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Psychedelics and the science of self-experience

  • Matthew M. Nour (a1) and Robin L. Carhart-Harris (a2)
Summary

Altered self-experiences arise in certain psychiatric conditions, and may be induced by psychoactive drugs and spiritual/religious practices. Recently, a neuroscience of self-experience has begun to crystallise, drawing upon findings from functional neuroimaging and altered states of consciousness occasioned by psychedelic drugs. This advance may be of great importance for psychiatry.

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Copyright
Corresponding author
Matthew M. Nour, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK. Email: matthew.nour@kcl.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Carhart-Harris, RL, Leech, R, Hellyer, PJ, Shanahan, M, Feilding, A, Tagliazucchi, E, et al. The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Front Hum Neurosci 2014; 8: 20.
2 Christoff, K, Cosmelli, D, Legrand, D, Thompson, E. Specifying the self for cognitive neuroscience. Trends Cogn Sci 2011; 15: 104–12.
3 Qin, P, Northoff, G. How is our self related to midline regions and the default-mode network? Neuroimage 2011; 57: 1221–33.
4 Nour, MM, Barrera, A. Schizophrenia, subjectivity, and mindreading. Schizophr Bull 2015; 41: 1214–9.
5 Seth, AK, Suzuki, K, Critchley, HD. An interoceptive predictive coding model of conscious presence. Front Psychol 2012; 2: 116.
6 Carhart-Harris, RL, Muthukumaraswamy, S, Roseman, L, Kaelen, M, Droog, W, Murphy, K, et al. Neural correlates of the LSD experience revealed by multimodal neuroimaging. Proc Natl Acad Sci USA 2016; 113: 4853–8.
7 Tagliazucchi, E, Roseman, L, Kaelen, M, Orban, C, Muthukumaraswamy, SD, Murphy, K, et al. Increased global functional connectivity correlates with LSD-induced ego dissolution. Curr Biol 2016; 26: 1043–50.
8 Nour, MM, Evans, L, Nutt, D, Carhart-Harris, RL. Ego-dissolution and psychedelics: validation of the Ego-Dissolution Inventory (EDI). Front Hum Neurosci 2016; 10: 269.
9 Grof, S. LSD Psychotherapy. Hunter House Publishers, 1980.
10 Northoff, G. How is our self altered in psychiatric disorders? A neurophenomenal approach to psychopathological symptoms. Psychopathology 2014; 47: 365–76.
11 Nordgaard, J, Parnas, J. Self-disorders and the schizophrenia spectrum: a study of 100 first hospital admissions. Schizophr Bull 2014; 40: 1300–7.
12 Muthukumaraswamy, SD, Carhart-Harris, RL, Moran, RJ, Brookes, MJ, Williams, TM, Errtizoe, D, et al. Broadband cortical desynchronization underlies the human psychedelic state. J Neurosci 2013; 33: 15171–83.
13 Josipovic, Z, Dinstein, I, Weber, J, Heeger, DJ. Influence of meditation on anti-correlated networks in the brain. Front Hum Neurosci 2012; 5: 183.
14 Nichols, DE. Psychedelics. Pharmacol Rev 2016; 68: 264355.
15 Carhart-harris, RL, Bolstridge, M, Rucker, J, Day, CMJ, Erritzoe, D, Kaelen, M, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 3: 619–27.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Psychedelics and the science of self-experience

  • Matthew M. Nour (a1) and Robin L. Carhart-Harris (a2)
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eLetters

Strokes, self and psychedelics

Simon A Vann Jones, ST4 in Old Age Psychiatry, Franklyn Hospital, Exeter
03 May 2017

In this compelling editorial the authors present a summary of the efforts to date to identify the neural correlates and anatomical distribution of self experience and highlight the potential problems with using self as object - inherently easier to study but may not accurate represent self experience - vis a vis self as knowing - perhaps the ultimate challenge for neuroscience today. In the article, the authors helpfully summarise research on the former, highlighting the involvement of the default mode network (DMN) in self attribution and make a strong case for the role of psychedelics in further exploring both approaches.



Post-stroke patients may also help us further understand this. Clinical experience has suggested that lacunar strokes causing subtle changes to white matter in areas associated with the default mode network may profoundly effect both self attribution and, consequently, self knowledge. We recently had a case of an elderly patient who presented with manic symptoms following an isolated lacunar infarct in the right corona radiata causing a temporary but profound disruption to his sense of self, specifically gross overestimation of his physical and mental capabilities making himself newly vulnerable in situations he had previously managed safely.. He had a strong sense of self pre-morbidly, accurately characterised as having achieved Erikson's final stage of ego integrity for many years prior to presentation. Fortunately the case was self limiting but provided a potentially valuable insight in to the inseparable nature of self as object and self as knowing.



The pathology evident in this example supports previous work [1-3] linking symptoms of bipolar and schizophrenia to decreased corona radiata activity and suggests another brain region that may be critical in Bleuler's "slackening of associative links that tie together thoughts, perceptions and affects". It would be interesting to explore the effect of psychedelics on the activity in this region to further explore its role in DMN integrity..



[1] Cui L et al. Assessment of white matter abnormalities in paranoid schizophrenia and bipolar mania patients. Psychiatry Research: Neuroimaging. 2011 Dec 30;194(3):347-53.



[2] Benedetti F, et al. Disruption of white matter integrity in bipolar depression as a possible structural marker of illness. Biological psychiatry. 2011 Feb 15;69(4):309-17.



