Belief now, true belief later: the epistemic advantage of self-related insights in psychedelic-assisted therapy Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy Chiara Caporuscioa,b,c,d (caporusciochiara1@gmail.com) Abstract Chris Letheby’s defence of psychedelic therapy hinges on the premise that psychedelic-facilitated insights about the self are in a better epistemic position than those about the external world. In this commentary, I argue that such a claim is not sufficiently defended. More precisely, I argue that one element is underexplored in Letheby’s otherwise compelling picture: namely, that unlike new beliefs about the external world, beliefs about oneself have the capacity to turn into self-fulfilling prophecies. Recognising the psychedelic experience and the subsequent integration process as opportunities not only to apprehend certain facts about the self but also to actively shape and redetermine those facts is key to understanding the epistemic differences between insights patients have about themselves and about the external world. Keywords First-person authority ∙ Insight ∙ Integration∙ Psychedelics ∙ Psychedelic therapy ∙ Self-shaping This article is part of a symposium on Chris Letheby’s book “Philosophy of Psychedelics” (OUP 2021), edited by Chiara Caporuscio and Sascha Benjamin Fink. According to the Comforting Delusion Objection to psychedelic therapy (henceforth CDO), psychedelic therapy should not be recommended even though its psychological effects are beneficial. The justification is that psychedelics produce positive psychological effects only because they induce comforting beliefs in a joyous cosmology, a divine consciousness, or an ultimate reality. Because such beliefs are incompatible with naturalism and therefore most likely false, defenders of the CDO argue that the therapeutic potential of psychedelics aOtto-von-Guericke-Universität Magdeburg, Germany. bDepartment of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Germany. cBerlin School of Mind and Brain, Faculty of Philosophy, Humboldt-Universität zu Berlin, Germany. dResearch Training Group 2386 “Extrospection”, Humboldt-Universität zu Berlin, Germany. Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. Philosophy and the Mind Sciences, 3, 6. https://doi.org/10.33735/phimisci.2022.9310 ©The author(s). https://philosophymindscience.org ISSN: 2699-0369 https://philosophymindscience.org https://orcid.org/0000-0003-3267-6251 https://doi.org/10.33735/phimisci.2022.9310 https://creativecommons.org/licenses/by/4.0/ https://philosophymindscience.org Chiara Caporuscio 2 comes with large epistemic costs that outweigh their psychological benefits (Letheby, 2021, p. 2). Chris Letheby’s book The Philosophy of Psychedelics is an elaborate and largely convincing rebuttal of CDO. Letheby accepts that the ethical status of psychedelic therapy hinges on its epistemic status. However, he contends that mental wellbe- ing is promoted not by changes in metaphysical beliefs but by changes in beliefs about the self: for example, “I am in touch with my emotions” (Watts et al., 2017), “My identity is not tied to being a smoker” (Noorani et al., 2018). According to Letheby, these self-related beliefs are less likely to be delusional than metaphysical beliefs, making the mechanism of psychedelic therapy epistemically (and therefore ethically) innocent. When assessing Letheby’s argument, we are immediately faced with the fol- lowing question: If psychedelic-induced beliefs about external reality are proba- bly false, why should the same not be true of psychedelic-induced beliefs about ourselves? Unlike the metaphysical beliefs questioned by the CDO, beliefs about the self are compatible with naturalism; however, this does not necessarily make them more likely to be true. Letheby makes a good case for the non-propositional epistemic benefits of psychedelic self-related insights, such as the acquisition of knowledge-how and knowledge by acquaintance, and for the indirect epistemic benefits gained through increased psychological well-being (see Chapters 8.4–8.8). However, his argument about the direct acquisition of knowledge-that about the self through psychedelics, discussed in Chapter 8.3, is less compelling. In what follows, I present a three-part response to this chapter. 1. I reconstruct Letheby’s argument for the acquisition of knowledge-that through psychedelics, and suggest that it leaves self-related insights in a very similar epistemic position to that of beliefs about the external world. 2. I argue that, if psychedelics are equally likely to bring about false beliefs about the self and about the world, Letheby’s reply to the CDO is not very convincing. 