This perspective (2022) provides an understanding of the psychedelic experience through 1) ego dissolution and mystical states, 2) hyperassociative states, and 3) the role of set and setting.
As interest in psychedelics as treatments for psychological problems grows, it is important for psychoanalysts to learn about them. Our patients will come to us to discuss their psychedelic experiences; additionally, psychedelics deserve reconsideration as meaningful collaborators with our field, at both the theoretical and clinical levels. After a brief history of these agents, the paper engages three specific areas: 1) psychedelics’ capacity to evoke egolysis, or ego dissolution, and mystical states; 2) their capacity to support hyperassociative states, free association, and emergence of unconscious material, and 3) the role of set and setting in psychedelic therapy. Drawing from the fields of neuropsychoanalysis, phenomenological research and neuroanthropology, the paper offers a discourse that connects mind and brain and psychedelics in ways meaningful for psychoanalysts.
Guss situates the paper within the renewed, multidisciplinary interest in psychedelics over the past three decades and argues that psychoanalysis is particularly well placed to engage with this revival. The Introduction outlines how psychedelics uniquely affect consciousness, perception, identity and meaning-making and emphasises that intentions for use and contextual factors are central to understanding psychedelic effects. Guss proposes a rapprochement between psychoanalytic theory and psychedelic practice, suggesting each can inform and deepen the other. The author explains that the paper will first canvass historical and cross-cultural uses of psychedelic substances, then focus on two core phenomena that are of primary relevance to psychoanalysts: ego dissolution (egolysis) and unconstrained, hyperassociative cognition. Through a synthesis of neuropsychoanalysis, phenomenology and neuroanthropology, the paper aims to connect brain-based findings with psychoanalytic concepts and to show how psychoanalytic settings and skills can be valuable in psychedelic therapy.
Papers cited by this study that are also in Blossom
Belser, A. B., Agin-Liebes, G. I., Swift, T. C. et al. · Journal of Humanistic Psychology (2017)
Bouso, J. C., González, D., Fondevila, S. et al. · PLOS ONE (2012)
Carhart-Harris, R. L., Erritzoe, D., Williams, T. et al. · PNAS (2012)
Carhart-Harris, R. L., Friston, K. J. · Brain (2010)
This paper is a narrative, theoretical and historical review rather than an original empirical study. Guss draws on a range of literatures — including indigenous and anthropological accounts, mid-20th century clinical practice, contemporary neuropsychoanalytic and neurophenomenological research, and clinical experience — to develop integrative arguments. The text includes descriptive historical review (indigenous uses; mid-century clinical work; socio-cultural developments in the 1960s), synopsis of neuroscientific findings, conceptual discussion of psychoanalytic constructs, and clinical vignettes from the author's practice. The extracted text does not report a formal, systematic search strategy, inclusion/exclusion criteria, or risk-of-bias assessment; it appears to be a selective, interpretive synthesis intended to build theoretical bridges rather than a systematic review or meta-analysis. Where empirical findings are cited (for example, studies linking Default Mode Network dynamics to ego-dissolution), the author summarises these results to support conceptual points rather than to perform pooled quantitative analysis.
Guss presents a historical overview showing long-standing indigenous uses of psychoactive plants in ritual and healing contexts, administered by trained guides (shamans, curanderas) within culturally contained settings. The paper highlights similarities between shamanic practice and psychoanalysis in terms of creating a shared, meaning-making space where dissociated material can become accessible; both rely on skilled, relational containment even though only shamans ingest plants as instruments of access. The author reviews the mid-20th century “golden age” of psychedelic research in psychiatry and psychoanalysis, noting that clinicians used psychedelics to facilitate oneiric, primary-process experiences, reduce defensive barriers, accelerate abreaction and deepen transference. Guss reports that approximately 40,000 psychedelic-assisted therapy sessions were conducted in that era and over 1,000 clinical papers were published, but he also notes that much early work does not meet current standards of rigour and that sociopolitical developments in the 1960s led to criminalisation and stigma. A central empirical and conceptual result presented is that psychedelics can evoke a graded disruption of the ordinary sense of self. Guss explains egolysis (partial softening of the autonomous, organising sense of self) and ego dissolution/death (more complete loss of narrative self prominence), and summarises phenomenological reports that small-to-moderate doses tend to soften defences while larger doses produce more extensive dissolution. He links these subjective changes to neuroscientific findings: activity and intra-network integrity in the Default Mode Network (DMN) are reduced under psychedelics while inter-network connectivity increases, a pattern associated with diminished narrative selfhood and heightened present-moment salience. The paper develops the distinction between the “minimal self” (moment-to-moment sensory/interoceptive experience) and the “narrative self” (autobiographical identity). Under psychedelics the minimal self becomes more prominent as predictive, self-referential filtering attenuates; people report heightened immediacy, decreased preoccupation with past/future narratives, altered body-ownership and experiences variously described as mystical, noetic or terrifying. Guss emphasises that such experiences are dose- and context-dependent and typically transient when conducted within supportive environments. Guss also summarises the concept of the ‘‘unconstrained’’ or hyperassociative mind: psychedelics reduce deliberate and automatic constraints on cognition, increasing sensory input and associative processing. He cites neuroimaging work showing increased connectivity between primary visual cortex and many other regions, and references findings (for example, from Imperial College and other groups) linking reduced DMN integrity with subjective reports of ego-dissolution. Phenomenologically, this manifests as novel, sometimes synaesthetic associations, enhanced imagination and primary-process thinking — processes psychoanalysis seeks to harness through free association. Clinical vignettes illustrate how psychedelic-assisted sessions can mobilise transference both toward the therapist and toward the substance. Guss describes cases in which reduced defensiveness permitted expression of previously disavowed negative transference and in which patients’ idealisation of the medicine threatened to bypass essential integrative work. He stresses that psychedelic experiences often require integrative “working through” after the acute effects and that the therapeutic container and the therapist’s skill in holding difficult affect are central to beneficial outcomes. Finally, the paper underscores the importance of set and setting: the individual's expectations, personality and preparatory context (set) and the physical, interpersonal and cultural environment (setting) jointly shape the valence, safety and meaning of psychedelic experiences. Guss notes that adverse outcomes are more likely in hostile or uninformed settings, whereas culturally contained, intentionally framed experiences are more likely to support therapeutic transformation.
