Solipsis – exploring the phenomenology of psychosis in art and science.

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Originally submitted as an artefact for a KCL Experience Award as part of the A Beautiful Mind: Art, Science, and Mental Health module.

 Materials: Acrylic on canvas (A1)

Post-production: Photoshop

Solipsism, to be solipsistic, is the concept that the self is all that can be known to exist. Clara Humpston (2018), building upon work from Louis Sass, Barnaby Nelson, and Josef Parnas (2001; 2009; 2014), suggests that the experience of psychosis is fundamentally that of a disturbance to a sense of self – a disruption to the bedrock of ‘I’. The disruption produces a meld of subject/object awareness, shifting focus of an individual to their moment to moment inner experience in a chaotic, unanchored manner – unable to differentiate fact from fiction. The experiencer becomes solipsistic in their being, but not out of choice.

The artefact “Solipsis” is simultaneously a depiction of fusion between subject and object awareness, and also an exploration of my personal experience that accompanied being drowned by my own inner world. Using techniques of art psychotherapy, content inspired out of the work of contemporary phenomenologists, and from my own reflective practice in therapy, the painting is an external representation of internal dynamics. It has been a process of making the invisible and intangible something that is visible and understandable.

The painting depicts two solar or star-like objects in a dance, with one consuming the other to become an assimilated state. The inspiration for the visual dynamics came from observations of black holes or stars swallowing another small, less stable entity. Analogously, the internal dynamics of psychosis as suggested by Sass, Parnas, Nelson, and Humpston is that of a consumption of the boundary between internal and external worlds – the internal world becoming so engorged that it draws in and annihilates the external. Without differentiation of subject and object, moment to moment experiences can be that of pure clarity or utter chaos outside of our apparent volitional control.

This artefact is a work of interdisciplinarity through its use of scientific literature, art psychotherapy, and personal experience. In this piece, much like it’s subject, prominent thought in phenomenological psychiatry is merged with artistic representation. Through this coalition the conceptual experience of psychosis is visually depicted, as well as using the opportunity to reflect upon personal experience in psychotherapy.

Ultimately the process of exploring the self, introspection, research into mental health, and indeed the scientific process requires some degree of solipsism. To progress and generate new ideas we must, even if fleetingly, fuse our internal and external world in moments of clear, and sometimes chaotic reflection to move laterally between trails of thought. This can be a tumultuous process, even if we’re just going by reflections from researchers in their PhD training, and in the best cases leads to new understanding about the boundaries of the self and our potential as human beings – both for clarity and chaos.

I hope this piece to not just be a conceptual fusion of subject/object when our experience of self can be compromised, but also a disintegration of the boundary between those with psychosis and those without – recognising that there is a common humanity in us all. I hope this is a process of developing compassion for those who cannot escape themselves alone – for whom the experience becomes a black hole without any ground of being to fall back on.

 References

Humpston, C. S. (2017). The paradoxical self: Awareness, solipsism and first-rank symptoms in schizophrenia. Philosophical Psychology, 1-22.

Nelson, B., Fornito, A., Harrison, B. J., Yücel, M., Sass, L. A., Yung, A. R., … & McGorry, P. D. (2009). A disturbed sense of self in the psychosis prodrome: linking phenomenology and neurobiology. Neuroscience & Biobehavioral Reviews, 33(6), 807-817.

Nelson, B., Parnas, J., & Sass, L. A. (2014). Disturbance of minimal self (ipseity) in schizophrenia: clarification and current status.

Parnas, J., & Sass, L. A. (2001). Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry, & Psychology, 8(2), 101-120.

Beyond Expectation – review of “Beyond My Control” for The Psychologist

URL: https://thepsychologist.bps.org.uk/volume-31/march-2018/beyond-expectations

There seem to be fewer and fewer occasions where subjectivity and neural disorder are married together without causing controversy; thankfully, Beyond My Control is raising the numbers. The public engagement initiative IMPACT – a collaboration between the University of Exeter and Exeter Northcott – communicates in equal measures the science, maths, and complex humanness of experiencing recurrent seizures.