[3] Stanfield AC, et al..Structural abnormalities of ventrolateral and orbitofrontal cortex in patients with familial bipolar disorder. Bipolar disorders. 2009 Mar 1;11(2):135-44.
... More

Conflict of interest: None Declared

Write a reply

Limitations to 'Psychedelics and the science of self experience'

Klaus Martin Beckmann, A/Prof., Child and Adolescant Psychiatrist , FRANZCP, MRCPsych, CCST, AMCAF, Griffith University, School of Medicine ; Member Section History Ethics & Philosophy of Psychiatry Queensland
Rob Brennan, Psychiatry Registrar , Bsc, BHSc ( Hons1) ,MB,BS, Chairman Section History Ethics & Philosophy of Psychiatry Queensland
Joyce Arnold, MBBS, FRANZCP, Cert Child & Adolescent Psychiatry, MA, MBA, MOEd, MEth&LS, Secretary Section History Ethics & Philosophy of Psychiatry Queensland
30 March 2017

We read Matthew Nour and Robin Carhart-Harris editorial with enthusiasm. The Section History Ethics & Philosophy of Psychiatry Queensland meets once a month in the Brisbane area. The writers of this eLetter met at the end of March 2017and discussed this editorial. We congratulate and we agree with Derek K Tracy in "highlights of this issue" that it is a mesmerising read. We found that the editorial is well composed, interesting in its logic and we notice the structure to the editorial. There are 6 separate headings: defining the self, self in neuroscience, self disturbance , psychedelics as a window into the self, therapeutic implications, and conclusions. We discussed that overall the paper only presents a reductionist, non-compatabilist, materialist theory of self, which becomes a fallacy of a circular argument. For the purpose of this editorial such a reduction of a complex philosophical area is indeed suitable, but ignores other models and we miss a paragraph on these limitations. We feel that it would have assisted if there had been frank comments on the reductionist approach and the diverse facets to self relevant to psychiatry.

The quantitative meta analysis locates self experience to default mode network in a cortical median and anterior cingulate brain anatomy. Other theories of the self in the light of memories and emotions for example, made us curious about FMRI findings in the amygdala and hippocampal areas. However acknowledging FMRI as "correlation", the subtext is identity with the subject of the correlation.

We were reminded that after all the self is a very complex philosophical area that preoccupied many eminent thinkers in the past (Remes P& Sihvola) We believe that also a discussion of other pathologies of self, multiple selves associated with dissociation and multiple personality disorder would have been more inclusive. We were curious about the role of language especially in people who speak several languages as the narrative (McAdams) of the self is based on semantics.

We believe that a paragraph highlighting the limitations to the approach would have made this a more balanced editorial. Also referencing evidence on psychedelics and clinical experience of their use, references that highlight a number of the risks and side effects (Larsen JK and Johnson M et al) would have added . There are merits in to including that psychedelics are also a potential double edged sword.

references:

Johnson M et al (2008)."Human hallucinogen research : guidelines for safety". Journal of psychopharmacology. 22 (6) .603

Larsen JK (2016) " Neurotoxicity and LSD treatment: a follow up study of 151 patients in Denmark". History of Psychiatry. 27(2),172-189

McAdams, D (2001). "The psychology of life stories". Review of General Psychology. 5 (2): 100–122

Remes P, Sihvola J (Editors) (2008). "Review - Ancient Philosophy of the Self" , Springer

... More

Conflict of interest: None Declared

Write a reply

Dr Simon Vann Jones

Simon A Vann Jones, Specialty Registrar in Old Age Psychiatry, Franklyn Hospital, Exeter
14 March 2017

In this compelling editorial the authors present a summary of the efforts to date to identify the neural correlates and anatomical distribution of self experience and highlight the potential problems with using self as object - inherently easier to study but may not accurate represent self experience - vis a vis self as knowing - perhaps the ultimate challenge for neuroscience today. In the article, the authors helpfully summarise research on the former, highlighting the involvement of the default mode network (DMN) in self attribution and make a strong case for the role of psychedelics in further exploring both approaches.

Post-stroke patients may also help us further understand this. Clinical experience has suggested that lacunar strokes causing subtle changes to white matter in areas associated with the default mode network may profoundly effect both self attribution and, consequently, self knowledge. We recently had a case of an elderly patient who presented with manic symptoms following an isolated lacunar infarct in the right corona radiata causing a temporary but profound disruption to his sense of self, specifically gross overestimation of his physical and mental capabilities making himself newly vulnerable in situations he had previously managed safely.. He had a strong sense of self pre-morbidly, accurately characterised as having achieved Erikson's final stage of ego maturity for many years prior to presentation. Fortunately the case was self limiting but provided a potentially valuable insight in to the inseparable nature of self as object and self as knowing.

The pathology evident in this example supports previous work [1-3] linking symptoms of bipolar and schizophrenia to decreased corona radiata activity and provides neuropathological evidence behind Bleulers "slackening of associative links that tie together thoughts, perceptions and affects". It would be interesting to explore the effect of psychedelics on the activity in this region to further explore its potential role in DMN integrity..

[1] Cui L et al. Assessment of white matter abnormalities in paranoid schizophrenia and bipolar mania patients. Psychiatry Research: Neuroimaging. 2011 Dec 30;194(3):347-53.

[2] Benedetti F, et al. Disruption of white matter integrity in bipolar depression as a possible structural marker of illness. Biological psychiatry. 2011 Feb 15;69(4):309-17.

[3] Stanfield AC, et al..Structural abnormalities of ventrolateral and orbitofrontal cortex in patients with familial bipolar disorder. Bipolar disorders. 2009 Mar 1;11(2):135-44.
... More

Conflict of interest: None Declared

Write a reply

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