Guss interprets the synthesis to argue that psychoanalysis and psychedelic therapy are natural interlocutors: psychedelics reveal aspects of mind that resonate with psychoanalytic constructs (egolysis, unconscious emergence, transference) while psychoanalytic skills offer an especially suited container for therapeutic work with these agents. The author positions contemporary neuroscientific findings (alterations in DMN dynamics, increased inter-network connectivity, sensory gating changes) as empirical correlates that map onto psychoanalytic descriptions of diminished narrative selfhood and heightened primary-process cognition. The discussion acknowledges historical and methodological caveats: early psychedelic research lacked modern standards of rigour and cultural backlash shaped public and professional attitudes; the paper does not attempt an efficacy review and explicitly refrains from focusing on outcomes literature. Guss warns about the risks of idealisation of psychedelics in popular culture and the potential harms of unsupervised or poorly framed use. He emphasises that ego-dissolving experiences are generally transient and dose-dependent and that distressing material can be therapeutically useful when held within a safe, containing setting rather than suppressed. In terms of implications, the author calls for increased dialogue and integration between psychoanalytic theory, clinical practice and neuroscience, proposing that psychoanalysis both contribute to and benefit from the psychedelic renaissance. Guss suggests that analysts’ expertise in creating a relational container, tolerating and interpreting transference, and supporting integration can enrich psychedelic therapy. The paper closes by inviting renewed curiosity and theoretical revision within psychoanalysis in light of psychedelic phenomenology, while underscoring the need for careful, culturally aware, and ethically grounded practice.
The past three decades have seen a tumultuous revival of interest, in both professional and lay circles, in the group of substances known as psychedelics (R.. These compounds, molecularly disparate, are united by their unique effects on consciousness, perception, identity, and meaning-making. Elucidating the nature of these effects and how they differ across individuals and settings is today an active area of inquiry, generating renewed research and scholarship in the interdisciplinary fields of neuroscience, psychiatry, psychology, anthropology, consciousness studies and information theory. Central to this work is the growing recognition that the intentions for use and context of use are crucial for understanding and using psychedelics in wise, valid, and effective ways. I suggest that psychoanalysis is a particularly well-suited setting for psychedelic work, and, in turn, that psychoanalysis has much to gain from the resurgence of interest in these substances, as they reveal the mind in a unique way. I hope to bring the discourses of psychoanalysis and psychedelic therapy together by exploring their affinities and demonstrating how both practices, drawing on individual and collective intentional and unconscious processes, offer a path toward subtle, yet radical, reconfigurations of the self. To set the stage for our exploration of the psychedelic/psychoanalytic relationship, I begin with a very brief review of past/current indigenous uses of psychedelic medicines, followed by reflection on the "golden age" of psychedelic research and the clinical use of psychedelics within psychoanalysis and psychiatry during the mid-20 th Century. After this, the paper's main focus: detailed descriptions of two complementary phenomena that form the core of the psychedelic experience most likely to be of interest to psychoanalysts: 1) ego dissolution and 2) unconstrained, hyperassociative cognition. I examine these phenomena through the lenses of psychoanalysis, neuropsychoanalysis and psychedelic phenomenology. I invite the reader to consider that the convergence between psychoanalysis and psychedelic therapy is indicative of a deep kinship, which, if recognized and strengthened, can inform, deepen, and expand the theory and practice of both.