Beyond My Control incorporates improvised acting to demonstrate the intricate relationship of neural networks, and what might happen when a seizure strikes. The show introduces us to a family, the Brains – a dad, mum, daughter, and her boyfriend – as they work their way through plausible social dilemmas. This helps explore what happens when communication goes awry, relating this to excessive synchronous activity in the brain. Not only is this a great analogy, but involving the audience to suggest ways forward for the family to work through an issue is actually pretty therapeutic (and entertaining!).

The main takeaway from the show was the recorded lived experiences of those with epilepsy and their relatives – the embarrassment, guilt, confusion, and sometimes pleasure, that a seizure can bring. This really helps drive home the human behind the diagnosis, and the show makes no bones about making this explicit. Diagnosis is treated as practical and sometimes helpful labelling, but by no means thought to be fully encompassing those labelled with it.

While the show emphasises how complex – socially and psychologically – experiences can be for those with recurrent seizures, no one ever disregards the neural basis of the experience. This non-mutual exclusivity is really something special, which we need to see more often. Too frequently there appears to be a split between those who want to treat neural syndromes as a biological or psychological and social phenomena, and Beyond My Control shows that is can be all three at once: saying someone has a brain disorder does not mean their psychological and social experience is meaningless.

Public engagement is rarely something that is put at the forefront of scientific research – it can be clunky and underinvested. Beyond My Control goes above what is often expected from a science and art collaboration – more like this please.

Hellblade: giving us a peak behind the veil.

There’s no doubt about it – computer games have now the same power as a book or a film to absorb us, change the way we think, live our lives through another characters eyes, and tangibly walk through a beautifully crafted fictional world where we can be heroes (just for one day).

It could be argued that they invite us in more than these other mediums by enticing our senses with the promise of escape for an hour (or sometimes more, if it’s a weekend) and truly living out and journeying in our absorption. I’m sure Joseph Campbell would be impressed.

With the new release of Hellblade, developed by Ninja Theory, we drawn into the mythological realm of the Nordes. The game opens by following the main hero, Senua, floating toward the lands of the Northmen after experiencing the death of her loved one and finding the ravaging of her community all too difficult to bare. This leads her on a journey of redemption that will take her down into the hell of Nordic mythos. Plagued by self-doubt, tormenting voices, and a fear of becoming her mother, Senua takes a trip into the underworld to battle the gods in hope she may find a lost part of herself.

This story sounds fairly straight forward so far, but what is truly unique is its mechanics and dynamic we as players have with the main protagonist: Senua. This story has done something rarely seen in modern day gaming, and that’s to give the main hero a mental health difficulty – something we are also bound to as we follow Senua through her tale, and something that many people in our community live with in a modern context. Now the immersive medium of video games can give us a form of lived experience that 99% of us will not inhabit, but sometimes share in fleeting moments when life throws us a curve ball.

The main character in this story, Senua, experiences psychosis. Psychosis is classed as a description of perceived reality which often involves hallucinations, such as hearing voices, and experiencing fixed beliefs called delusions. Often this experience has been wrongly stigmatised by the media as something that produces violence and aggression in those who suffer with it, but in reality most likely involves someone vulnerable in need of support.

While originally experiences of psychosis like auditory verbal hallucinations alone could warrant you a diagnosis like schizophrenia, we’re finding out more and more that it’s the only the malign, paranoid, and tormenting nature of experiences which can be debilitating – infact often voice hearers would prefer not to get rid of the useful ones. Evidence is being accumulated to suggest that the general population will experience a momentary hallucination at some point, and even pretty scary ones, but not have it lead to requiring clinical care. If you’ve experienced a night terror or the loss of someone close to you, you might know what I’m on about.

The relationship between hallucinations, their content, and experiencers are unique – however those in the throes of psychosis tend to describe a particular tone to these hallucinations which is something the developers of Hellblade wanted to make sure they were accurate in their portrayal. Ninja Theory closely worked together with service users, mental health experts, and the Wellcome Trust to help guide and accurately depict Senua’s experience of psychosis – including some excellent sound design using binaural recording to stay true to the sensation of voice hearing.

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Top image: binaural recording – used in the development of Hellblade – tries to more accurately capture the true experience of auditory perception.

Senua invites us to walk with her every step of the way – from heart-breaking loss to battling demons we can’t ever be sure really exist – while all the while we are constantly interrupted, helped, chastised, berated, and comforted by the voices in her head.

