tl;dr – Comment below with arguments for why psychedelic research & advocacy should not be an EA cause area. On June 3rd, the most upvoted argument will win $400. The second- and third-most upvoted arguments will win $200 & $100, respectively.
1. Background on why I’m making this post & offering a prize
This effort was inspired by Grue_Slinky’s prize for the best argument against the EA Hotel.
I’m offering a $400 USD prize for the best argument against psychedelic research & advocacy being an EA cause area. I’m also offering $200 for the second-best argument & $100 for the third-best.
Uncovering another high-impact cause area seems very valuable, as EA’s impact is closely correlated with the quantity & quality of the cause areas it supports. This prize is a small effort towards assessing whether psychedelics should be taken up as an EA cause area.
The primary motivation here is to surface previously unconsidered arguments for why psychedelics should not be an EA cause area. My current view is that psychedelics are an extremely promising altruistic cause area – I’d like to stress-test that view to see what I’ve missed.
Below, I offer some arguments for why psychedelics should be an EA cause area. These arguments are provided as a jumping-off point for arguments against.
2. Specification of the prize
To be considered for the prize, add your argument against psychedelics being an EA cause area as a top-level comment on this post. (Only top-level comments on this post will be considered as valid submissions.)
On Monday, June 3rd, I’ll award $400 USD to the most-upvoted argument against, $200 USD to the second-most-upvoted argument against, and $100 USD to the third-most-upvoted argument against. I will break any ties, by choosing my favorite of the tied arguments.
I’ll contact the prize winners via a Forum direct message to coordinate the remittance of their prizes. Once payouts are complete, I’ll announce the winners in a comment on this post.
Feel free to upvote other people’s submissions, even if you submit an argument yourself. (I suppose you could also downvote other submissions, though that doesn’t feel very sporting.)
To avoid potential bias, I will not upvote or downvote any prize submissions.
You can also comment with things that aren’t arguments against psychedelics being an EA cause area, though note that such comments will not be considered as prize submissions.
3. Arguments for the importance of psychedelics
To seed discussion, here are some arguments for the importance of psychedelics as an altruistic cause area.
3(a). Psychedelics are appealing to both long-termist & short-termist views
Almost everyone in EA holds either a long-termist view (everyone who will exist over the entire of course of the future deserves moral consideration) or a short-termist view (only people who exist before some time horizon deserve moral consideration).
If you hold a long-termist view (i.e. all future people deserve moral consideration) & you're a consequentialist (as far as I know, almost every long-termist is consequentialist), then it’s very difficult to do long-term cause prioritization, because you have limited visibility into the outcomes occurring 10,000+ years into the future – and these are outcomes you want to know about when assessing today’s actions. Practically, we're clueless about many long-term consequences of our present actions. You can read more about consequentialist cluelessness here.
Given this theoretical problem, long-termist cause prioritization should include “robustness to cluelessness” as a major factor.
Some x-risk interventions seem pretty robust to cluelessness, e.g. Eliezer Yudkowsky’s work raising awareness of the AI alignment problem. Eliezer’s advocacy work seems robust because in almost every scenario you can imagine, it’s good for more researchers to be aware of the AI alignment issue.
Interventions that increase the set of well-intentioned + capable people also seem quite robust to cluelessness, because they allow for more error correction at each timestep on the way to the far future.
The psychedelic experience also seems like a plausible lever on increasing capability (via reducing negative self-talk & other mental blocks) and improving intentions (via ego dissolution changing one's metaphysical assumptions).
I compare the mechanisms of impact of the psychedelic experience and of programs like CFAR & Paradigm below.
By “changing one’s metaphysical assumptions,” I mean that the psychedelic state can change views about what the self is, and what actions constitute acting in one’s “self-interest.” Consider Michael Pollan’s account of one of his psilocybin trips, in How to Change Your Mind:
“I” now turned into a sheaf of little papers, no bigger than Post-its, and they were being scattered to the wind. But the “I” taking in this seeming catastrophe had no desire to chase after the slips and pile my old self back together. No desires of any kind, in fact. Whoever I now was was fine with whatever happened. No more ego? That was okay, in fact the most natural thing in the world.
