Should we be leery of being Leary? Concerns about psychedelic use by psychedelic researchers

Introduction

There is burgeoning interest in the use of psychedelics—psilocybin, LSD, MDMA, and others—to treat psychiatric illness (Nutt, 2019). Research is proceeding rapidly, despite ongoing legal and regulatory barriers (Lamkin, 2022) and persisting questions about study design and implementation, such as the difficulty of ensuring adequate blinding (Burke and Blumberger, 2021), the relative overrepresentation in studies of participants who have previously used psychedelics (Mitchell et al., 2021), and whether personal experience with psychedelics is necessary for those who provide psychedelic-assisted therapy (Nielson and Guss, 2018). Here, we wish to explore two distinct concerns, namely, whether personal use of psychedelics by researchers could threaten or, secondarily, simply be perceived to threaten, the objectivity and ethical conduct of psychedelic research itself. In 2020, Anderson, Danforth, and Grob suggested in passing that psychedelic use could lead even “conservative individuals to become wildly enthusiastic about the potentials of psychedelics to heal and transform” (Anderson et al., 2020). Recent popular press criticisms of current psychedelic science, in particular critiques of the MAPS Phase II and Phase III MDMA-Assisted Therapy trials for PTSD, have also raised questions about whether personal use of psychedelic drugs by psychedelic therapists could compromise scientific objectivity, lead to the exploitation of research subjects, or promote biased reporting of results (Nickles and Ross, 2021). Here we elaborate on and attempt to delimit these concerns, with the goal of informing policy related to psychedelic research and the eventual clinical use of psychedelics. In particular, we explore whether the possibility that psychedelic use can directly and positively affect investigators’ enthusiasm about psychedelics themselves raises concerns about bias and scientific integrity (Yaden et al., 2021). We then discuss several practical strategies the field could adopt to enhance objectivity, ethical standards, and reduce perceived conflicts of interest. To be clear, our concern is different from the worry, raised by Pollan (2015) and explored extensively by Letheby (2021), that psychedelic use can lead to problematic beliefs because it produces “comforting delusions.” We think psychedelics could problematically affect motivation even if they do not change a person’s beliefs.

Why we should be concerned

It is normal and expected for clinical researchers to have enthusiasm for their work and to regard the treatments they study as valuable. In science, such ordinary enthusiasm is necessary to surmount the many barriers to conducting research. One must believe that what one is studying has enough promise to make its study worthwhile. We worry, however, that psychedelic researchers could sometimes have what we might call excess enthusiasm for psychedelics—effectively, changes in their values that make psychedelics seem more important than is warranted, and which is, causally, due to capacity for these compounds to generate motivation psychopharmacologically, rather than in response to an impartial assessment of their clinical potential. We raise this concern for three related reasons.

First, while we are not aware of any formal study of this issue, it seems likely to us that the majority of psychedelic researchers and those who wish to provide psychedelic treatments have themselves utilized psychedelics. Other have reported this impression, too; Manoj Doss, himself a psychedelic researcher, stated “I know only one psychedelic researcher who’s never done psychedelics. . .[T]his means you’ve got some stakes in the game: you did drugs, you liked them, now you’re studying them. . ..There’s a conflict of interest” (Hu, 2021). More objectively, it is common in some psychedelic training programs, such as MAPS, for study therapists to undergo experiential training, as this is thought to help them more effectively shepherd participants through their own experiences (MAPS, 2010). This is not a reason for concern itself, necessarily, but is an important background condition.

