Schizophrenia

Pivotal Mental States

This theory-building paper (2020) introduces the 'pivotal mental state', a hyper-plastic state (as reaction to chronic and acute stress -; or incited by psychedelics) which can mediate psychological transformation.

Authors

  • Robin Carhart-Harris

Published

Journal of Psychopharmacology
meta Study

Abstract

“This paper introduces a new construct, the ‘pivotal mental state’, which is defined as a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation. We believe this new construct bears relevance to a broad range of psychological and psychiatric phenomena. We argue that pivotal mental states serve an important evolutionary function, that is, to aid psychological transformation when actual or perceived environmental pressures demand this. We cite evidence that chronic stress and neurotic traits are primers for a pivotal mental state, whereas acute stress can be a trigger. Inspired by research with serotonin 2A receptor agonist psychedelics, we highlight how activity at this particular receptor can robustly and reliably induce pivotal mental states, but we argue that the capacity for pivotal mental states is an inherent property of the human brain itself. Moreover, we hypothesize that serotonergic psychedelics hijack a system that has evolved to mediate rapid and deep learning when its need is sensed. We cite a breadth of evidences linking stress via a variety of inducers, with an upregulated serotonin 2A receptor system (e.g. upregulated availability of and/or binding to the receptor) and acute stress with 5-HT release, which we argue can activate this primed system to induce a pivotal mental state. The pivotal mental state model is multi-level, linking a specific molecular gateway (increased serotonin 2A receptor signaling) with the inception of a hyper-plastic brain and mind state, enhanced rate of associative learning and the potential mediation of a psychological transformation.

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Research Summary of 'Pivotal Mental States'

Introduction

Brouwer and colleagues frame ‘‘quantum change’’ or rapid, enduring psychological transformations as phenomena that have been described in psychology and philosophy but poorly specified in neurobiological terms. They argue that past work has focused on outcomes (for example spiritual conversion versus psychotic breakdown) rather than on the transient states that mediate such changes. Drawing together literature on stress, psychosis, spirituality and psychedelic drug effects, the paper proposes a new construct — the pivotal mental state (PiMS) — intended to capture a processual, multi-level state of mind and brain that can precipitate large psychological shifts. The paper sets out to define PiMSs operationally, to review evidence for their distal and proximal causes, to identify a plausible molecular gateway (the serotonin 2A receptor, 5-HT2AR), and to integrate phenomenology, pharmacology and systems-level neurobiology. Brouwer and colleagues emphasise that PiMSs are outcome-agnostic: the same mediating state can lead to beneficial or harmful long-term changes depending on context, predisposition and subsequent integration work. They also propose that understanding PiMSs can inform therapeutic approaches — notably psychedelic-assisted therapy — as well as other culturally embedded practices that intentionally induce intense mental states.

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Study Details

References (99)

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