I can't have it. I don't hallucinate. I don't even dream of creatures, not even daydreams. I only dream of humans. I only dream of reality. My dreams aren't an escape from anything, they are just more of the same. My imagination isn't an escape from anything, because it's not real. It doesn't look real, it doesn't feel real. It's just a tease.
And this hurts. There is some sort of deep, existential pain that I feel whenever I am reminded of this. "Species dysphoria". If anyone had trouble understanding gender dysphoria before, boy do I have a concept for you.
I don't know what is wrong with me. I don't know what caused me to dissociate from the body. It's supposed to be my body, it's supposed to be one with me, it's supposed to be me. I'm supposed to be comfortable in it, and it's supposed to be under my control. But it's not. It's not me, it's not comfortable, and it's not under my control.
I blame some of it on autism and ADHD. Being autistic deprives me of control over the body, and ADHD deprives me of the ability to override that. But I also blame it on the lack of proper fantasy in my dreams. I think, that because my dreams have never truly been an escape from anything... that I'm missing something that I'm not supposed to be missing. In other words... "transcendent experience as a fundamental psychological need". And I haven't had any. I am incapable of it.
I've tried writing stories. I've tried roleplaying. I've tried to make myself more comfortable in the body, through actual physical comfort, or from expression of this "otherkin" identity. But nothing seems to help. Nothing actually feels like it means anything. I'm just not getting it.
I just feel trapped. Trapped in this body. Trapped in this reality. I don't know what to do about it. I don't know what I can do about it. I've tried LSD, tried ketamine. I like LSD, and still use it somewhat regularly. But it still doesn't do what I want, or what I need. It's a recreational activity for me, but it doesn't seem to help with anything deep inside.
Stimulants like dexedrine used to help, but every time I try them after a couple months' break, they either barely help at all, or they help for a few weeks and then my tolerance skyrockets.
The depression is the lack of any hope that this will ever change. The depression is this deep discomfort with myself, my body, my life... and the fear that it will be this way forever. That I will never get what I am seeking, and that I will never be able to fix what is broken inside, either.
I've talked to doctors about this, I've talked to therapists about this. I'm getting a neuropsychological evaluation in a few months. I'm trying to help myself, I just don't know if there is anything left to try. The best I can do is get recognized.
Any thoughts or suggestions would be appreciated, of course.
Are you claiming that there is a soul? Becauae many posit that the brain and thus our experiences are made of matter and energy and as mechanistic as anything else.
I don't know if I got any chemical benefit from subsequent use, other than fun (with the consistently worsening serotonin crash afterwards). But just being able to step outside my usual angsty 19-year-old brain for a few hours had a profound effect.
Although I do know people who are clinically depressed, and the hangover/crash doesn't bother them as much, because it's their normal state anyway.
Granted, I never did it in a quiet "therapeutic" environment, I would have thought of it as a waste because I considered the music and dancing an integral part of the experience, it's a pretty recreational and hedonistic substance after all.
It's not that surprising that if you only use it to "rave for hours" and "open the door for other chemical drugs", then you'll find it a "recreational and hedonistic substance". That's practically a tautology.
"“Enlightenment in a pill,” many have pointed out, is a quintessentially American concept. Who’s got time for all that prayer and study and meditation and practice when there’s an easier, faster way?
But there isn’t. Therein lies the great danger of LSD and its dopey cousin, marijuana. By offering a simulacrum of spiritual and intellectual growth – a very convincing simulacrum at times – it takes you everywhere except where you need to be, which is doing the long, hard work of learning to live."
I resonate with what he says because, like the author mentions later on, I also have many friends who went deep into the psychedelics journey while claiming it was 'freeing their minds', 'enlightening' them, or whatever other concept they liked to use, only to end up, a decade or two later, in either a regular struggling life like so many others, or a downright bad place. I'm probably wrong to generalize, as I'm sure it can help many, but the drugs still can't substitute the individual's effort and struggle to grow, and overcome, and the learning of how to live a meaningful life.
It isn’t like they transform into the ubermensch and transcend the bodily functions of eating and shitting. At the end of the day we all have insecurities
You can be struggling, you can be in a bad place, but that’s orthogonal to feeling connected and spiritually awake
And I’m not saying drugs are how you can (or should) get there, just that the material conditions that someone is living in have nothing to do with being “there”
And by “there”, I mean a sense of abandonment of self to the fabric that you arose out of. Which is not the same thing as conformity, more like a sense of understanding and acceptance of where you belong in the grand scheme of things
It's rather shocking to someone who's not familiar with the inner workings of the pharma industry and medicine in general.
