• Introduction to the Special Section on Psychedelics Research and Treatment
• Dominic Sisti

Against a backdrop of post-pandemic malaise, diseases of despair, and a fragmented mental health care system, psychedelics have enjoyed a resurgence of interest as powerful psychotherapeutic agents and as catalysts of personal growth. The true power of these substances—some of which are considered sacramental by Indigenous peoples—has been shrouded for half a century by cultural mythology, political propaganda, and misuse. From about 1940 to 1970, psychedelics including psilocybin and LSD were studied and used by clinicians to treat a range of psychiatric disorders from alcoholism and depression in adults to "autistic schizophrenia" in children.

In June 1971, the Nixon administration's racist and illiberal War on Drugs inaugurated what was essentially a total ban on psychedelics. Society was robbed of half a century of scientific progress, and one can only speculate how differently our society might now function, and how many people might have been spared the trauma of mental illness and incarceration. Thankfully, it appears the time has arrived for psychedelic medicines to be decriminalized and included again in the pharmacopeia.

In June 2023, a group of psychedelic researchers, therapists, bioethicists, Indigenous scholars, and advocates met at the Banbury Conference Center at Cold Spring Harbor Laboratory. There, this interdisciplinary group discussed several pressing ethical issues in psychedelics research and treatment that continue to [End Page 114] challenge the field. The aim of this meeting was to develop a bioethical framework for the use of psychedelics in mainstream medical settings. That is, how should psychedelics be employed responsibly by everyday clinicians, including psychiatrists, psychologists, social workers, and other behavioral health-care providers? This special section offers a sampling of three topics in psychedelic bioethics raised by the Banbury group, several of whom appear as coauthors.

In our first paper, Logan Neitzke-Spruill and colleagues offer an overview of explanatory models describing the therapeutic mechanisms of psychedelic substances and how each of these models generates unique ethical quandaries. Starting from molecular biology and moving to neural circuitry and networks, neurobiological models now propel contemporary scientific research into psychedelics. Knowing how these substances work on a molecular level may offer promising ways forward in the development of new molecules designed to treat serious mental illnesses and other neurologic conditions. Perhaps neuroplastic mechanisms will be harnessed to develop new therapies without necessitating a psychedelic trip—a controversial premise discussed in our third paper, by Katherine Cheung, Brian Earp, and David Yaden.

Such "neuroreductionism" risks ignoring the subjective psychological and spiritual experiences of patients that appear to be pivotal in psychedelic-assisted therapy, often described as mystical and utterly transformative. At the psychological level, these substances engender a kind of vulnerability and suggestibility requiring clear ethical standards to ensure patients' psychological and physical safety. And so too, practitioners will need structural and cultural competency to recognize the spiritual or moral values that inspire patient reactions during and after their psychedelic experiences. Ethically informed psychedelic practitioners will have to navigate between disciplinary silos and explanatory models. One practical upshot is the open question of how best to train psychedelic practitioners who hold this broad set of competencies.

To that end, well-trained practitioners will need to be able to disclose in some way the transformative properties of psychedelics to prepare patients for their experiences. But how does one describe the ineffable? This raises the question of how or if it is possible for patients to truly consent to the transformative experience elicited by psychedelics, often described as one of the most important experiences of a person's life. The experience might stimulate significant emotional healing, or it might be horrifying. This sounds like a problem uniquely attached to psychedelics: after all, most pharmaceuticals don't trigger changes in one's fundamental moral values, life choices, and commitments, nor are they intended to. Yet, Brent Kious, Andrew Peterson, and Amy McGuire challenge the view that the psychedelic experience is uniquely transformative and impervious to the disclosure requirements of informed consent, a bedrock of bioethics. Ultimately, the writers show how consent is possible even if the experiences are dramatically different from most medical interventions, endorsing a practical view of consent [End...