For what was observing the scene was a vantage and mode of awareness entirely distinct from my accustomed self; in fact I hesitate to use the “I” to denote the presiding awareness, it was so different from my usual first person.
Where that self had always been a subject encapsulated in this body, this one seemed unbounded by any body, even though I now had access to its perspective… Everything I once was and called me, this self six decades in the making, had been liquefied and dispersed over the scene. What had always been a thinking, feeling, perceiving subject based in here was now an object out there.
Like Pollan describes, people often experience extremely altered self-awareness during psychedelic trips. This is part of the “mystical experience,” which appears to be correlated with the therapeutic benefits of psychedelics (see Roseman et al. 2017, Griffiths et al. 2008).
To sum up, under a long-termist view, psychedelic interventions are plausibly in the same ballpark of effectiveness of other interventions that increase the set of well-intentioned + capable people. This is because these interventions seem quite robust to consequentialist cluelessness – the extreme difficulty of confidently assessing far-future consequences of today's actions.
If you hold a short-termist view (i.e. only people who exist before some time horizon deserve moral consideration), mental health appears to be a cause area on par with global poverty, i.e. if global poverty interventions meet the criteria for being an EA cause area, so too should mental health interventions.
Mental illness appears to cause more suffering than poverty in developed countries, and it seems to cause roughly as much suffering worldwide as poverty does. Unlike poverty, the mental health burden isn’t shrinking. (See Michael Plant's cause profile on mental health for an analysis of how mental illness causes roughly as much suffering as global poverty.)
Psychedelics are showing a ton of promise as treatment for a battery of chronic mental health issues: anxiety (see Gasser et al. 2015, Griffiths et al. 2016), depression (see Carhart-Harris et al. 2018, Palhano-Fontes et al. 2019), OCD (see Moreno et al. 2006), and addictive disorders including smoking (see Johnson et al. 2017) & alcoholism (see Bogenschutz et al. 2015, Krebs & Johansen 2012).
For a summary of some of these findings, see dos Santos et al. 2016, a systematic review of the mental health effects of psychedelic therapy.
So, under a short-termist view, psychedelic interventions are plausibly in the same ballpark of effectiveness as global poverty interventions.
In summary, psychedelic research & advocacy seems particularly compelling as a cause area, because it performs well under both short-termist and long-termist worldviews. Given our uncertainty about morality, this appears to make psychedelics more robust than cause areas that rely on a single sequence of reasoning to justify their impact.
3(b). Comparison of rationality training to the psychedelic experience
As discussed above, both rationality training and the psychedelic experience seem to be levers that increase the number of well-intentioned + capable people. This is plausibly robust to cluelessness (the difficulty of assessing outcomes that occur 10,000s of year in the future), because well-intentioned + capable people can course correct as we head into the future.
Comparing rationality training programs (e.g. CFAR, Paradigm Academy) to psychedelic experiences is tricky. It's hard to make an apples-to-apples comparison, because the interventions are operating on very different levels of abstraction.
The rationality training programs I know of operate almost entirely on the conceptual level (though I believe Paradigm uses some bodywork modalities also). The basic structure of conceptual rationality training is something like:
- Instructor says some words about a rationality topic
- Trainee hears these words & tries to internalize the topic
- Trainee practices their internalized version of the rationality topic (by themselves, with other trainees, or with the instructor)
- Instructor provides feedback to trainee to improve the trainee's internalized model of the topic
I think this structure can work really well for information & technique transfer, especially when the trainee is engaged & the instructor is skillful.
