Inherited Assumptions: A Philosophical Audit of the Psychiatric Presuppositions Embedded in Psychedelic-Assisted Therapy Research
Maximiliano Zeller
Psychedelics October 1, 2026 DOI: 10.1016/j.psyche.2026.100047 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Psychedelic-assisted therapy |
| Key points | Argues that psychedelic research inherits five contested presuppositions from mainstream psychiatry (nosological, aetiological, outcome measurement, methodological, and pharmacological agency assumptions) that form a mutually reinforcing system resisting partial reform. Contends that the field's own findings are in tension with the framework within which they must be reported and evaluated, rendering its most distinctive contributions partially invisible, and proposes the field as a site for testing alternative process-oriented frameworks. |
Abstract
The psychedelic renaissance is routinely presented as a paradigm shift in psychiatric treatment. Yet the research programmes through which psychedelic-assisted therapies are developed and evaluated inherit foundational presuppositions from mainstream psychiatry that are contested within psychiatry and its philosophy. I conduct a philosophical audit of five of them, the nosological, aetiological, outcome measurement, methodological, and pharmacological agency assumptions. For each, I reconstruct the critique, show how the assumption operates in current psychedelic research, and identify the distortions it produces. I then argue that the five form a mutually reinforcing system that resists partial reform, and that the psychedelic field's own findings are in tension with the framework within which those findings must be reported and evaluated. The result is a field whose most distinctive contributions are rendered partially invisible by the infrastructure designed to validate them. Because psychedelics expose these tensions with unusual clarity, the field could serve as a productive site for testing alternative frameworks, organised around processes, that have found limited institutional traction within psychiatry.
Comparable studies
Other theoretical and historical papers on psychedelic-assisted therapy, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Theorizing that Psychedelic Assisted Therapy May Play a Role in the Treatment of Trauma-Induced Personality Disorders. | 2024 | Theoretical or philosophical paper | |
| Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance | 2020 | Theoretical or philosophical paper | |
| Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy | 2018 | Theoretical or philosophical paper | |
| Ethical and legal issues in psychedelic harm reduction and integration therapy | 2021 | Theoretical or philosophical paper | |
| Towards psychedelic apprenticeship: Developing a gentle touch for the mediation and validation of psychedelic-induced insights and revelations. | 2022 | Theoretical or philosophical paper |
Citations in the library
Cites 40
- Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial Journal of Psychopharmacology November 30, 2016
- Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial Journal of Psychopharmacology November 30, 2016
- Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder JAMA Psychiatry November 4, 2020
- REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics Pharmacological Reviews June 20, 2019
- Psychedelics Promote Structural and Functional Neural Plasticity Cell Reports June 1, 2018
and 35 more in the library