The current "psychedelic renaissance" arrives with a long and complex history. These medicines are, and have been, a central part of meaning-making and community-building rituals within indigenous cultures, where suffering is understood as an imbalance in the connection with the spirit world and nature. It is by facilitating communication with this world that sacred plants may bring about healing by conveying special types of information. Psychedelic plants are endemic to varying climates around the world and have been used ritually in indigenous cultures across the globe for centuries. In Western Africa, Bwiti practitioners of Gabon conduct healing rites using preparations of Tabernanthe iboga. Mescaline-containing cacti have been prominently featured in ceremonies by the Huichols of Mexico for thousands of years. Ayahuasca has been a central element of religious initiation and other mystical, curative, and transformative tribal rituals across Mesoamerica, perhaps for millennia. Amanita muscaria, the recognizably red-capped toadstool, is a sacrament in Siberian shamanism and is described in the Rig Veda. While the plants (and their extracted active ingredients) are quite molecularly diverse, they are deployed in similar ways and play a common cultural role within these societies: allowing entry into an unseen world and facilitating experiential connection with it. They are administered by a knowledgeable guide -shaman, Roadman, curandera -trained through an extended apprenticeship-following ritual practices passed down through the generations (rather like psychoanalytic training institutes). Many indigenous shamanic ceremonies are aimed at diagnosing and healing physical, mental, and spiritual maladies, serving both individual and community needs. Aztecs believed psilocybin mushrooms allowed healers to enter "the world beyond," offering healers divine knowledge that could be brought back to the individual and their community. Many indigenous cultures recognize these medicines as bestowing the shaman with special insight into the causes of illness, energy imbalances, disturbances with nature, spirit possession, or soul loss. In the shamanic endeavor, the meaning of the experience is entrained through the creation of a shared state of consciousness, shaped by culturally determined, previously internalized modelsand accompanied by heightened attunement to the present moment. The same occurs, in the psychoanalytic scene; meaning is co-created, through a shared analytic space, wherein previously dissociated intrapsychic contents become accessible and available for affective experience and self-reflection. Unlike shamans, psychoanalysts do not ingest medicine, literally, to facilitate access to an unseen world. But through our training, we internalize a method for altering our perceptions and our awareness, along with those of our patients, in order to glimpse unconscious processes, individual and collective. Like shamans, psychoanalysts perform a psychointegrative function, acting as Laughlin's "symbolic drivers" in the assimilation of inchoate perceptual and affective experience with representational, linguistic knowledge. In what follows, we will see how psychedelics may come to act in psychoanalytic settings as catalysts for softening defenses, allowing dissociated or repressed contents to emerge, and enabling guided restructuring of rigid or poorly integrated self-narratives. In each context, the shaman, psychedelic therapist, and psychoanalyst must know how to "stand in the spaces between realities without losing any of them," to borrow Bromberg's phrase. In shamanic discourse, spirits, ancestors, visions and soul loss are the terms used to reify this dissociated, repressed or otherwise hidden reality. Between psychedelic therapy and psychoanalysis, the terms may differ, but similar psychological processes are being explicated.The golden age of psychedelic use in psychiatry andpsychoanalysis
The formal introduction of psychedelics to mainstream Western culture waited until the late 19th century, as scientific and technological advances propelled the development of modern pharmaceutical science. In 1887, German pharmacologist Arthur Heffter identified mescaline as the principal psychoactive ingredient from the Lophophora peyote cactus, and several decades later, Swiss chemist Albert Hofman began extracting psilocybin from Psilocybe mushroom samples. In 1937, Hofman synthesized lysergic acid diethylamide (LSD), derived from ergot alkaloids of the rye fungus. By 1947, the Swiss pharmaceutical company Sandoz had introduced LSD to psychiatrists across Europe and, by 1949, to those in the US. The compound was studied for its potential to augment conventional psychiatric therapies and traditional psychoanalysis, promote access to mystical experience, and provide a putative model for the molecular toxin imagined to be the cause of psychosis. At the time LSD came of age in the West, psychoanalysis was the most influential theory in mainstream psychiatry. Psychoanalysts used LSD as an innovative tool for unlocking unconscious material in a swift and predictable way, profoundly facilitating traditional analytic methods. LSD therapists, many of them psychoanalysts, shifted from seeing the psychedelic state as a model for psychosis to attending to its ability to evoke dream-like experiences. In fact, some researcherspreferred the term oneirogen ("giving rise to dreams") to psychotomimetic. By inducing primary process and oneiric phenomena during an analytic session, psychedelics facilitated free association (much in the spirit of traditional Freudian analysis), which encouraged therapeutic regression and allowed symbolic material from the unconscious to be harvested. Beyond its oneirogenic properties, substances like LSD were also observed, in the psychoanalytic frame, to lessen defensiveness, intensify the therapist-patient transferential matrix, accelerate abreaction (the "reliving" of early repressed experiences), and promote acceptance of interpretations with less resistance. Clinicians such as Betty Eisner, Sidney Cohen and Hans-Carl Leuner wrote extensively on the ways that LSD facilitated analytic processes in small frequent doses (termed psycholytic therapy) while fostering major transformations or even mystical experiences at larger, more infrequent doses (termed psychedelic therapy). The patients who underwent these treatments carried a range of diagnoses, from mild anxiety to trauma, addiction, and existential distress due to cancer. Some were "diagnosed" with analytically narrated problems that would raise eyebrows and blood pressures these days, yet the suffering depicted is all too familiar. (A fascinating description of this era can be found here:The arrival of LSD onto the clinical scene spurred a wave of excitement and research during the 1950s and 60s that came to be known as the "Golden Age" of psychedelic therapy research and practice. During this period, some 40,000 sessions of psychedelic-assisted therapy were conducted in the US, Canada, and Europe, with over 1000 clinical papers published. This academic scholarship has gone largely unstudied, partly because much of this early research falls short of today's rigorous standards for demonstrating efficacyand partly because rising psychedelic self-administration outside academic institutions throughout the Sixties raised serious societal concern and professional suspicion about their safety and clinical utility.