3. I offer an alternative argument, underexplored in Letheby’s book, as to why self-related insights might after all be in a better epistemic position than insights about the external world. First, Letheby’s argument. Chapter 8.3 defends that we have grounds to believe that at least some of the self-related insights facilitated by the psychedelic experi- ence are genuine and can promote the acquisition of new propositional knowledge, or knowledge-that. The argument for the possibility of obtaining knowledge-that about oneself from psychedelic administration goes like this: 1. Decreasing the weighting of self-related priors can increase the probability of accurately apprehending certain facts about oneself (from general Predic- tive Processing theory) Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. Philosophy and the Mind Sciences, 3, 6. https://doi.org/10.33735/phimisci.2022.9310 ©The author(s). https://philosophymindscience.org ISSN: 2699-0369 https://doi.org/10.33735/phimisci.2022.9310 https://creativecommons.org/licenses/by/4.0/ https://philosophymindscience.org Belief Now, True Belief Later 3 2. Psychedelic administration temporarily decreases the weighting of self- related priors (from the REBUS model and the predictive self-binding theory) 3. Therefore, psychedelic administration can increase the probability of accu- rately apprehending certain facts about oneself. (Letheby, 2021, p. 169) There is a problem with this, which Letheby himself points out: The fact that cer- tain insights are likely to be accurate does not mean that all insights will be. As Andy Clark (2016, p. 288) puts it, priors are always both constraining and enabling. By filtering out evidence that contradicts them, they can impair access to certain facts, but they can also prevent implausible hypotheses from being considered and accepted. A temporary loss of confidence in the brain’s prior knowledge does not imply that all resulting beliefs will be veridical, nor that they will all be false: “[…] when it comes to propositional knowledge about our own mind, psychedelics facil- itate both genuine insights and placebo insights, and there is no general formula for telling the two apart” (Letheby, 2021, p. 171). According to Letheby, the only way to assess the accuracy of these insights is through sober integration after the psychedelic session. Letheby’s emphasis is on beliefs about the self. However, the same argument can be applied to self-independent beliefs. An example of priors constraining our knowledge about the external world is provided by popular explanation of the Hol- low Mask Illusion, according to which a strong reliance on the assumption “faces are convex” causes our brain to ignore evidence to the contrary and perceive a ro- tating concave mask as popping out. According to this explanation, a loss of confi- dence in the brain’s top-down priors causes patients with schizophrenia (Dima et al., 2010) or people on psychedelics (Millière et al., 2018) to perceive the mask more accurately than controls. Hence, Letheby’s argument for the possibility of obtain- ing knowledge-that about the self through psychedelic use can be generalised as follows: 1. Decreasing the weighting of priors can increase the probability of accurately apprehending certain facts (from general predictive processing theory). 2. Psychedelic administration temporarily decreases the weighting of priors (from the REBUS model and the predictive self-binding theory). 3. Therefore, psychedelic administration can increase the probability of accu- rately apprehending certain facts. If the argument generalises, the special status reserved by Letheby for self-related beliefs seems unjustified. Of all new insights acquired after a psychedelic session, some of those about the external world may be veridical, and some of those about ourselves may be false. Imagine your friend Maria (Letheby, 2021, p. 162), who Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. Philosophy and the Mind Sciences, 3, 6. https://doi.org/10.33735/phimisci.2022.9310 ©The author(s). https://philosophymindscience.org ISSN: 2699-0369 https://doi.org/10.33735/phimisci.2022.9310 https://creativecommons.org/licenses/by/4.0/ https://philosophymindscience.org Chiara Caporuscio 4 claims to have gained propositional knowledge from a psychedelic experience. When you ask her what she has learned, she responds by listing three new be- liefs she has gained. First, she has discovered some aspects of herself that were hidden from her before, including a deep desire for human connection. Secondly, she has discovered something she feels is a deep truth about another person’s mind: She realises that the actions of a family member that she had always thought stemmed from selfishness and greed are actually motivated by anxiety and insecu- rity. Thirdly, she has gained a metaphysical insight, namely that all existence in time is equally real. All of these insights are plausible, and all of them have the potential to cause lasting psychological benefits to Maria. But is one of these in- sights more likely to bring epistemic benefits, and in particular new propositional knowledge? In other words, are there epistemic differences between psychedelic- mediated