The basic structure of a psychedelic trip is very different:
- Participant thinks about and articulates the intentions & expectations they have for their upcoming psychedelic experience (to themselves, or to a facilitator)
- Participant ingests a psychedelic (by themselves, or with a sober facilitator present)
- Participant has a psychedelic experience. This experience can include a wide range of subjective elements:
- Old memories can come up and/or become salient
- New perspectives on relationships with friends, family, one's immediate environment can be adopted
- Emotions can be felt very intensely, especially emotions about salient people & topics in the one’s life
- Insights can be had about the participant's psychology, social assumptions, epistemic assumptions, and metaphysical assumptions
- New personal narratives ("this is the story of my life; this is what my life's about") can be adopted
- Once sober, participant integrates the experience (by themselves, or in dialogue a facilitator)
- How did the actual trip match up to your expectations about the trip?
- What came up? What was interesting? What was trivial, or silly?
- Did anything come up that's worth incorporating into your everyday life?
(See the Psychedelic Explorer’s Guide for more on how to structure an effective, safe trip.)
I think this structure can be really helpful for surfacing emotional blocks (e.g. things that generate akrasia, i.e. acting against one’s better judgment), as well as for resolving known emotional blocks.
The psychedelic experience can also help change one's assumptions, internal monologue, and personal narrative. (See the above Michael Pollan quote for an example of this. Also note that the psychedelic experience doesn't do this automatically, it can just help "loosen you up." The participant still has to intentionally work towards changing these things.)
So, to the extent that the EA community is limited by information & technique transfer, I'd expect conceptual rationality training to be more leveraged.
To the extent that the EA community is limited by emotional blocks & unhelpful personal narratives, I'd expect the psychedelic experience to be more leveraged.
My current view is that the EA community is more limited by emotional blocks & unhelpful personal narratives. The 2019 Slate Star Codex reader survey offers some data here: 17.4% of survey respondents have a formal diagnosis of depression (another 16.7% suspect they are depressed but haven’t been diagnosed); 12.6% of respondents have a formal diagnosis of anxiety (another 18.7% suspect they have anxiety but haven’t been diagnosed).
3(c). Interlude – on quantitative comparison
The above is merely a theoretical comparison – a quantitative comparative analysis would be helpful for thinking through the potential of psychedelics relative to other causes. Here’s one attempt at quantifying the benefits of a psychedelic intervention using DALYs, concluding that the intervention has a cost-per-DALY-averted of $472.
Note that DALY & QALY frameworks probably underweight mental health interventions due to the retrospective survey methodology used to construct their weightings.
Also note that there aren't many quantitative analyses that compare across EA cause areas. (e.g. comparing animal welfare interventions to global poverty interventions, or comparing x-risk interventions to animal welfare interventions.) Michael Dickens' cause prioritization app attempts this, though as far as I know it hasn't been used to drive much decision-making.
3(d). Trauma alleviation
The first time I heard Robert Anda present the results of the ACE study, he could not hold back his tears. In his career at the CDC he had previously worked in several major risk areas, including tobacco research and cardiovascular health.
But when the ACE study data started to appear on his computer screen, he realized that they had stumbled upon the gravest and most costly public health issue in the United States: child abuse.
[Anda] had calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. It would also have a dramatic effect on workplace performance and vastly decrease the need for incarceration.
Psychedelic therapy seems very promising for resolving PTSD, which could plausibly break the cycle of abuse that creates new traumatic experiences. (Trauma appears to transfer from generation to generation via multiple pathways.)
In particular, MDMA-assisted psychotherapy for PTSD is yielding extremely promising results in recent randomized controlled trials (see Mithoefer et al. 2012, Mithoefer et al. 2018, Ot’alora et al. 2018). From the abstract of Mithoefer et al. 2018:
At the primary endpoint, the 75 mg and 125 mg groups had significantly greater decreases in PTSD symptom severity (mean change CAPS-IV total scores of −58·3 [SD 9·8] and −44·3 [28·7]; p=0·001) than the 30 mg group (−11·4 [12·7]). Compared with the 30 mg group, Cohen's d effect sizes were large: 2·8 (95% CI 1·19–4·39) for the 75 mg group and 1·1 (0·04–2·08) for the 125 mg group.