Second, like Doss, we worry that psychedelic use itself could undermine objectivity about psychedelics. There are multiple ways this could occur, including the fact that having a positive experience could, in a very ordinary way, make a person want to help others have that experience, too. More worrisome, however, is the possibility that psychedelics increase enthusiasm for psychedelics because of their underlying psychopharmacological mechanisms of action. While these mechanisms are still incompletely understood and hotly debated (Daws et al., 2022), psychedelics appear to increase suggestibility (Carhart-Harris et al., 2015), subjective insightfulness (Kometer et al., 2015), perceived creativity (Mason et al., 2019), and attributions of meaning (Hartogsohn, 2018). Indeed, participants in psychedelic trials frequently rate their experiences as among the most personally meaningful events in their lives—on a level with getting married or the birth of a child (Griffiths et al., 2008). It is widely known that participants in psychedelic studies report a greatly increased sense of belongingness, oneness with the universe, and spiritual connection (Liechti et al., 2017). Any of these pharmacologically specific effects could lead to excess enthusiasm for psychedelics after exposure to them, with potential consequences for researchers’ priorities. We call this notion “excess enthusiasm” because we hypothesize that alterations in liking, salience, and psychological orientation that can follow psychedelic experiences could independently and powerfully affect motivation to engage with psychedelic research, beyond any independent motivation related to conscious appraisal of the potential objective benefits of these substances. This term also tracks language used elsewhere to express concerns about psychedelic exceptionalism (Anderson et al., 2020; Johnson, 2020; Yaden et al., 2021).

To be clear, we are not suggesting that psychedelics are addictive—the evidence that they are not, when addiction is measured in terms of self-administration, craving, or similar indices, is compelling (Nichols, 2016). But if experiences of increased insight, meaning, and the like are associated with the use of psychedelics, then psychedelic researchers who themselves use psychedelics could have greatly increased enthusiasm for them. This enthusiasm would be excessive in the sense that it may not necessarily reflect the potential of psychedelics to treat specific psychiatric illnesses. Indeed, even if the enthusiasm for psychedelics turns out to be proportionate to their therapeutic potential, we would still regard this as “excessive” where it is generated as a psychopharmacological effect of personal psychedelic use, rather than by the state of psychedelic research. The concern is that such excess enthusiasm—which would be merely coincidental with any evidence that psychedelics are beneficial for specific psychiatric illnesses—would be less responsive to the evolving scientific picture.

Third, the early history of psychedelic research suggests, indirectly, that enthusiasm-generating pharmacological mechanisms could affect research. Early efforts to characterize the effects of psychedelics were often marked by blurred boundaries between science and spirituality, between scientists and subjects (Lattin, 2009). Scholars like Timothy Leary were widely criticized for applying excess pressure to participants in their research, abandoning appropriate scientific methodologies, and approaching the field with quasi-religious fervor rather than cautious skepticism. The fact that many of these early researchers themselves engaged in psychedelic use, and often recounted their experiences publicly, at the very least raises questions about the impact of psychedelic use on their objectivity. And while the powerful experiences afforded by psychedelics might justify great enthusiasm about them for spiritual purposes or personal growth, this should not be assumed to generalize to the treatment of psychiatric conditions.

Tempering our concerns

We acknowledge that our hypothesis needs testing. It could be wrong. It may be that relatively few psychedelic researchers have used psychedelics. Even if they have, it may not be true that researchers who have personal experiences with psychedelics tend to be especially enthusiastic about them, compared to researchers who haven’t had those experiences. And even if they are, this may not negatively affect their work. It may not produce bias or lead to blurred boundaries. Instead, it could easily lend itself to greater care and rigor and to better research. Most broadly, even if excess enthusiasm did lead to biases, this would not show that psychedelics themselves are ineffective or harmful.

It also remains unclear what level of enthusiasm for psychedelics is scientifically appropriate. It is not unreasonable, given the limited efficacy of many conventional psychiatric treatments and the high burden of untreated suffering due to mental illness, to have excitement about promising new interventions. As the recent American Psychiatric Association position statement on psychedelics states, however, the use of psychedelics to treat specific forms of psychopathology has limited current evidence to support it (APA, 2022).

We also acknowledge that psychedelic science is not unique in being subject to bias. Scientists are exposed to multiple pressures that may reduce their objectivity: financial pressures from industry ties, the need to commit themselves wholeheartedly (or single-mindedly) to a scientific research paradigm to successfully publish and to win grants, and even the unconscious need to protect their egos from injury when they have devoted their lives to a certain scientific paradigm. We think, however, that the enthusiasm associated with psychedelic use itself may, for neurobiological reasons, be unique.