When they were first being investigated in their therapeutic role within the clinic, psychedelics like psilocybin and LSD were not regulated and were not illegal to manufacture, distribute, or administer. In fact, Sandoz freely distributed LSD to any interested psychiatrist or psychologist, provided that they were engaged in some type of research. The academic and psychoanalytic work with psychedelics that had begun in the 1950ʹs gained notoriety as practiced by Harvard psychologists Timothy Leary and Richard Alpert (aka Ram Dass), among others. Their controversial campus experiments with psilocybin from 1960-1962, and their outspoken advocacy for the public use of psychedelics in the years that followed, garnered national attention and contributed to the precipitous departure of these substances from their academically sanctioned contexts. Soon, psychedelic use became widespread among young adults within universities as well as the broader community. During this time, psychedelic use coincided with a confluence of cultural forces already underway: opposition to the Vietnam War, rejection of corporate culture and consumerism, environmental awareness, civil rights activism, the sexual revolutions, (women's and gay liberation movements), the practice of Transcendental Meditation and spiritual pursuits, post-modern trends in music, and anti-authoritarianism. These waves were momentous in their own right, and their importance was magnified by the widespread self-administration of psychedelic compounds by many in these movements and groups. The zeitgeist of this time is inextricably bound to the attitudes and beliefs that we all carry with regard to these substances. In the absence of cultural traditions of regulation and meaning making, recreational users lacked culturally sanctioned guidance; established sources of context and meaning were lost or inverted. In their stead, countercultural forces prevailed, and to a large degree, it is their close association with these countercultural movements that, to this day, continues to define the lay public's perception of psychedelics. Disconnected from millennia of indigenous wisdom, the public's infatuation with the consciousness-expanding potential of psychedelics suffered from the lack of an existing context for meaningful use and an absence of guidelines for safety, leading to instances of real distress and harm. Multiple factors -clinical, political, and sociocultural -contributed to the eventual cessation of psychedelic research and the full criminalization of these medicines in 1970 through Nixon's signing of The Controlled Substances Act of 1970. As a result of this backlash, and the misinformation propagated by the "War on Drugs," psychedelic use was heavily stigmatized and lost its connotations to psychological health and healing, to the point of becoming spuriously associated with carcinogenesis or chromosome damage). North American psychoanalysis followed suit, coming to view psychedelics with suspicion and disdain, dismissing their utility in the clinical process, and ultimately disavowing their place in psychoanalytic history. While traditional psychoactive pharmaceuticals and psychoanalysis have settled into a workable truce, more or less psychedelics remain abjured by much of psychoanalysis, born out of a fear that they are dangerous, illusory, disruptive, excessive, childish or phony. I suggest that psychoanalysis would do well to overcome this aversion and fear. We must remember the past, the promise and the peril, but still ask: what value might these catalysts hold for the world of psychoanalysis and our inquiry into the nature of mind and human suffering as we continue to develop our theories and therapy? While there are now dozens of studies showing efficacy of psychedelic-assisted therapy in treating numerous DSM-5 defined conditions, I will not focus on the outcomes or methods of psychiatric efficacy studies here. (For a detailed manual on conducting psilocybin-assisted therapy to treat major depressive disorder in contemporary research and clinical settings, see,. Instead, I wish to introduce the reader to contemporary research in neuropsychoanalysis and cultural neurophenomenology to show how psychedelics elicit particular subjective experiences that are analogous to those we privilege and pursue in the psychoanalytic endeavor. In doing so, I hope to arouse fresh interest and curiosity for the coming revolution that psychedelics will bring to our understanding of the mind: who we are, how we are, and how we change.
These terms, encountered frequently in psychedelic discourse, seldom appear in the psychoanalytic literature. However, the processes are not unfamiliar to analysts. Contrary to what may seem implied, ego dissolution and ego death do not refer to the annihilation of the synthetic functions of the ego (i.e., its underlying capacity to organize and unify complicated impulses, energies, and aspects of the personality;. Rather, they encompass a subjective continuum along which the discriminating, adaptive sense of self that binds identity and is instantiated in ordinary waking consciousness -what we recognize as our autobiographical self -gradually softens and cedes its prominence as the organizer and creator of present experience. Depending on the degree of identity diminution, this is referred to as "egolysis" (partial) or ego dissolution/death (complete). There is considerable research evidence that small to moderate psychedelic doses result in a softening of defenses consistent with egolysis, while higher doses lead to a greater and occasionally complete dissolution of the ego. Such processes may be accompanied by considerable affective arousal as long-held self-representations transiently soften, then fall away. It might be useful here to consider psychedelics' effects on the ego through a conceptual framework of the self that has become increasingly central to modern psychoanalytic theory, advanced by Bromberg, Rosenberg, and others. According to this view, the self exists as a multiplicity of self-states, at times conflictual, which may be well or poorly integrated with one another depending on the dialectic between shifting self-referential elements ("views about oneself") and external/ "other" elements ("views about others and how one is perceived"). It is the discontinuity, poor integration, and conflict within or among self-states that results in the type of suffering we call psychopathology. Depression and anxiety, for example, may be seen as sequelae of a failure to assimilate internally incompatible mental-affective self-states, leading to rumination, self-preoccupation, and/or worthlessness-feelings that are stubbornly unyielding. We might imagine psychedelics, then, as agents that reliably perturb the mechanism by which conventional identity and self-recognition are maintained. The result is that disparate self-states communicate and share co-consciousness with one another. The user feels known or shown to himself/herself in a highly unique way that is at once foreign and uncannily familiar. The disruption of defenses can unleash a torrent of unwanted (repressed) memories, affects, and self-representations that can be uncomfortable, or even excruciating, to bear, as previously disconnected or dissociated states rise to awareness. At the extreme end of this spectrum ("ego death" or "ego dissolution"), the old self-state organization is (transiently) dissolved, and one accepts, or fights, the emerging expanded communication among self states. Aided by a skillful therapist, the emotional deluge can be held and contained, a function the psychoanalyst is especially well-trained to provide. With a reorganization of self-states, greater co-consciousness becomes possible, as a new and expanded "self-unity" may be experienced. This experience is often remembered with extraordinary clarity and holds a sense of salience long after the intense moments have passed.