Not only do we experience the rich environment Senua moves through, but also the rich environment of Senua herself. This is as much an epic mythological quest into the Nordic unknown as it is plumbing into the painful depths of the protagonist.

What is interesting is that this game takes a much more personable and intimate stance to our main hero by having to experience our surround through her eyes – creating a dynamic between the hero and the environment not often seen in gaming tropes – a risky move that has in this case paid off (in my humble bias opinion) for Ninja Theory.

In a lot of games, our predefined and personable hero is part of an artificially rendered world which we can rely upon to stay within the boundaries of its fiction. For example, in Assassins Creed we operate with the physics of being able to scale walls and jump from high buildings in historical scenes while being fairly confident that we won’t suddenly be swallowed up by the ground, and in The Witcher we buy into the magic and supernatural pretence of the world where we operate – and even in the most mystical cases we learn to expect ghouls, demons, and distorted monstrosities. In these cases, we stand outside of the hero and ‘see’ the world within a paradigm, extraneous to how the hero necessarily sees it themselves. This means all the biases, hangups, and embarrassing memories that suddenly pop up on aren’t shown to us explicitly – we’re sort of playing the role of scientist by having to infer their internal world from their interactions. If only we too could see the look on the characters’ face when their social media feed shows them a photo of what they looked like 6 years ago (thanks Facebook).

Sometimes our hero is faceless – for example in Dark Souls we are not told anything about our hero – even as far not having a voice in the interactions with non-playable characters that inhabit the decaying and bleak universe. This sometimes allows the player to assume the identity of the hero much more convincingly – putting our interpretations and feelings about the game’s universe onto our avatar. This is even reflected obviously in the way in which the game is played, customising the look and attributes of the player to personal choice. While this is effective and obviously fun, it’s a mechanic which doesn’t create an intimacy with another point of view – and we’re rarely aware of the fact that we’re doing this (which is part of the beauty of it).

However in Hellblade, Senua forces us to live her experience and face her reality in an active, intimate, and obvious way. In this dynamic, both she and the external world in which she inhabits is completely unreliable – and we share this oscillation along with her. One minute we’re walking through a glade which is quickly transformed into a fiery and bleak scene. Senua distorts the ability to stand outside of the hero and accept the environment for what it is, and instead makes everything we see potentially misleading – completely knocking us off guard and forcing us to question what is true. We’re tethered to the interpretations, fears, doubts, and perceptions of Senua as we progress in the game, and this creates a shared experience we’re not often used to in media.

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So what does this really say about the human experience of reality more generally? How can we learn something about ourselves from this experience?

A recent talk put forward a popular theory of consciousness suggesting that all we see, hear, touch, taste, and smell is a form of hallucination – a way of our brains trying to predict the environment to be able to operate in it. Learning these associations with our environment creates familiar concepts that we can interact with: that person is my friend Dan, that object is a ball, that’s my cat, that’s another pile of catsick I have to clean up again. All of these concepts are highly interwoven with aspects such as emotion and memory to form a continuous and seemingly concrete sense of ‘I’ within a space, but in actuality, we’re a bundle of cogs working together to form a whole.

When we introduce social relationships instead of just objects to our sense of ‘I’ we begin to form mental concepts of those relationships too. Recent evidence has suggested that the social relationships we hold throughout life can form internal conceptual identities – inner frameworks of how we would imagine people to act or think. You can probably do this right now by imaging what your best friend or partner might say if when you saw them next you suddenly started swearing at them for no reason. Our finely tuned and complex brain is able to integrate these representations so that we can think about them in this sort of third-person and rehearsed perspective. As we get to know others for longer and form closer social and emotional bonds with them, these internal ideas of who they are become more of a part of who we are. They can form our inner monologues and influence how we might think about something or our ‘selves’ in the future.

If someone we are close to or rely upon emotionally causes us a great harm or we go through a powerful trauma, especially at a young age, this can hugely impact the way we interact with others in the future and possibly give us a more threatening outlook on how we might view people we don’t even know yet. This traumatic experience can disrupt the finely tuned integration of our conscious sense of ‘I’. In some cases, this can lead to our internal social concepts or personality attributes of people we known or have known to appear to exist outside of us – this is what we may called auditory verbal hallucinations, but might not always be expressed verbally.  They become disembodied voices of the strict authoritarian, the benevolent carer, or the critical sibling. Understanding how this might happen isn’t so tricky when you consider that the interpretation of who you are and who you are not requires a finely tuned and complex system working to create this seamless – but illusory – unitary experience, and even then it only really works properly sometimes.

