Psychedelics & Palliative Care: A Comparative Analysis of Institutional Logics
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The need for improved treatment options for those dealing with psychological suffering, such as end of life anxiety and depression is critical, particularly for healthcare systems such as palliative care which already tend to such patients. A promising new therapeutic treatment may be found in psychedelics such as LSD and psilocybin, which have already shown encouraging results in clinical trials dealing with such conditions. Their potential for adoption, whilst clearly significant at the macro-, and meso- level, i.e. effects of the market and state, should also, critically, be understood on the more localised micro-level, in that ultimately it is individuals who will adopt these practices. A useful theory with respect to this, known as institutional logics, describes how institutional ideas manifest in everyday practice. In this paper, I conduct a qualitative inductive methodology that draws from previous conceptualisations of institutional logics to a) identify the multiple institutional logics present in both fields, b) explore the intra- and inter-domain overlaps and tensions across fields, and c) suggest what these overlaps and tensions might mean for policy makers and professionals. This cross-case comparison, itself a novel approach to the application of this theory, was conducted through an iterative process between data collection, namely interviews with specialists, and a theoretically driven analysis. The results showed an overlapping array of conflicting logics between the two cases, with encouraging similarities with respect to many of the shared norms, values, and means of operating. For one, the holistic logics, defined by its multi-dimensional patient-centred approach to care, had a strong presence in both domains, as well as a comparable presence of two scientifically backed professional logics: the medical, and research logics. Intra-domain tensions were also consistent, mainly between the professional logics and a business-like managerial logic. A key finding, and stumbling block in the legitimisation of psychedelics, is the presence of what I define as a psychedelic logic, where issues of objectivity, and the misalignment of goals were established. This embryonic logic, mostly composed of cultural-cognitive elements, I argue will be a key factor in the legitimising process, either by aligning itself with more established logics, or becoming more established through activist powers. All in all, insights from this paper suggest encouraging overlaps with respect to the micro-level dynamics of these domains, which is important for the fact that psychedelic therapy may one day become part of the palliative arsenal that deals with serious psychological suffering.