insights about the self, about another person, and about the external world? I argue that relevant epistemic differences between self-, other-, and world- related insights cannot be found if we treat the epistemic status of the psychedelic experience as purely dependent on acquiring new knowledge of pre-existing facts. Maria’s insight about herself and her two insights about self-independent objects are all likely to have been caused by a weakening of her prior beliefs, which has allowed her to see herself and others in a new light. But this is no guarantee that any of the newly acquired beliefs is true. Thus, Letheby’s optimism about the possibility of gaining propositional knowledge about oneself rather than the external world seems unmotivated. Psychedelics put Maria in an epistemically promising but uncertain position, where she is likely to have acquired false beliefs about the world, other people and herself that she can only tentatively differentiate from the true ones by carefully scanning them for plausibility after her session. If it is the case that self-related insights have no firmer epistemic grounding than self-independent ones, Letheby’s rejection of the CDO is considerably weak- ened. At least some of the self-related insights driving psychological improvement are probably still comforting delusions, and the epistemic status of psychedelic therapy is only partially rescued by indirect epistemic benefits and post-session evaluation. There are obvious epistemic faults in a therapeutic method that will sometimes work by convincing a person who lies continually that they are honest and dependable, for example. And because Letheby accepts the CDO’s premise that epistemically bad means ethically bad, the possibility of comforting delusions about the self is a reason to refrain from recommending psychedelic therapy. I propose an alternative reason why Maria might be in a better epistemic posi- tion regarding her insights and newly acquired beliefs about herself than regarding those about the external world. More precisely, I will argue that one element is un- derexplored in Letheby’s otherwise compelling picture: namely, the recognition of the psychedelic experience and the subsequent integration process as opportu- nities not only to apprehend certain facts about oneself but also to actively shape and redetermine those facts through exploratory thinking and behaviour. Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. Philosophy and the Mind Sciences, 3, 6. https://doi.org/10.33735/phimisci.2022.9310 ©The author(s). https://philosophymindscience.org ISSN: 2699-0369 https://doi.org/10.33735/phimisci.2022.9310 https://creativecommons.org/licenses/by/4.0/ https://philosophymindscience.org Belief Now, True Belief Later 5 Moran (2001) and McGeer (2008, 1996; McGeer & Pettit, 2002) both talk about the the power of first-person authority to shape the self. In their view, the au- thority of self-knowledge derives not from a passive, error-free ability to detect our mental states, but from our capacity to regulate our thoughts and actions in accordance with the claims we make about ourselves. For example, the thought “I hate laundromats” might contribute to creating and sustaining the declared hate for laundromats, thus turning into a self-fulfilling prophecy (Schwitzgebel, 2011). Deciding as a child that your favourite colour is blue might causally influence your choice of outfits, objects, and self-expression, feeding into a growing appreciation for the colour blue. According to McGeer (2008), self-shaping is not only a capac- ity, but a moral responsibility: In order to be intelligible as rational agents, we owe it to ourselves and others to behave and think in the ways we declare we do. Our core beliefs about ourselves can (and should) turn into self-fulfilling prophecies, providing us with familiar patterns of expression and behaviour, allowing us to act as predictable agents, and fulfilling the expectations that we have created in ourselves and others. However, this also means we might end up stuck in our core beliefs about our- selves. In pathological cases, this is extremely problematic. A depressive patient who believes they are unable to find pleasure in going outside will behave in accor- dance with this belief—or, in terms borrowed from the active inference framework, they will sample their environment for evidence that will confirm the belief and avoid evidence that will disconfirm it (Ramstead et al., 2020). Not only will this behaviour reinforce the belief in an endless loop, but it may also make it true: by committing to act in line with the belief that they are incapable of getting out of bed and having a nice day, they will make it impossible for themselves to enjoy being outside. In his book, Letheby argues that the psychedelic experience allows for a relax- ing and rewiring of self-related priors, thus allowing patients with negative self models to access