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Now that we have some theories about what’s actually going on, can’t we just explain away these experiences as meaningless?

Just because we can form theories about the way in which an experience is created is not to explain away the deep feeling of realness when we come into contact with an experience like Senua’s. In fact, the beauty of Hellblade is the simultaneous knowledge that most of what we see is illusory and yet being helpless to form genuine reactions to it. We know that the voices are part of Senua’s personal reality that others don’t necessarily share, and we know that the meaning she finds in things are possibly false, yet we find ourselves developing feelings toward the characters that speak to her and we’re driven to find out more of the supernatural world she inhabits. This experience brings us closer to the balanced understanding that while the mechanics of something can be known, that knowledge should never rob us or anyone of understanding the real and genuine human experience it can produce.

Movements such as the Hearing Voices Network work to openly discuss these experiences and help normalise them. There’s also a great podcast here which discusses what it’s like to hear voices.

There is no secret that we can get easily absorbed into a fiction realm every time we pick up a book, a controller, or sit down in the cinema to enjoy a movie. This mechanism of immersion helps bridge the divide between Senua and many other people that live every day with psychosis as we’re given 8 hours of a simulated experience. The journey and struggle is created honestly, and gives us the realisation that psychosis is not an alien trait but completely understandable by virtue of being a human having lived through difficult conditions.

We all have our own unique interpretations of the world whether consciously or not, and Hellblade therapeutically and somewhat ironically brings us closer to that reality- and while we can debate this reality as a relative illusion long after the game has ended, the one thing that this game gives us clarity over is the feeling of Senua’s despair, anguish, vulnerability, and loss. That much we can sure of.

In essence, Hellblade is a prime example of excellent storytelling, immersive, bleak, and beautiful environments, stark self-reflections, and active intimate engagement with Senua’s struggle. This is a story about love, loss, and the relationship with aspects of ourselves – as beautiful and or as distressing as you can fathom. Through Senua’s struggle, we can get a taste of what it is like to live everyday with voices or to see reality being constantly pregnant with meaning. This game is something that I think should be a staple for all those interested not only in mental health, but for all who are truly interested in bridging the divide between ‘them’ and ‘us’ so frequently portrayed in the media with mental illness. It is exhilarating and exhausting, but highly worth the effort.

What are psychedelics actually doing? Some thoughts about future research challenges.

A fascinating recent article posted in Science Reports drew a lot of attention over the evidence that a higher state of consciousness had now been captured on MEG through the use of psychedelics.

The team on the paper – a collaboration between researchers at Sussex, Imperial, and Auckland – collected Magnetoencephalography (MEG) data from participants using Ketamine, LSD, and Psilocybin, and aimed to take a look at how a change in spontaneous signal diversity corresponded with the psychedelic subjective experience.

The essential conclusion was that Psilocybin, Ketamine, and LSD reflect an opposite pattern of neural diversity to anesthetics, such as propofol, and a greater level of spontaneous neural activity in comparison to normal waking consciousness – such as you’re using to read this – and so this might be called a more ‘signal rich’ mode of perceiving your conscious experience.

On top of being pretty novel in terms of its findings, the paper was a genuinely interesting way of looking at neural data, and works toward trying to pair phenomenological experience to brain activity in aid of understanding how our underlying perceptual machinery can produce such a strange experience – especially as consciousness has typically been studied through the loss of experience (such as anesthesia), and not often, if at all, through the increased complexity of experience compared to our every-day perceptions.

This paper has definitely got me thinking about the complex role of our brain to filter and define our incoming information moment to moment so that we can perform day-to-day tasks we take for granted, and how changes to this filtering might give us some fascinating insight into what’s actually going on under the hood.

It might also represent a different mode of signal detection, where otherwise ‘silent’ experiences and perceptions which would be otherwise ignored are now pushed up into our subjective platform.