An alternative term for "ego" as it is used in these studies is "narrative identity." Matthew Nour, psychiatrist and clinical neuroscientist from the King's college Institute of Psychiatry, Psychology and Neuroscience, offers a model of mind that distinguishes the "minimal self" from the "narrative self." The minimal self consists of moment-to-moment interoceptive and exteroceptive sensory perceptions; it is close to Stern's "unformulated experience"and akin to what Wilfred Bion described as "beta" elements. This minimal self is characterized by transience, immediacy, and intensity of sensation rather than sharp discriminations regarding time and space, the constrictions of language, imagining the past or future or the need to extrude certain information from awareness (i.e., through one's defenses). The narrative self, on the other hand, is our personal, familiar notion of who we are, shaped by our sociocultural context, genetics, and unique collection of memories, experiences, triumphs, traumas, and values. It is the story we witness unfolding before us, lived out by our unique, adaptive, and self-aware personalities, a story that, by definition, is maintained by keeping certain material out of consciousness and privileging other information as salient. As part of its attempt to generate internal unity and cohesion, narrative identity contains, maintains, and excludes conflicts, complexes, archetypes, memory, affect and dissociation. This organizational skill in defining and separating the known from the unknown is essential to the creation of a functional and cohesive sense of self, serving the narrative self's ability (and need) to make predictions about the world and to seek out information that either confirms or rejects them. When this sense-making mode becomes particularly inflexible in its filtering and distillation of the world, such as when the narrative identity is extremely rigid, feelings of being hopelessly "stuck" in one's story predominate impeding other ways of experiencing the world. The narrative self, internally generated and reinforced by interactions with the world and self-esteem, may be well-integrated, adaptive and coherent or scattered and poorly integrated, but it nonetheless has an enduring quality; it is experienced as a thing that really exists and persists; it feels solid. One might say that the narrative self is an object that we create in order to think about ourselves and which, through the lens of object relations theory, is composed of self-representations, otherrepresentations, and the affective links between them. In profound psychedelic medicine experiences, this narrative self may be quite disrupted, and Nour suggests here that the minimal self becomes more prominent and more salient, with its exquisitely attuned focus on bodily and external perceptions in the present moment. Previously imperceptible data -interoceptive cues, fleeting somatic states, memory traces, and subtle sensory information from the environment -enter consciousness as vibrant, immediate experience, unmediated by language or selection by defenses. The (predictive coding) mechanism for "I expected this, I know this, this is familiar" is attenuated; things seem new, fresh and seen as if for the first time. (R.L.. Along with this unfiltered immediacy of conscious experience, salience of the present moment heightens, preoccupation with future and past narratives decreases, "everything" feels important, the demands of logic soften, and self-other boundaries recede. If the autobiographical self is an object of experience, the minimal self is the pre-reflective, sensuous subject of experience, unhindered by adaptive contextual constraints and thus increasingly awake and engaged in the present moment, attuned to the here-and-(eternal?) now. Neuroscience-based psychedelic research has discovered that the narrative self maps quite well onto the Default Mode Network (DMN), a circuit of connected and distinct areas in the brain that show synchronous activity during introspection, when we are immersed in our autobiographical identity and are the object of our own thoughts. During self-reflective, selffocused experience, the core DMN is highly active and other networks (such as those involved in directing our attention to the external environment) are inhibited (M.D.. Interestingly, under the influence of a psychedelic medicine, activity in the DMN alters predictably, mirroring the softening of narrative identity verbalized by participants undergoing simultaneous brain function examination. Along with colleagues at the Imperial College of London, Nour examined the association between DMN activity and phenomenological changes to the ego evoked by psilocybin using simultaneous MRI scanning and subjective reports. The group found a meaningful correlation between the diminution of core DMN function and the subjective loosening of narrative identity. Participants reported that the experience was infused with a marked sense of aliveness and immediacy, similar to the state psychoanalysts might call "experience-near"or Tronick's "dyadically expanded state of consciousness". Many subjects experiencing ego dissolution report a sense of expansiveness and unity characteristic of the mystical state. For some, ego dissolution was accompanied by deep fear, even terror, and a profound sense of strangeness and loss of control triggered by the flood of new associations. At times, these distressing feelings occurred alongside positively valenced mystical ones, either within the same journey or at the same time. The strangeness or alienation is curiously double-edged. While it reflects a break from the quotidian sense of ownership that pertains to the narrative self ("me-ness, my body, my mind, my social context, my identity"), the dissociated aspects of the self are not in fact entirely alien, since they live in the personal and cultural unconscious. Their emergence into the spotlight of awareness, then, can seem strange and familiar at once, a situation both paradoxical and liberating: "I died but never felt so alive," or "I have never felt so scared while feeling profoundly safe and held." Enduring this tumultuous "dark night of the soul"may even be perceived as a spiritual awakening or transmogrification. This process of near-death, terror, and rebirth is a recognized and almost universal narrative (or fabula) in cultures around the world and throughout time. In psychedelic growth narratives, a life review -a rush of memories about one's past actions and decisions -can lead to clarification of personal values and