On “Pivotal Mental States”

A new paper discusses how stressful experiences – or psychedelic drugs – might produce profound mental change.

Authors Ari Brouwer and Robin Lester Carhart-Harris, writing in the Journal of Psychopharmacology, introduce the concept of ‘pivotal mental states’. (Although this is a new term, the idea echoes and Carhart-Harris, these pivotal states may be triggered by severe psychological or physiological stress, but they can also be produced by drugs, especially psychedelics such as LSD or psilocybin (magic mushrooms). Biologically, they say, stress and psychedelics have related effects on the brain in that stress upregulates and Carhart-Harris illustrate the idea of a pivotal mental state as a “moment of decision” with a rather beautiful piece of art showing a person facing two ways forward, one towards sunny health and the other, gloomy illness:

Pivotal Mental States

From Brouwer and Carhart-Harris (2020)

So what determines if the outcome of a pivotal state is good or bad? The authors point to “contextual factors” – the social, psychological, and emotional environment, broadly speaking – as being key. These need to be “treated with special attention and therapeutic care (where possible) if an individual’s psychological wellbeing is to be safeguarded”, and this applies to individuals on psychedelics as well as acute psychosis.

I found this paper bold and thought provoking, although I’d have liked to see the pivotal mental state described in more detail. The authors point to drug experiences, some forms of psychosis and some spiritual experiences as examples, but I would have liked to see more detail on what the state looks like (or feels like) phenomenologically.

I also didn’t find the biological aspects of the paper, with the focus on 5HT2A receptors, to be entirely convincing. This is a complex issue and there are thousands of relevant scientific studies, but in a nutshell, I don’t think we can equate the effect of stress with increased 5HT2A in all cases, and clearly stress does not always have the same effects as a dose of LSD, while LSD effects are not identical with psychotic symptoms.

Overall, the entire paper ends up raising more questions than it answers, and leaves the ‘pivotal mental state’ as something mysterious. This is not necessarily a bad thing – there can be value in describing a mystery, as a first step towards solving it. But there is a lot more work to do here.

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