• 致幻剂研究和治疗专题介绍
• 多米尼克·西斯蒂

在大流行后的不适、绝望疾病和支离破碎的精神卫生保健系统的背景下，致幻剂作为强大的心理治疗剂和个人成长的催化剂，重新受到人们的关注。这些物质的真正力量——其中一些被原住民认为是神圣的——半个世纪以来一直被文化神话、政治宣传和滥用所掩盖。大约从 1940 年到 1970 年，临床医生研究并使用包括裸盖菇素和 LSD 在内的致幻剂来治疗一系列精神疾病，从成人的酗酒和抑郁症到儿童的“自闭症精神分裂症”。

1971 年 6 月，尼克松政府发起了种族主义和非自由主义的禁毒战争，开启了对迷幻剂的全面禁令。社会被剥夺了半个世纪的科学进步，人们只能推测我们的社会现在的运作方式可能会有多么不同，以及有多少人可能免受精神疾病和监禁的创伤。值得庆幸的是，迷幻药物非刑事化并再次纳入药典的时机似乎已经到来。

2023 年 6 月，一群迷幻研究人员、治疗师、生物伦理学家、原住民学者和倡导者在冷泉港实验室的班伯里会议中心举行会议。在那里，这个跨学科小组讨论了致幻剂研究和治疗中的几个紧迫的伦理问题，这些问题继续对该领域提出挑战[结束第 114 页]。这次会议的目的是为在主流医疗环境中使用致幻剂制定一个生物伦理框架。也就是说，日常临床医生（包括精神病学家、心理学家、社会工作者和其他行为保健提供者）应如何负责任地使用致幻剂？这个特别部分提供了班伯里小组提出的迷幻生物伦理学三个主题的样本，其中几位小组是共同作者。

在我们的第一篇论文中，Logan Neitzke-Spruill 及其同事概述了描述迷幻物质治疗机制的解释模型，以及这些模型如何产生独特的道德困境。从分子生物学开始，转向神经回路和网络，神经生物学模型现在推动了当代迷幻药的科学研究。了解这些物质如何在分子水平上发挥作用，可能为开发用于治疗严重精神疾病和其他神经系统疾病的新分子提供有希望的方法。也许神经可塑性机制将被用来开发新的疗法，而无需迷幻之旅——这是凯瑟琳·张、布莱恩·厄普和大卫·亚登在我们的第三篇论文中讨论的一个有争议的前提。

这种“神经还原论”有可能忽视患者的主观心理和精神体验，而这些体验似乎在迷幻辅助治疗中至关重要，通常被描述为神秘且具有彻底变革性的治疗。在心理层面，这些物质产生一种脆弱性和暗示性，需要明确的道德标准来确保患者的心理和身体安全。因此，从业者也需要结构和文化能力来认识在迷幻体验期间和之后激发患者反应的精神或道德价值观。具有道德知识的迷幻从业者将不得不在学科孤岛和解释模型之间进行导航。一个实际结果是如何最好地培训拥有这一广泛能力的迷幻从业者的悬而未决的问题。

为此，训练有素的从业者需要能够以某种方式揭示迷幻药的变革特性，让患者为他们的经历做好准备。但如何描述不可言喻的事物呢？这就提出了一个问题：患者如何或是否可能真正同意迷幻药引起的变革性体验，这种体验通常被描述为一个人一生中最重要的体验之一。这种经历可能会刺激显着的情绪治愈，也可能会令人恐惧。这听起来像是迷幻药特有的问题：毕竟，大多数药物不会引发人们基本道德价值观、生活选择和承诺的改变，它们也无意引发这种变化。然而，布伦特·基厄斯、安德鲁·彼得森和艾米·麦奎尔对迷幻体验具有独特的变革性并且不受知情同意的披露要求（生物伦理学的基石）的影响这一观点提出了质疑。最终，作者展示了即使体验与大多数医疗干预措施截然不同，同意也是可能的，支持同意的实际观点[完……