a need for reconciliation and reintegration of disparate self-states ("a striving for wholeness";. By virtue of our profession, analysts are (in our best moments) attuned to our patients' emotional states and adept at holding a curious and accepting stance with them, no matter how turbulent the waters might become. This principle of treatment is similarly embedded within psychedelic therapy; psychoanalysis and psychedelic therapy alike seek to nurture a state of safety as deep as the dyad can allow. As in psychoanalysis, the treatment approach recommended during a psychedelic crisis is not emotional suppression or the reestablishing of old defenses ("talking someone down"), but a sustained witnessing of the shared experience (e.g., "talking through, being with"). The analyst and the psychedelic therapist are observers as well as participants in the process, engaged in its creation, stable continuity, and integration: causing and repairing ruptures, supporting immersion in emotional states, and affirming the emergence of memory and desire. Along with a diminution or loss of narrative identity, one's sense of body-ownership, "me-ness," and personal agency may diminish or disappear as well in the psychedelic state. For some in Nour's study, the gradual ebbing away and dissolution of the ego led to a reduction in their belief that the self was the creator of self-experience. In other words, subjects were more receptive to the notion that their lived experience was arising from a source outside the self, from a "non-me" location, rather than their familiar mind. This can lead to the feeling that one's internal experience is being given or shown to the self. Some psychedelic therapists use the term "inner healer" to describe this "Other" that appears when needed. Others see the plant as having wisdom to impart and allowing its wisdom to be perceived. Others may describe ancestors, cultural wisdom, or spirit forces intervening as a novel source of hope to explain this phenomenon. I suggest that this parallels the psychoanalytic situation in which the unconscious resources of the analyst/analysand dyad, their dreams and faith in the process, comprise the conditions for expanded knowledge of self and other, paving the way for a transformative experience. This may be what happens when both the analyst and analysand surrender to the process of analytic healing, even in the face of terrifying emotions, relying on their mutual trust in the wisdom of their surrender to the process. The change in sensitivity and increase in epistemic trust experienced by the analysand as well as the psychedelic patient can open ways of seeing the world and being in the world that foster an altered relationship with culture, community and cosmology. When these interconnected webs of meaning are suddenly experienced as an illumination of the present moment, it may feel as if important truths were emerging from an external source, perhaps even a divine one. This noetic quality may sound fanciful to a humanist and is sometimes dismissed as defensive religiosity or unscientific "woo woo." We do not need to invoke a divine source, however, to value such self-transcendent experiences, which describe an expansion of one's identity beyond the boundaries of a narrated, embodied egoand which Maslow ultimately recognized as the peak of healthy human psychological development. The vastness of the individual, the collective unconscious, and our cultural milieu offer resources rich enough to flood the psychedelically enhanced mind with layers of new and familiar meaningwithout needing to resort to unfounded supernatural claims. On the other hand, there is no need to exile The Divine from the consulting room (provided She is appearing among consenting adults). The ego-dissolving effects of culturally contained psychedelic experience are transient, dose dependent, and, most importantly, sought out intentionally, distinguishing them from psychosis (where such dissolution is neither sought nor desired, doesn't not end in a timely manner and is usually terrifying) and from careless or unthoughtful use of a psychedelic. Careful use of these agents does not incur any enduring loss of adaptive ego functioning or neuropsychological damage. If psychedelic use occurs in a hostile, uninformed, or unsupportive environment, the risk of retraumatizing affect storms, including panic and paranoia, is likely to be greater. Yet within a safe, contained, and creative therapeutic space, affective eruptions (what we might call catharsis or abreaction in psychoanalytic language) can lead to a budding and transformative inquiry into the nature of challenging or overwhelming experiences. The influence of context on the quality, valence, and usefulness of the experience became recognized early in the psychoanalytic psychedelic treatment era. The common locution, "set and setting," was popularized (prominently by Leary) to denote this key insight. Set refers to the full collection of psychological variables -preparation and expectations, personality, and underlying unconscious processes -that the individual brings to the experience. The counterpart of "set" in the psychoanalytic discourse would be the complex internal matrix that analysts recognize as character and disposition, mood and temperament, ego structure, family history, cultural imprinting, and current experiences. Part of the set includes what the patient believes about therapy and the therapist, and what she or he hopes, and fears, will emerge from treatment. Setting, on the other hand, refers to the physical, social, cultural and historical environment in which the experience is taking place. Setting includes both microcultural and macrocultural elements. The former refers to the physical space and location in which the experience is taking place as well as to the relationships among the individuals involved. The latter includes the broader societal backdrop, such as the legality of the treatment;, the therapists' training history and clinical experience; past and current cultural conceptions of mental health and illness; and the historical and sociopolitical forces which surround the treatment (e.g., systemic racism, inequalities of gender, class, and income, governmental drug policy, societal perceptions and stigma, etc.;. Understanding such layers of meaning, insofar as they may color and shape the patient's (and therapist's) subjective experience, is at the heart of psychoanalytic inquiry and process. It is precisely this sensibility that makes psychoanalysis such a valuable locus for psychedelic work.