In particular in psychiatry, we have working theories about how the various agents work to achieve anti-depressive or anti-psychotic effects, which are taken as the gospel or proven fact. And then those models turn out absolutely wrong. And we have to face the fact we're prescribing drugs to sick people we have no clue how and why they work. And whether they work at all, often.
It's especially the case when a given drug must be taken for months before any effect is seen. It's essentially impossible to control for other variables over MONTHS of someone's life. You can easily convince them they feel slightly better now because they've been months on end taking Zoloft. They may've easily been better if they hadn't taken it.
There's no vast conspiracy here (well, sort of), but a simple principle: anything that is demonstrable to be USEful, is demonstrable to be abUSEable. No one is restricting homeopathic remedies, they don't have side-effects, or drug interactions, and that's because they don't do anything.
Many antidepressants also don't require too strict of a regime, that's because they actually have very poor therapy effects overall, but even when they do, their effect and side-effects are so stretched out in time, it's very hard to show a hard cause-effect relationship. Despite reading the list you see all sorts of conditions on a drug that may occur as a side-effect, often many of those just occurred during a study, but had little relation to a drug, while other effects were underreported (say often around sexual function as people are embarrassed, or things people can't feel, and aren't tested about, things which doctors don't expect they need to check).
So basically "long-running drugs" are a big question mark, and often turn out to be garbage.
But stimulants like Ritalin, Adderall, Vivanse, Concerta and so on are known to instantly alleviate a number of symptoms of ADHD, depression and so on. Not in months. But within AN HOUR of taking a pill. You can immediately see how it works. But of course you can abuse them, and your body craves them over time, because the body and mind adapts to everything, that's the whole point of homeostasis. So they're restricted and you're told they're not good for you because they can be abused. But this cause-effect relationship is only visible because their effect is also apparent. Not just to medicine, but also to your own body. Your mind makes the cause-effect relationship "this makes dopamine good, circuits work better, take again".
But the fact of the matter with drugs is they're all poison, and the therapeutic effect is in the right dose and application. There's no way around it. If it was nice and fun at any quantity, it's at best just sugar, or at worst some random chemical that few bad studies pushed through, which doesn't at all act like it's supposed to.
This doesn't apply just to stimulants. I have issues with my circadian rhythm so I found a brand of melatonin of Jamieson that is 10mg, slow release. I notice on the first night it works. Other smaller doses from random supplement companies did nothing, heck who knows if they even had the active ingredient.
So I'm in EU. And lo and behold, the EU notices melatonin is USEful at dose over 3mg. Therefore also abUSEable, and has side-effects in some. Very minor I might add.
But it was immediately pulled from shelves, so a long and tedious registration can begin for it as a medication rather than a supplement, and until then, EU people who need it are screwed I guess. It's absurd, but it follows the principle that if it works, it becomes controlled. So the irony in all this is that we have easiest access to garbage that doesn't help, and the drugs that do help, have high prices and restricted access due to over-regulation.
One of those things of the modern world.
Similarly, I bet that if you gave psilocybin to someone under anesthesia, they wouldn’t get the same benefits as someone who took it while awake.
Ruling out the general anesthesia as having an effect because general anesthesia without expectation of depression improvement doesn't improve depression seems like it toys with a false negative in ignoring the possibility of combined factors (specifically psychological disassociation plus expectations of change).
Always thought that was a pretty funny line
No wonder you had a bad trip, although I have absolutely 0 idea about those drugs or their combined effect on one's mind.
The paramedics/doctors I used to work with would administer ketamine from time to time, but they would always pair it with this other drug (maybe midazolam? I don’t quite remember), for the sole purpose of preventing hallucinations.
They made it very clear that the only reason for this mix was that ketamine hallucinations of that dose are often violent or sexual or both, and you don’t want to deal with those kind of allegations.
I personally tried low dose pure ketamine (intramuscular) and it was quite pleasant.
https://www.sciencedirect.com/science/article/pii/S000709121...
The confidence interval in the new study includes zero, although the average beneficial effect is still surprising when considering the usual expected negative effects. I suspect that the real effect may simply be that general anaesthesia causes a susceptibility to suggestion.
It's not clear if ketamine — or anything else — should be expected to work normally when it is administered to patients under general anesthesia. General anesthesia has profound effects on the functioning of the nervous system.
Very much this! Additionally when discussing ketmaine it's method of action (NMDA receptor antagonist) specifically could be disrupted by the effects of another anesthetic compound.
Just no comparison.