evidence about themselves that was previously hidden because it conflicted with those models. This is likely to be true, but not the whole story: If damaging self-related beliefs are (at least to some extent) self-fulfilling, losing confidence in them allows psychedelic users not only to access previously hidden evidence but also to create new evidence by acting and thinking in new, uncon- strained ways. Imagine, in line with Moran and McGeer’s examples, that by thinking of herself and presenting to others as self-sufficient, independent, and emotionally distant, Maria has been committing for most of her adult life to act and think in a way that would fulfil that expectation. Because of this, at the time of her psychedelic experience, evidence of a deep desire for human connection is not only hidden by her self model, but scarce. She has been leading a life of voluntary isolation, keeping distance from her family and friends, and she has rarely been imagining or wishing for a different lifestyle. Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. Philosophy and the Mind Sciences, 3, 6. https://doi.org/10.33735/phimisci.2022.9310 ©The author(s). https://philosophymindscience.org ISSN: 2699-0369 https://doi.org/10.33735/phimisci.2022.9310 https://creativecommons.org/licenses/by/4.0/ https://philosophymindscience.org Chiara Caporuscio 6 However, by relaxing her belief about herself through psychedelic use, she is able to temporarily break free from her commitment to act and think in line with it. She can exploratorily entertain new thoughts, imagine new modal truths about how her life could be (Letheby, 2015; 2021), and test out different behaviours, like opening up and expressing closeness to her trip sitters or companions. These new thoughts and behaviours then contribute to the evidence for her new, emerging insight that at her core is a deep desire for human connection. If Maria comes out of her trip with strong confidence in this belief then this confidence will, in turn, exercise its power to shape the self. During the sober integration period, Maria will consolidate her belief by maintaining and incorporating into her life the thoughts and behaviours she tentatively explored during the psychedelic experience. Con- trast this with the knowledge-acquisition story described by Letheby in Chapter 8 of his book. Maria is not only detecting previously unnoticed patterns of her prior behaviour that indicate her deep desire for human connection; she is (during the psychedelic experience) exploring new patterns of thought and action in line with her newly formed belief, and (during the subsequent integration period) sticking with them. Let us return to the epistemic status of self-related insights mediated by psychedelics. Two questions might be asked: 1) Has Maria acquired new proposi- tional knowledge? 2) Is she in a better epistemic position regarding her insights about herself than regarding those about the external world? Her epistemic position regarding her new self-characterisation is an interesting one. Prior to the psychedelic experience, her position would probably have been inaccurate: She had a strong belief that she was happy by herself and never had thoughts or carried out behaviours indicating that she was longing for connection. However, months after the experience, Maria finds herself enjoying the company of others and letting barriers down with her loved ones, as she has learned to do during her trip and has consolidated the habit of doing during the integration period. Belief first, true belief later: She might have ended her trip with an illusory insight, but months later this has turned into new propositional knowledge. Does the same apply to her self-unrelated belief that the actions of her family member were motivated by anxiety and insecurity? Imagine this second insight was also, prior to the experience, false: This person’s actions were in fact guided by selfishness and greed. Does this inaccurate belief have any self-fulfilling capacity? Maybe, very indirectly and to a much lesser extent: By reconnecting with the other person thanks to her favourable disposition, Maria might be able to partially influence their ways of acting and thinking in line with her belief. However, this is likely to be much harder and only successful in specific circumstances (for one, the other person must be receptive and willing to connect). Finally, beliefs whose object is completely mind-independent, like Maria’s metaphysical insight about the nature of time, are even more clearly not self-fulfilling. Maria’s capacity to shape and influence self-independent objects and people is not comparable to her capacity to shape and influence her own mental states and behaviour. Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. Philosophy and the Mind Sciences, 3, 6. https://doi.org/10.33735/phimisci.2022.9310 ©The author(s). https://philosophymindscience.org ISSN: 2699-0369 https://doi.org/10.33735/phimisci.2022.9310 https://creativecommons.org/licenses/by/4.0/ https://philosophymindscience.org Belief Now, True Belief Later 7 The self-fulfilling character of these beliefs has some noteworthy implications. First, my account suggests a more prominent role for the integration period and psychological support following the psychedelic experience, which aligns with existing evidence that these elements are important predictors of successful out- comes (Johnson et al., 2008; Teixeira et al., 2022). In Letheby’s account, follow-up sessions are important for epistemic purposes because patients can soberly scan insights for plausibility and distinguish accurate ones from placebos with the help of a trained therapist. While this is likely true, I argue that direct truth-testing is not the main mechanism that renders the months following the experience crucial in determining epistemic benefits. The epistemic success of psychedelic therapy happens in two steps: The trip is for discovery, and its aftermath is for consolidation and commitment. During the trip itself, self-related beliefs are relaxed, allowing patients to momentarily escape the self-fulfilling effects of damaging self models, explore new and healthier ways of thinking and acting, and consequently acquire new insights about themselves. However, the process of self-shaping involves changing one’s behaviour and think- ing over much longer timescales than six or twelve hours. This is why most of it happens while sober. With the help of trained therapists, patients can consider which beliefs about themselves that have been tested out during the psychedelic experience are worth committing to, and plan for ways to change their behaviour to integrate and fulfil these new (or newly appraised) beliefs. If they do not adapt their lifestyle, thoughts, and actions to conform to their trip-induced insights, their newly formed beliefs are unlikely to turn out to be true and will probably be aban- doned. The second consequence of the account I have presented is that while the self-fulfilling nature of self-characterisations helps mitigate the epistemic risks of psychedelic therapy, it also carries serious psychological risks. Not only is there nothing intrinsically true about psychedelic-mediated insights, there is also noth- ing intrinsically positive: While some people report feelings of bliss and newfound self-acceptance, others experience anxious spiralling, negative emotions, and self- deprecating thoughts. If positive insights can actively shape users’ future mental states and behaviour, so can psychologically damaging ones. In this account, a bad trip triggering the new belief that one is deeply incapable of being happy carries more than just epistemic risks. In order to prevent damaging self models from be- ing accepted and incorporated as a result of a negative psychedelic experience, it is extremely important to take the danger seriously and carefully assess whether and to what extent it can be reduced. I suggest that, in order to mitigate the risk, we should focus on the following two aspects. First, appropriate preparation be- fore the psychedelic experience, moderate dosage and controlled set and setting can significantly reduce the chances of a bad trip. Secondly, psychological and behavioural support during the integration period can help an individual not only to integrate psychologically and epistemically beneficial insights into their life but also to recognise and discard damaging ones. Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. Philosophy and the Mind Sciences, 3, 6. https://doi.org/10.33735/phimisci.2022.9310 ©The author(s). https://philosophymindscience.org ISSN: 2699-0369 https://doi.org/10.33735/phimisci.2022.9310 https://creativecommons.org/licenses/by/4.0/ https://philosophymindscience.org Chiara Caporuscio 8 Psychedelics can facilitate a state of temporary flexibility where damaging self models can be discarded and new ones can take their place, be consolidated and powerfully shape one’s future self. Old beliefs are abandoned, and new beliefs are accepted and turned into reality. However, this increased flexibility is neutral in itself: it is what happens before, during and after the session that really determines whether the newly adopted models will be harmful or therapeutic. Acknowledgments Funded by the German Research Foundation (DFG) - 337619223 / RTG2386. References Clark, A. (2016). Surfing Uncertainty: Prediction, Action, and the Embodied Mind. 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Journal of Humanistic Psychology, 57(5), 520–564. https://doi.org/10.1177/0022167817709585 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 Interna- tional License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Caporuscio, C. (2022). Belief Now, True Belief Later: The Epistemic Advantage of Self-Related Insights in Psychedelic-Assisted Therapy. 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