Seeing without self: Discovering new meaning with psychedelic-assisted psychotherapy

Psychedelic-assisted psychotherapy can be transformative by dissolving the ego boundary, which normally acts as a defense mechanism regulating the significance objects hold for the self. This ego dissolution uncouples midline cortical structures and deactivates defenses that mitigate the threat of losing loved objects, allowing dreamlike primary process imagery, regression to earlier object relations, and feelings of love and connectivity. The noetic quality of the psychedelic state arises from recognizing that experiences without character defenses feel more genuine. The process supports Freud's oceanic mode of relating to the world, better suited for finding meaning, alongside the narrower ego feeling suited for survival. An analogy to Fonagy's mentalization model suggests that psychedelic-assisted psychotherapy enables transformative self-acceptance by seeing oneself through another's eyes.

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Abstract

New research in psychedelic-assisted psychotherapy merits a reexamination of the neurobiology and phenomenology of psychedelic states. First person accounts of psychedelic-assisted psychotherapy are used to re-conceptualize the ego boundary as a defense mechanism which regulates the significance that objects hold for the self. Therapeutic action is attributed to ego dissolution, which enables subjects to see new significance in things. This process coincides neurobiologically with uncoupling certain midline cortical structures, and psychodynamically, with deactivating defense mechanisms which mitigate the threat of losing the loved object. It also enables the dreamlike imagery, symbols, and metaphor of the primary process, a regression to earlier ways of relating to objects, and feelings of love and connectivity. The process supports Freud's ideas about the oceanic mode of relating to the world existing alongside the narrower, mature ego feeling. The former is better suited for finding meaning in life, while the latter is better suited for survival. The noetic quality of the psychedelic state derives from an unconscious recognition that experiences without character defenses feel more genuine than others, and conform to earlier ways of feeling and thinking. The accessibility of the primary process makes psychedelic-assisted psychotherapy transformative, not just informative. An analogy is drawn to Fonagy's developmental model of mentalization. Absent the defensive, self-critical lens of a prior self-concept, psychedelic-assisted psychotherapy serves as an ideal paradigm for the transformative experience of seeing oneself through the eyes of another, leading to greater self-acceptance. Flight instructions for navigating this royal road to the unconscious are considered.