Free association was developed by Freud as an alternative to hypnosis for accessing unconscious material. As contemporary analysts, we might do well to imagine free association as an ideal to strive for, rather than a goal to achieve, because we know it is quite impossible to achieve fully; all associations originate somewhere and are headed somewhere -rather the opposite of what we might call free. Nonetheless, we encourage free association as a means to help our patients speak more freely, imagine more deeply, and know themselves in richer, more fulfilling, and less fearful ways, even if that means allowing the patient, temporarily, to revert to an earlier stage of development so that he or she may reexperience trauma and seize the opportunity for self-repair (dubbed "regression in service of the ego,". This altered state of consciousness (regression, reverie, imagination) occurs in the analyst as well as the analysand, since such spells, trances, and mutual regulation processes naturally flow in both directions. Our refined methods of attunement, and the care we give to regularity, frequency, safety, and attachment, are our invitation to the patient to enter the alternative states of consciousness that are most fruitful at any given time in a session. A similar process is central for carefully conducted psychedelic therapy. Michael Lifshitz and colleagues at McGill University chose the term "unconstrained mind" in their work on the neurophenomenology of psychedelic experience to denote this altered state of consciousness. Lifshitz includes the psychedelic state among a variety of unconstrained or spontaneous mental states that can arise when the mind/brain, deprived of external stimuli or task demands, is held in a container of safety, meaning and creativity. Such states include daydreaming, mind wandering, self-generated thought, imagination, and stimulus-independent thought. To understand what is meant by unconstrained thought, Lifschutz describes how we constrain thoughts. He distinguishes two types of constraints: 1) deliberate constraints, through which we voluntarily direct thoughts toward a task or object of focus, and 2) automatic constraints, which involuntarily direct the spotlight of awareness to a particular subset of mental contents at the expense of all others. We might think of these automatic constraints as another term for the defense mechanisms that shape our ego, the agency that "decides" which thoughts, affects and memories we become more (and less) aware of, giving rise to the narrative self. As practicing analysts, we are acutely attuned to this mysterious discriminator that selects, out of an infinite number of percepts, memories, and sensations, those that are formulated into a thought, those that remain buried, and those that exist instead in the liminal space between (sometimes known as the preconscious). As we sit with our patients, we come to appreciate how our words, breath, movements, and even reveries can have a profound impact on our patients' thoughts and affective climate. Psychedelic medicines reduce both deliberate and automatic constraints in a curiously interdependent fashion. First, they relax one's deliberate control over thoughts (i.e., one's sense of agency as the "discriminator" of experience), and second, they increase, through a "bottom up" process, the amount of sensory input received from the body, the brain/mind system, and the outside world. There is a marked increase in associative functions of the brain just as more sensory information reaches the neocortex (via reduced thalamic gating), a combination that effectively overpowers the already muted "mysterious discriminator.". This rich variety of stimuli are noted as salient, causing the concerted breakage of old associative links and the emergence of new and unusual ones. This parallels the dissolution of the narrative self, which neuroscientific research has shown to be accompanied by altered dynamics in the Default Mode Network. Carhart-Harris and collaborators (2014) found that, under the influence of psilocybin, the core DMN nodes show reduced intra-network integrity and heightened inter-network connectivity. In other words, at the same time that the robust cortical networks of ordinary self-cognition (same old me) are disrupted, others become differentially integrated/connected in newly forged communicative patterns, with evidence of greater spontaneity in their functional properties. The result, phenomenologically, is a reduction in the generation of familiar narratives along with a rush of unusual, unexpected content, all of which can lead to freer associations and enhanced imagination and creativity in a type of thinking Freud dubbed primary process. The circuits activated in REM sleep, psychosis, depersonalization, and dreamlike experiences are also prominent in psychedelic experience. Interestingly, during a psychedelic journey, there is an increase in neural connectivity between the primary visual cortex and multiple other cortical and subcortical regions. This reorganization of the brain's networking promotes cognitive flexibility but also heightens the salience of unusual and unexpected associations, at times blurring into synesthesia. These novel associations are felt by some to be essential to the change process in psychedelic therapy. While they may be experienced as effortless (not requiring any agency to evoke), they may also feel uncontrollable and foreign, as if the thoughts and images were generating themselves and insisting that connections be made and seen. One might describe this as the "Otherness" of the brain/mind system assuming the center stage of consciousness, a shift sometimes referred to as expanded consciousness. Put more concretely, the brain (and the mind that emerges from it) becomes more flexible on psychedelics, more open to novel patterns of awareness amid greater integration of previously disparate parts, at both neurological and psychological levels. Different cultures offer divergent explanations for the wealth of new patterns and connections that emerge from an unconstrained, hyperassociative mind. A shaman might perceive literal ancestral forces (ghosts, spirits, spells) bringing healing, guidance, spite, or malice to the sufferer, while we psychoanalysts might say that these enhanced perceptions and feelings are visiting from our favorite places of mystery: the personal unconscious, the body, and their grand container -the collective unconscious. Whether the physical setting is an indigenous ceremony in the rainforest, a small urban office, or an MRI scanner, the unconstrained cognition and hyperassociation provoked by the psychedelic state exist always in the cultural context wherein the experience unfolds. As in the psychoanalytic frame, this context affords permission, facilitation, safety, and an interpretive framework. I propose this formulation to spark the reader's imagination: Psychedelic medicine offers us the opportunity to work in the hinterlands between our patients' narrative self and minimal self: "the spaces between." Into this matrix, as we shall see in the clinical reflection to follow, transference emerges more readily, uncanny and unbidden, yet always saturated with potential meaning and transformative power. The analyst, skilled in creating a safe, dynamic container for this, is intermittently rewarded by moments of special connection, breakthrough emotional clarity and engagement, and the patient's expansion of selfconcept and self-acceptance.