Cognitive Neuropsychiatry takes a similar approach to this paper by studying the neural activity of individuals who have a very different experience of the world – such as in delusions – and using these findings to give us a clue as to the dynamics of related neural function e.g. belief formation.

This study adds to the field by demonstrating that instead of using individuals with a mental illness or neurological difficulty to peek behind the veil, we might be able to use psychedelics to transiently produce very different modes of subjectivity. This has huge potential, and I look forward to seeing where it progresses.


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Magnetoencephalography (MEG) records the firing rhythms of the cortex. These different frequencies are given names like theta, delta, and alpha.
Image taken from MIT News

 

However – I do have some thoughts about challenges the field might face moving forward and some healthy criticism of the data – I hope this only helps to develop our interpretations.

Essentially, I think we need to be careful with getting carried away with the term ‘higher consciousness’ at this point, especially when trying to be true to the data, and the authors do indeed mention that the use of the phrase ‘higher state of consciousness’ is to be cautiously interpreted.

I see this as an issue on two related fronts.

First, as with anything, the media like to make a lot of hype around this finding, and it can be useful to be honest about some of the assumptions that we might attribute to what is actually being said.

For instance – when we hear the word ‘higher’, we might immediately associate this with being synonymous with ‘better’, or even more exotically, ‘enlightened’, as the suggestive image heading this blog post might portray.

But this is a tricky situation, as this plays into some potential assumptions about the quality of our conscious experience, for example, the idea that we need to somehow escape our ‘regular’ or everyday state of mind.

We could equally interpret our brain in its everyday state as an optimal and balanced organ working to reduce incoming information into digestible and manageable pieces which can be used to navigate the environment – much like that theorised in a new paper here.

Now, this isn’t to say that having interesting and rich experiences outside of our every-day can give us a whole new perspective on ourselves and insight into our malleable perceptions, or even that our ‘everyday’ mind can always be a good thing (e.g. outdated beliefs or overbearing self-criticism), but I fear associating this increased ‘free energy’ form with a more desirable function to be can lead to a ‘grass is greener’ type situation which ultimately gives our more everyday, and perhaps more mundane, experiences lesser value. But we need to remember that it’s these more typical experiences that give us the ability to do all the small things we take for granted (cue Blink 182).

Now I might be jumping the gun a little here as to how far most might take the idea of a ‘higher’ consciousness, or even over exaggerating the interpretations, but I think keeping on top of our exoticism over the experience can mean we don’t fetishise it and instead try to fully understand what this altered state actually is doing, and what this might mean for our understanding of the mind.

This leads into my next point, which is that the over exposure of the media may actually begin to bias the subjective experiences of future participants, and may greater amplify the placebo effect.

Neuroskeptic recently wrote an article addressing this issue with the recent APA consensus statement around the medicinal use of ketamine for depression.

Because of psychedelic research permeating most news outlets with tales of fascinating and powerful subjective experiences, we may all now be automatically biased toward what we expect from taking something like LSD.

Future experimentation aiming to further understand the correlation between subjective experience and symptom reduction will possibly find it increasingly harder to parse out expectation and the placebo effect from ‘drug related’ causal effects.

This isn’t to undermine the placebo experience as a useful and effective therapeutic tool, but if we are to get to the bottom of the causal neural mechanisms surrounding the use of psychedelics, massive expectations only work to muddy these results.

Questions might be being raised at this point between what we might consider ‘causal’ mechanisms, and whether we should make a distinction between ‘non-placebo’ neural changes as a hallmark of ‘genuine’ change as this might start bringing up a lot of false separations between our brain and subjective states, as each are one in the same, and doing so undermines the powerful effect of environment, social dynamics, and community belief.

My main question here is: is it the drug that is doing the driving of the experience, or is our expectation and our submission to the ritual process of taking it? If it’s the former, then it matters which drug we are administering, if its the latter, then psychedelics may not be as special as is often touted.

Of course, as with anything, it’s probably a mix of the two. However, if prior belief and expectation are found in future research to play a massive role in the changes in symptom changes, taking psychedelics in a modern medicinal setting with guidance may be conceptually on par with rituals we might not consider relevant in modernity anymore, like the Catholic mass or Sufi twirling – this is simply our modern take with lots of perceptual fireworks.

