{"id":4759,"date":"2026-03-12T01:01:12","date_gmt":"2026-03-12T00:01:12","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4759"},"modified":"2026-03-12T01:01:12","modified_gmt":"2026-03-12T00:01:12","slug":"the-trip-is-not-the-transformation","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/03\/12\/the-trip-is-not-the-transformation\/","title":{"rendered":"The trip is not the transformation"},"content":{"rendered":"

By Chiara Caporuscio<\/p>\n

The first time I read patient testimonies from psilocybin trials, I found them startling. Someone who had been drinking since the age of seventeen described how, after a single session, alcohol had become simply \u201cirrelevant\u201d to him. Something that had been part of his life for decades now felt beside the point, like a hobby he had outgrown. Others talked about shedding a life-long fear of death. These reports did not sound like incremental improvements, but like people describing a different version of themselves.<\/p>\n

The philosopher L.A. Paul uses the analogy of a vampiric bite to describe experiences so transformative that the person who goes through them comes out the other side as someone new. For a while, some researchers and ethicists argued that psychedelics worked the same way: one experience with the power to completely and irreversibly change who you are.<\/p>\n

Some of the evidence about the long-term impact of psychedelic transformation, however, does not quite back that up. A study on ayahuasca retreat participants <\/a>found that people\u2019s glowing self-reports of inner transformation weren\u2019t matched by what their friends and family observed. There seems to be a pattern of people reporting radical value shifts, only to slip back into old behaviours within weeks. The ego-dissolved guy is still somehow kind of a narcissist.<\/p>\n

None of this means those experiences aren\u2019t real. But I\u2019d argue that what happens during a psychedelic session is better understood as an epiphany than a transformation: a sudden, vivid encounter with a new way of seeing things. The mental furniture gets rearranged; old certainties loosen. A door opens, but that in itself is not enough: walking through is the hard part, and it doesn\u2019t happen automatically. It happens through the choices that come after: the daily decisions to act in accordance with the new insight, the slow and sometimes tedious work of actually changing how you live and who you surround yourself with to enable lasting change. Paul herself offers a better analogy than a vampiric bite: falling in love. Nobody falls in love in a single moment. There\u2019s a first conversation, a dinner, a choice to call again, and another after that. A long accumulation of small decisions that, looking back, add up to become life transforming.<\/p>\n

This has important implications for informed consent to psychedelic therapy. If one psychedelic session rewrote you in ways you couldn\u2019t foresee or control, then the ethical ground under psychedelic therapy would feel shaky: how do you consent to becoming a different person? But if the real work of transformation happens afterward, in ordinary waking life, through choices made with a clear head, then the person who signs the consent form and the person who does the integrating are continuous enough for that consent to mean something. The door that opened in the dosing room still has to be walked through, and you\u2019re still the one walking.<\/p>\n

Article<\/strong>: Transient or Transformative? Psychedelics, Agency, and Informed Consent<\/a><\/p>\n

Author<\/strong>: Chiara Caporuscio<\/span><\/p>\n

Affiliation<\/strong>:<\/p>\n

Psychedelic Substances Research Group, Department of Psychiatry and Neurosciences, Campus Charit\u00e9 Mitte, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Berlin, Germany
\nCentre for Philosophy and AI Research (PAIR), Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Erlangen, Germany
\nGerman Center for Mental Health (DZPG), Berlin, Potsdam, Germany<\/p>\n

Conflict of Interest<\/strong>: None to declare<\/p>\n

Social Media<\/strong>: @chiaracap on X<\/p>\n","protected":false},"excerpt":{"rendered":"

By Chiara Caporuscio The first time I read patient testimonies from psilocybin trials, I found them startling. Someone who had been drinking since the age of seventeen described how, after a single session, alcohol had become simply \u201cirrelevant\u201d to him. Something that had been part of his life for decades now felt beside the point, […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":522,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8053,8106],"tags":[],"class_list":["post-4759","post","type-post","status-publish","format-standard","hentry","category-consent","category-psychedelics"],"yoast_head":"\nThe trip is not the transformation - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/03\/12\/the-trip-is-not-the-transformation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The trip is not the transformation - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Chiara Caporuscio The first time I read patient testimonies from psilocybin trials, I found them startling. 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