Having thus laid out some analytic theory to limn an understanding of how psychedelic therapy works, it might be valuable to share examples of these ideas. I offer several clinical moments that illustrate two instances in which my training and experience as a relational psychoanalyst enriched my work as a psychedelic therapist and were central to the shared understanding of the therapeutic process. Both involve transference: one between the patient and me, the other between the patient and the medicine. Most analysts know to be wary of a treatment that never engages negative transference in a deep and authentic manner. Some patients are in such need of a positive, loving connection that they are unable to recognize, much less express, intense negative transference (some analysts, too). In my work with Aaron, emotionally and physically abused by his father and uncle, he carefully constructed our relationship to be safe -for him as well as for me. While there were numerous examples of aggressive competitiveness, devaluation, and rage and hurt expressed toward other important figures in his life, he kept the two of us apart from all this. My noting and reflecting this pattern back to him didn't help; he understood what I was getting at, but there wasn't much shift away from this splitting. During a medicine session, however, things changed. Just after the peak of the experience, his defenses markedly softened, and negative transference was expressed with an intensity and complexity that had previously eluded us. He was able to speak of his envy of me, his competitiveness, his perceived use of seductiveness, manipulation, and intimidation to control and shape my behavior. My analytic training and the medicine's effects worked in tandem to open up this very important and delicate area of our relationship for our exploration and understanding. This direct experience was markedly powerful on its own, but it also meaningfully connected to his recurrent, intrusive fantasies of catastrophic failure, guilt, and anxiety that followed successful, typically aggressive negotiations in business. We came to understand the link between his idealization/devaluation of our treatment and his intrusive fantasies of immense failure and a lonely, impoverished death. I offer another instantiation of idealization, this time toward the substance: just as psychoanalysis underwent a process of cultural idealization in the 1950s and 60s, psychedelics are currently in a phase of cultural idealization. The media is teeming with promises that psychedelics will offer rapid, lasting cure for any number of ailments and maladies. Patients often arrive at a psychedelic session with these hopes in tow, some realistic and some not, as part of their "set." The underlying narrative is oftentimes: "Nothing else has worked at all, this is my last hope." The devaluation of other interventions, especially SSRI medications and "talk therapy," holds hands with the idealization of psychedelic healing. Unfortunately, some psychedelic practitioners, themselves, have become enchanted by this utopian vision. Understanding this defensive process, and working with it skillfully, both in the patient's mind and the analyst's is a requirement for understanding the situation when things fall short of the hoped-for miracle. Aaron fervently sought "complete ego dissolution"; without it, he claimed, "we haven't gotten there yet." He was quick to cast aside biographical material that was clinically meaningful, calling it "boring" or "dreary," since he was "still there" and did not have obliteration of his narrative identity, his idealized portal to change. My analytic training made it second nature for me to guide us toward the discarded "dreary" images and affects, attending with curiosity and interest to just what he sought to throw away. These images and affects entered my reverie, enhanced by our extended time together, and together we found our way to deep sources of meaning and emotion. Following this work, the urgent desire for ego annihilation ebbed, and we came to understand that longing as his wish to bypass painful, shame-ridden areas of his life in favor of a "rebirth" narrative that elided the needed exploration. The desire to be reborn dramatically as a new or different person -free of the trauma and wounds and rage that such labor entails -is, of course, yet another idealization, something no treatment or transformative process can deliver. The metabolism of idealization had a profound emotional impact, held in the post-peak state of reduced defensiveness and heightened trust and receptivity that can be part of a psychedelic therapy session. While it is true that, in some cases, long-lasting and profound change can follow a single psychedelic journey, psychedelic therapy always demands active work to integrate the insights and revelations of the medicine experience into day-to-day life, very much in the spirit of psychoanalytic "working through".
Psychedelic processes offer an opportunity for psychoanalysts to understand psychic functioning in our own vernacular, relation to culture, and the value of integrating our theories with neuroscience. Psychedelic consciousness offers psychoanalysis an invitation to revise, reconceptualize, and expand our theories by diminishing the boundaries that limit our vision of the human psyche and the human condition. In turn, the psychoanalytic attitudewe cultivate offers an extraordinary setting for psychedelic therapy. I look forward to all the ways, some as yet quite unimagined, that psychedelic experience will stimulate creative critical thinking and analytic theory in the years to come. Stanislav Grof and Joan Halifax wrote the following in their 1977 book on their work with LSD therapy, The Human Encounter with Death: "The psychotherapeutic work and effects of the drug are interdependent; they complement and reinforce each other and create a new treatment process". Within a treatment process that may occasion phenomena that appear disorganized and chaotic at times, psychoanalyst Gerald Stechlersaw the potential for radical and lasting change. I offer his comment here: "If the therapist can stay connected with his own and with the patient's destabilization, both can move toward openness and affective authenticity."
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Papers in Blossom that reference this study
Buchborn, T., Kettner, H., Kartner, L. et al. · Frontiers in Neuroscience (2023)
Ponomarenko, P., Seragnoli, F., Calder, A. et al. · Journal of Psychopharmacology (2023)