Our argument might seem vulnerable to an important counterexample. One could draw an analogy between first-person experience in psychedelic research and other fields, like psychoanalysis, where there is a well-established expectation that providers will themselves undergo treatment—what is called training analysis (Nielson and Guss, 2018). The worry we have raised about excess enthusiasm in psychedelic research might seem imply that training analysis (and other forms of demonstration psychotherapy) should preclude later engaging in clinical practice—at least if they cause participants to be enthusiastic about the therapy. There are two key reasons to resist this analogy, however. First, our conjecture is not simply that first-person experience with psychedelic use engenders excess enthusiasm for it, but rather the idiosyncratic psychopharmacological effects of psychedelics on motivation do so, and these are not likely to be present in training psychotherapy. Second, our point is primarily directed at the use of psychedelics by persons engaged in clinical research, and might not hold for persons using psychedelics in clinical practice, once they have been shown through robust studies to be efficacious.

Lastly, we concede that individual bias may not always threaten the public validity of a field. As a branch of human knowledge, science is uniquely effective in establishing rules of conduct that correct for human bias. Indeed, as Michael Strevens argues, (Strevens, 2020) scientific progress uniquely harnesses the idiosyncratic motivations of individuals and provides a methodology for error correction and truth finding. Even if psychedelic science is exposed to particularly acute biases, we might hope that scientific methodology can correct for them.

Practical implications

The possibility that psychedelic use could bias the work of psychedelic researchers has practical implications. The first is a need for more information. Cataloguing the personal experiences of psychedelic researchers through surveys and interviews, documenting their own personal attitudes toward psychedelics and how those attitudes evolve over time, and correlating their experiences and views with outcomes in their studies may help to attenuate worries about bias—or identify ways that biases need to be corrected. Such studies, however, need to be conducted in a way that preserves anonymity and avoids exposing well-intentioned researchers to unmerited legal and academic repercussions. This presents certain challenges that deserve careful attention.

Second, it is worth mentioning that even if personal psychedelic use does not cause scientists to become excessively enthusiastic about psychedelics, it can still threaten the viability of psychedelic research if the public (and especially, funding agencies, law makers, and regulatory bodies) comes to believe that it is a source of bias. Although McCoy and Emaneul (2017) have argued that perceived conflict of interest is not the same as, and not as problematic as, actual conflict of interest, the perception of a conflict of interest can still have consequences. It could, among other things, lead to unwanted and highly reactive regulation, and undermine trust in scientific findings, potentially limiting their translation into treatments and subsequent uptake. Such perceptions do not yet appear to have arisen at a population level. Still, psychedelic researchers and clinicians should take steps now to demonstrate objectivity in their work. In particular, we think, researchers should strive to ensure that their scientific teams contain individuals who have not used psychedelics, and that these individuals have a role in overseeing the work from a standpoint of data analysis and integrity. This presupposes the possibility of openness about personal psychedelic use and nonuse within and outside of research teams. Such a policy would require clear guidelines for disclosure both to encourage honest reporting and to mitigate fear of repercussions.

Tempering researchers’ enthusiasm for psychedelics may also enhance the protection of research subjects, by reducing the chance that they will be exposed to unnecessary harms, undue pressure to participate, or boundary violations. The frequency with which psychotherapists generally are accused of inappropriate relationships with their patients—thought to be due to the powerful sense of intimacy engendered by psychotherapy, among other factors (Norris et al., 2003)—and the clear ability of psychedelic compounds to foster feelings of intimacy, love, and connectedness suggest the need for special vigilance in psychedelic-assisted therapy.

The well-being of research participants and the integrity of science are not our only concerns. We think that, even on the most conservative estimates, psychedelics do show great promise for the treatment of conditions within and outside of psychiatry. We’d hate for a series of missteps—which would undoubtedly be highly publicized, given the great attention paid to psychedelic science so far—to derail this program of research again.