PTSD symptoms were significantly reduced at the 12-month follow-up compared with baseline after all groups had full-dose MDMA (mean CAPS-IV total score of 38·8 [SD 28·1] vs 87·1 [16·1]; p<0·0001).
A Cohen’s d of 2.8 is extremely large (“Cohen suggested that d = 0.2 be considered a 'small' effect size, 0.5 represents a 'medium' effect size and 0.8 a 'large' effect size” source). Here’s a good resource for interpreting Cohen’s d.
In this study, 30 mg of MDMA was used as an active placebo, and the intervention groups were given 75 mg or 125 mg of MDMA.
From Mithoefer et al. 2012, a long-term follow-up of the first MDMA RCT:
We found the majority of these subjects with previously severe PTSD who were unresponsive to existing treatments had symptomatic relief provided by MDMA-assisted psychotherapy that persisted over time...
MDMA helped resolve severe PTSD symptoms in patients who had not responded to other treatment regimens. For 86% of patients, this benefit persisted 17+ months after the MDMA session.
3(e). Other (speculative) arguments for impact
Below are a few other mechanisms by which psychedelics could be highly impactful. These are speculative and I suggest holding them weakly – most of my own interest in psychedelic research & advocacy as an EA cause area is driven by the arguments given above.
Outcomes for the problems participants had been stuck on:
- A commercial building design, accepted by the client
- Design of a linear electron accelerator beam-steering device
- Engineering improvement to a magnetic tape recorder
- A chair design, modeled and accepted by the manufacturer
- A mathematical theorem regarding NOR gate circuits
- Design of a private dwelling, approved by the client
Anecdotally, Steve Jobs said that taking LSD was “one of the most important things in my life.”
Eric Weinstein (mathematician, venture capitalist), Sam Harris (public intellectual), Aldous Huxley (writer), Kary Mullis (inventor of the polymerase chain reaction), and Douglas Engelbart (computer scientist, inventor of the computer mouse) have all spoken highly of psychedelics and/or are known to use them.
Psychedelics may expand one’s circle of moral concern. As far as I know, there hasn’t yet been a randomized study of the relationship between psychedelic use & altruism. (Though I’d love to see one!)
Lerner & Lyvers 2006 found that psychedelic users scored higher on empathy scales than non-drug users, though non-psychedelic drug users also had higher empathy scores than non-drug users, so it’s not clear if there was an effect driven by psychedelic use.
Anecdotally, see this essay by anonymous philanthropist Pine, who attributes their decision to set up the Pineapple Fund to a psychedelic experience: “I’ve had the idea to donate a large portion of my bitcoins for a while, and it is through this journey of discovering myself [with the help of psychedelics] that made me actually commit to it.”
Info hazard. Finally, there’s a pathway to impact that I give some weight to, but can’t discuss publicly due to concern that talking about the pathway would be an information hazard. If you’re interested in learning more about this consideration, shoot me an email.
(This consideration is only a small part of why I’m excited about psychedelics, and I’d still be bullish about psychedelics as an EA cause area in its absence.)
4. Neglectedness and tractability
How do psychedelics perform under the importance, neglectedness, tractability framework? The “importance” consideration is discussed above. Neglectedness and tractability are considered below.
In short, psychedelic research is neglected. As discussed here, scientific research is very expensive, and current psychedelic research is happening only because a handful of private donors are funding it. (For more background, see this list of Open Phil analyses of the scientific research funding landscape.)
Governments are a major driver of scientific funding (NIH intends to grant $39.1 billion in 2019), and governments have not funded psychedelic research at all (presumably due to concern about optics, as well as bureaucracies being generally slow to update their stance).
From conversations I’ve had over the past two years, psychedelic research seems highly funding constrained, such that more money would convert into more research.
