Psychedelic therapies and belief change: are there risks of epistemic harm or epistemic injustice?

Abstract

ABSTRACT Psychedelic-assisted psychotherapies (PAPs) have shown promise in treating mental health disorders, but concerns persist regarding their potential to elicit “false beliefs” through altered states of consciousness. Some argue that metaphysical or mystical beliefs conflicting with philosophical naturalism could signify “epistemic harm” in patients. We contend that such accusations may conceal a form of epistemic injustice by disqualifying non-naturalistic beliefs under a presumption of epistemic superiority, compromising the validation of pathologized subjective states. We argue that fostering exotic metaphysical beliefs in PAPs could be considered epistemically and medically benign, with the primary focus on generating positive mental health outcomes rather than instilling specific metaphysical convictions. We explore the capacity of PAPs to modify beliefs, examine allegations of epistemic harm and injustice, adresse the “comforting delusion” objection, and discuss the importance of respecting patients’ epistemic agency and cognitive liberty. We contrast philosophical naturalism with epistemic pluralism, advocating for the latter in PAPs. Finally we discuss implications for the future of psychedelic research and therapy, emphasizing the need to prioritize therapeutic outcomes over the specific beliefs elicited.