Australian & New Zealand Journal of Psychiatry
November 17, 2022
Riccardo Miceli Mcmillan, Anthony Vincent Fernandez
30 citations
Psychedelic-assisted psychotherapy is being studied as a treatment for various psychiatric illnesses. Current evidence indicates that the subjective experiences caused by psychedelics are important for therapeutic outcomes. Most knowledge of these experiences comes from psychometric scales like the Mystical Experience Questionnaire. The authors argue that more detailed descriptions of how psychedelics change subjective experience are needed. They propose using qualitative methods from phenomenological psychopathology to systematically investigate these changes. This approach aims to characterize therapeutic psychedelic experiences using concepts from philosophical phenomenology, which should help clarify the mechanisms of psychedelic therapy, the role of integration therapy, and related philosophical debates.
Medical Humanities
September 1, 2022
Riccardo Miceli Mcmillan
25 citations
Psychedelic compounds are regaining interest for their therapeutic effects, and their controversial nature demands bioethical guidance. This paper argues that psychedelic-using communities should be included in bioethical discussions about psychedelic medicalisation. These communities possess epistemic expertise from embodied experiences, enabling them to identify normative considerations others might overlook. They are also uniquely affected by medicalisation, so their needs must be considered. The counterargument that such communities are less capable of deliberative reasoning is acknowledged, but the author proposes that consultation is owed to undo epistemic injustice.
Medicine, health care, and philosophy
June 1, 2022
Riccardo Miceli Mcmillan, Christopher Jordens
15 citations
Psychedelic-assisted psychotherapy (PAP) may treat major depressive disorder by inducing broadened pre-intentional possibility, which produces sudden, profound, and enduring changes in how patients experience their bodies, self-narratives, and social connections. Drawing on phenomenological accounts, the paper argues that depression involves three forms of alienation or unhomelike being-in-the-world: illness suffering (embodiment), existential suffering (self-narratives), and political suffering (social relationships). PAP counteracts the loss of pre-intentional possibility that characterizes depression, consistent with a bio-psycho-social model of mental health. This framework supports the plausibility of reported treatment success and justifies further empirical research.
Journal of Psychedelic Studies
September 17, 2021
Riccardo Miceli Mcmillan
13 citations
The re-medicalisation of psychedelics risks turning their ecological sources, cultural contexts, and therapeutic experiences into exploitable resources, endangering ecosystems, appropriating traditional knowledge, and reducing therapeutic effects. Applying Martin Heidegger's critique of modern technology and Fredrik Svenaeus' extension reveals these normative issues. Preserving non-reductionist, non-instrumentalising traditional understandings of psychedelic compounds is essential to mitigate these consequences. Bioethicists have remained silent on this topic, and more discussion is needed to address these global challenges for the psychedelic renaissance.
Journal of Medical Ethics
November 4, 2020
Riccardo Miceli Mcmillan
12 citations
Psychedelic-assisted psychotherapy shows promise for treating psychiatric conditions, with therapeutic outcomes predicted by mystical experiences characterized by profound meaning. This suggests psychedelics may work as meaning enhancers, triggering a meaning response similar to placebo effects. The paper argues that if psychedelics operate this way, their use can be ethically justified from a hedonistic moral perspective. It addresses an anti-hedonistic objection based on Nozick's Experience Machine thought experiment, concluding that even if pleasure and pain are not the only morally relevant factors, therapeutic meaning enhancement remains justified in cases of extreme suffering, and psychedelic states may not represent a false reality, thus not problematic by Nozick's standards.
J Eat Disord
September 2, 2025
Elena Koning, Riccardo Miceli Mcmillan, Aaron Keshen et al.
3 citations
This paper argues that current psychedelic-assisted therapy studies for eating disorders may fail to capture meaningful outcomes because they rely on standard psychiatric measures that overlook the subjective, first-person experience of the disorder. From a phenomenological psychopathology perspective, the authors contend that eating disorders involve profound alterations in self-perception, embodiment, and identity that cannot be adequately assessed through symptom checklists or behavioral metrics alone. They suggest that incorporating experiential data and qualitative accounts of transformative shifts in sense of self and body relationship could provide a more accurate picture of therapeutic efficacy.
Philosophical Psychology
November 25, 2024
Riccardo Miceli Mcmillan, Jack Reynolds, Anthony Vincent Fernandez
3 citations
Psychedelic therapy's effectiveness partly depends on the nature of the experiences it produces, especially altered time perception, such as feelings of timelessness. Interpreting these reports is challenging because true timelessness may be impossible to experience, and descriptions vary in clinical relevance. Using a phenomenological approach to temporality, this article clarifies ambiguities in current assessment tools. It proposes that psychedelic temporality might counteract depressive temporality, offering a preliminary mechanism for therapy. A dedicated phenomenological research program could map psychedelic time experiences, resolving philosophical and clinical uncertainties and guiding future studies.
Journal of Homosexuality
July 8, 2025
Riccardo Miceli Mcmillan, James A Fowler, Tamara C. Erbacher et al.
2 citations
LGBTQA+ individuals who have used classic psychedelics emphasize that healthcare providers must examine their own biases and learn relevant language to build trust and ensure safety during preparation sessions. Providers should adopt a flexible, client-led approach when supporting identity exploration, particularly around returning from a 'universal consciousness' experience. They also need to thoughtfully modulate their presence during clients' psychedelic experiences. These findings highlight the need for psychedelic-assisted therapy protocols that acknowledge the varied experiences and needs of LGBTQA+ communities.
Aust N Z J Psychiatry
November 5, 2023
Riccardo Miceli Mcmillan, Anthony Vincent Fernandez
2 citations
The author responds to a Letter to the Editor, reiterating the argument that phenomenology is essential for understanding subjective experience in psychedelic-assisted psychotherapy. The reply defends the original position that phenomenological methods can provide valuable insights into the nature of these experiences, which may be overlooked by purely quantitative approaches. The author maintains that incorporating phenomenological perspectives can enhance therapeutic understanding and outcomes in this emerging field.
International Journal of Transgender Health
June 8, 2026
Tiana Bartholomaeus, Samantha J. Brown, Annette Brömdal et al.
An analysis of 225 Reddit posts from trans individuals describes how psychedelic experiences can both help and harm. Psychedelic-induced altered states can lead to self-acceptance, gender euphoria, and gender realization, and psychological release during trips can facilitate a journey of self-acceptance. These experiences can function as a catalyst for change but can also simultaneously support and exacerbate gender dysphoria. The findings highlight a duality in psychedelics for trans people, with both healing qualities (e.g., gender euphoria, self-acceptance) and harming qualities (e.g., exacerbated dysphoria and grief). Clinical applications should consider this duality to inform responsive and affirming psychedelic-assisted psychotherapy protocols.