This might be quite a humbling piece of information, and serve to illustrate a) how powerful community consensus can be for therapeutic means, and b) how much we have in common with our previous generations.

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This might appear antiquated to modern day 20- somethings, but is the key to a powerful psychological change belief, subjective prowess, and communal agreement?

 

My final point I hope illustrates my previous two, and it’s regarding the data presented in this study when looking deeper at the association made in the paper between the use of all three psychedelics, their effect of increased cortical signal complexity, and a large change in subjective experience.

Authors use a mathematical algorithm to analyse the MEG data called the ‘Lempel-Ziv complexity‘. This algorithm is essentially telling us how ‘random’ the neural signal generated from the brain is across 90 different sites – the assumption here is that the larger the value, the more complex, chaotic or ‘entropic’ the cortex is at that particular time – this is what the authors’ call a ‘richer’ or ‘higher state’ of consciousness because less filtering of our sensory experience is theorised to be occurring, and this is therefore suggested to accompany a vast change in subjective experience, such as the onset of hallucinations, ego-dissolution, and distortions in time and space.


Increased spontaneous signal diversity for PSIL, KET and LSD.
Figure 2(a) Mean scores across participants for the signal diversity measures LZsN, LZcN and ACEN are higher for each of the three drug conditions (white discs) than for the corresponding placebo conditions (black discs). A solid line across conditions indicates p < 0.001 and a dotted line 0.001 < p < 0.05, uncorrected, obtained from a two-sided t-test. (b) Difference in single channel Lempel-Ziv complexity, LZsN, between respectively PSIL, KET, LSD and placebo at the single participant level. The error bars indicate standard error across trials.
Image taken from : Schartner, M. M. et al. Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin. Sci. Rep. 7, 46421; doi: 10.1038/srep46421 (2017).

 

The above figure shows the difference in neural communication complexity using the algorithm I mentioned before. Notice that LSD and Ketamine both demonstrate significant differences between the drug condition (white discs under ‘a)’) and placebo condition (black discs under ‘a)’), but psilocybin doesn’t at all. This insignificance is compounded by the fact that individuals were actually scanned during their peak when you would expect the largest changes to be occurring.

This would suggest that for ketamine and LSD, changes in neural activity using this algorithm may reflect vastly different subjective experiences if we find a significant difference in participants phenomenological reports using the same drugs.

This would support the argument that the different compounds are having a different and meaningful neural impact.


Correlations across measures and questionnaire answers.

Figure 4

(a) For each drug, a matrix indicates in colour the Pearson correlation, r, of the score difference between drug and placebo condition (averaged across trials) of each measure pair across participants. The upper triangular entries and entries with |r| < 0.5 are omitted (and set white) to highlight strong correlations only. These correlations should be considered somewhat exploratory and are not controlled for multiple comparisons as each experiment had a limited sample size. Across drugs, signal diversity measures show high correlation with each other, yet inconsistently, as they capture different flavours of signal diversity. (b) Correlations between the changes in the measures ACEN, LZcN and LZsN and the questionnaire scores (same scale as above). No consistent correlation across drugs was found for any combination of the measure’s scores and scores for a particular question. (c) The changes in subjective ratings under each drug condition are shown as averages with standard error bars across subjects. The average of all changes across these 14 questions (except “InScanner”) is denoted as “total” and shown normalised by factor 20 in order to fit the scale. No consistent differences are apparent across drugs.
Image taken from : Schartner, M. M. et al. Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin. Sci. Rep. 7, 46421; doi: 10.1038/srep46421 (2017).

 

While all drugs showed an increase in signal diversity after drug administration, this hasn’t been established with significance at all for all drugs.

Now, the above figure suggests that psilocybin has the greatest total change in subjective experience compared to LSD and Ketamine, especially on experiences of seeing strange shapes, geometric patterns, and having vivid mental experiences.

As there was no significant difference between using psilocybin and placebo in terms of signal diversity, the fact that psilocybin expressed the greatest difference in subjective experience leaves me with alot of questions.

There still seems to be many questions regarding whether different compounds produce markedly different subjective experiences, and how this relates to symptoms reduction and neural activity.

The study however takes great steps to get the ball rolling in answering this question, and I look forward to seeing how these results develop, with different analyses, replications, and richer phenomenological reports being drawn upon to test these different hypotheses.