Roughly $40 million has been committed to psychedelic research since 2000.
In comparison, the Open Philanthropy Project has granted $104 million to scientific research since 2011.
Another comparison point: Open Phil’s grant to establish CSET ($55 million) is larger than the total amount spent on psychedelic research in the last 20 years, worldwide.
I’ve spent the last two years learning about the various projects going on in the psychedelic community. My general conclusion is that there are many tractable projects that could be happening but aren’t, due to lack of funding & capacity.
Here are the most important lines of psychedelic work currently happening:
- MDMA is being shepherded through the FDA approval process for PTSD treatment by MAPS.
- Psilocybin is being shepherded through the FDA approval process as a treatment for depression by both Compass Pathways and the Usona Institute (independently).
- State-level political campaigns to liberalize psychedelics are underway in Oregon & California. The city of Denver recently decriminalized psilocybin, by a narrow margin.
Both MDMA for PTSD & psilocybin for depression have received breakthrough therapy designation from the FDA, which indicates that the FDA thinks that these treatments “may demonstrate substantial improvement over available therapy.”
MDMA therapy is on track be made available as a prescription medicine in 2021 or 2022. Psilocybin therapy is on track to be made available as prescription medicine sometime between 2022 and 2025.
There’s a huge amount of work that needs to be done to make these rescheduling processes go well. There are insurance considerations, marketing considerations, regulatory considerations, and legal considerations that haven’t been figured out yet but need to be.
There isn’t an obvious place for psychedelic therapy in the current US healthcare infrastructure, so new infrastructure will need to be built (e.g. clinics for administering psychedelic therapy). There are opportunities to address this from both non-profit and for-profit approaches.
Furthermore, we still don’t granularly understand how psychedelics work neurologically, and we haven’t explored much of the space of possible applications of these substances. More research is needed – research groups at Johns Hopkins, NYU, Yale, the Heffter Research Institute, and Imperial College London all have deep research agendas they’d like to pursue, and they are all funding-limited.
Finally, as rescheduling approaches & psychedelics gain popularity, there’s a massive amount of public education work that needs to be done. The psychedelic experience is not without risk. As a greater number of inexperienced people have psychedelic trips, it’s important to propagate good guidelines for how to approach psychedelics in a safe & respectful way.
I’m offering three prizes for the best arguments against psychedelic research & advocacy being an EA cause area. Any argument submitted as a comment on this post will be considered for these prizes.
I’ll award $400 to the most-upvoted argument, $200 to the second-most-upvoted argument, and $100 to the third-most-upvoted argument. Winners will be assessed on Monday, June 3rd.
The driving motivation for this post is to surface arguments against psychedelic research & advocacy being an EA cause area. My current view is that psychedelics are an extremely promising altruistic cause area (on par with global health & x-risk reduction) – I’d like to learn more about how this might be mistaken.
If my view about psychedelics being a very promising cause area isn't mistaken, I’d like to see more attention paid to psychedelic research & advocacy by the EA community.
Cross-posted to LessWrong. Thanks to the Clarity Health Fund for a microgrant that enabled me to offer these prizes. This post was inspired by Grue_Slinky’s prize for the best argument against the EA Hotel.
: More arguments in support of psychedelics being an EA cause area in these posts: Legal psychedelic retreats launching in Jamaica, Psychedelics Normalization, "A Psychedelic Renaissance" (Chronicle of Philanthropy)
: Even for this case, you could imagine some scenarios where the intervention doesn't result in good outcomes.
To the extent there are not-good scenarios you could say it's not robust. It's probably best to model "robustness to cluelessness" as a continuum, wherein some interventions are more robust than others.
: In correspondence with one of the study authors, it was revealed that some of the study participants were also given methamphetamine. The author said that back in the 1960s, they were considering methamphetamine to be similar to caffeine, so did not think much about administering it. Nevertheless, the study results are seriously confounded because of this.
: Estimate confirmed via private correspondence.