Current Psychedelic Therapies Use Flawed Models of the Mind — Healing Maps

The rebirth of psychedelic-assisted therapy (PAP) has been garnering a great deal of attention lately. Not only in medicine and academia but in the media and the public consciousness at large. Many herald this renaissance after decades of legal embargo, but some have expressed a good deal of skepticism and caution. Is it time to move to a relational therapy approach?

A key concern around current PAP is that the field is being dominated by medical and research institutions (e.g., Imperial college London, John Hopkins University). On the one hand, this is to be expected and accepted to the extent that organized, well-funded empirical work is necessary. On the other hand, it creates an approach organized around the shared commitments and ideologies of the medico-scientific establishment.

The result is that almost all of the current research into and discourse around PAP is cast in terms of individualistic, cognition-centric theory. I will call it the “IC-C framework.”

This isn’t just a problem because it is biased toward one particular way of viewing PAP. Much more importantly, it is a problem because such a view, as I will attempt to show, is based on weak, outmoded and problematic foundations.

The Current Model of Mind: The Dominance of the ICC framework

The lion’s share of PAP research is based on the assumptions and language of cognitive psychology and neuroscience. From this standpoint, mental phenomena are best explained in terms of internal cognitive processing and the neurological systems correlated with such processing.

Following this, the literature is almost exclusively focused on cognitive phenomena. And how beliefs, perceptions and thinking patterns etc — may have become problematic and how psychedelics may change those things. One of the leaders of the field, Carharrt-Harris, suggests that PAP is principally concerned with the “de-weighting of a plethora of maladaptive cognitive/ perceptual schemas or ‘sets’ about self, others and the world” (Carhart-Harris and Brouer, 2021).

Social and interpersonal levels of experience and functioning are largely ignored and our embodied-affective involvement in the world and with others is neglected by design.

In line with this, we find cliche mind-as-computer metaphors widely employed, i.e., ‘rebooting’ or ‘resetting’ ‘malfunctioning’ or ‘distorted’ thinking. It is not at all incidental that computers are devoid of social and interpersonal experience and context.

What we are talking about, then, is clearly cognition-centric and thoroughly individualistic. The focus is on the individual and their thinking abstracted from context.

Unsurprisingly the kinds of psychotherapy currently used in PAP are ones that share consonant assumptions and biases. Namely, the Cognitive-Behavioral group of therapies.

Classic CBT is what we might call the master psychotherapeutic theory of a group of therapies that come under the title of CBT (usually expressed in terms of ‘waves’). The core premise of classic CBT is that emotional and psychological suffering principally follows from irrational or erroneous beliefs, attitudes, or other cognitive structures that the person holds.

For CBT, the broad goal of psychotherapy is to effectively correct the errors in such thinking. The therapist’s role is to challenge underlying beliefs and attitudes and/or use behavioral ‘experiments,’ which seek to interrupt the cycles between thinking, feeling and behavior that are believed to cause the emotional suffering involved.

Acceptance and Commitment Therapy (ACT), part of the so-called “third wave” of Cognitive Behavioral Therapies, currently holds sway at the key institutions (e.g., Imperial college and John Hopkins). While ACT and related mindfulness based ‘third-wave’ models do offer a more nuanced and sophisticated set of assumptions about the individual and what effects psychotherapeutic change, the essential problems of the ICC framework nevertheless remain the same.

In all cases, the issue is understood in or with the individual. The solution is deemed to be found in the corrective power of an otherwise un-implicated therapist. The importance of which will become clear below.

Now, while this may sound like just what therapy is, or is supposed to be, this has much more to do with the power and resources behind these kinds of approaches than anything necessary about their assumptions.

Why the individualistic, cognition-centric framework is flawed

These models are speaking the same language because they assume the same philosophical framework. This framework, however, is not something that is scientifically evidenced. In fact, it is not even something founded upon a well-accepted philosophy. On the contrary, it is essentially based on a set of outmoded enlightenment era assumptions, which have not borne out the test of time.

The largely foreign idea that ‘mind’ is separate from others and the world and the exclusive seat of experience and identity principally arose through the philosophy of Descartes and the British empiricists in the 17th & 18th centuries.

While this fundamental philosophy has been largely abandoned outside of psychology and psychiatry, it has persevered in the psy-disciplines (i.e. psychology and psychiatry). This is mainly due to it being highly convenient for doing the kinds of quantitative, empirical research that gains the acceptance and prestige associated with the ‘hard sciences.’ The psy-disciplines have historically been very insecure in this regard, and as a result, all the more ardent in their identifications with such philosophies.

For our purposes here, there is one key, well-established reason that poses irresolvable problems for this framework. This comes from developmental research.

In its psychological incarnation, the ICC framework has been predicated on the assumption that we come into this world as experientially private, internal subjects with little correspondence to the ‘outside world’ and its key others. This model principally derived from Freud and Piaget, both of whom assumed the same 19th century philosophical background.

The notion of psychological development that arose from this starting point was one concerned with connecting internal experience and otherwise unknowable things outside via internal representations, which had to be centralized to explain the linkage. The whole of western academic psychology and psychiatry more or less followed this.

Consequently, psychology became focused on the individual and their internal constructions, rather than what is going on in their world and with others.

Infant research over the past several decades, however, has conclusively shown these assumptions to be false. In fact, it shows the complete opposite of the assumptions of the ICC model to be the case.

We now know that come into this world aware of, and psychologically attuned to, primary others from the very beginning. Infants and caregivers are shown to engage in intimate intersubjective exchange from the very beginning. And it is this, not internal cognitive processes, that form the basis of psychological development (e.g. Beebe & Lachamn, 1993, 2014; Fonagy et al, 2002; Meltzoff & Moore, 1998; Stern, 1978; Stern et al, 1985; Trevarthen and Hubley, 1978; Trevarthen, 1979, 2010; Tronik, 2007)

We are not the isolated subjects we were assumed to be, but social, experientially open beings that are inextricably bound up with the world and primary others from birth.

The implications of this cannot be overestimated. As prominent infant researcher, Trevarthen, wrote in 2010, “the story of human infancy told by philosophers and medical and psychological sciences has been rewritten.” (2010; p.145).

One might legitimately point out that PAP is not doing research or psychotherapy with babies. However, one’s stance on our basic psychological nature is not just about development. It tells us something vital about our core psychological and experiential selves and represents the core of the subsequent psychology, which all further ideas and theory are built around.

In the present context what this means amounts to the following: if we are not first and foremost private individuals but inherently intersubjectively related beings, then psychological and emotional suffering and what ameliorates it is some