I keep going back and forth on this, but honestly I think the "meaning-generating technology" frame might have the same problem you're identifying in the efficacy frame — just flipped.

"What psychedelics actually do is generate meaning"

But do they generate meaning, or just make you feel like you found it? In design we call this the difference between a good concept and a good-looking concept. The client feels something, the room nods, but if you pull it apart there's no actual structure holding it up. I've had friends come back from ceremonies absolutely convinced they'd accessed some fundamental truth about themselves, and six months later they're... basically the same person, just with new vocabulary.

Your Tower analogy is actually what makes me skeptical. You're right that it's about stripping false structures. But The Tower doesn't tell you what to build next. It doesn't even guarantee you will build something. Sometimes it's just destruction. And I think we're romanticizing that — assuming the dissolution automatically leads to reconstruction, because the psychedelic experience feels meaningful in the moment.

Jung's transcendent function requires actual integration work over time. It's not the lightning strike itself, it's what you do with the aftermath. And I wonder if focusing on "meaning generation" as the thing psychedelics do is still a kind of reductionism — just an aesthetic one instead of a clinical one.

I'm not saying they're useless. I'm saying maybe the meaning isn't in the substance any more than the efficacy is. Maybe it's in the slow, boring, unglamorous work after — which looks a lot more like therapy than we want to admit.

The evidence supports you more than the standard efficacy narrative. A 2022 meta-analysis by Goldberg et al. in JAMA Psychiatry found that while psychedelic-assisted therapy showed significant effects across multiple conditions, the effect sizes were highly variable and the therapeutic mechanism remained essentially unexplained. That variability isn't noise — it's the signal. It reflects what you're pointing at: the outcomes depend on what meaning is generated during the experience, not on the pharmacological intervention alone.

Your thermometer/lightning strike analogy is sharper than you probably intended. The PHQ-9 is designed to measure depressive symptom severity. Psychedelics, as you note, don't primarily reduce symptoms — they generate a confrontation with something true about the patient's life. That confrontation may result in symptom reduction, but the mechanism isn't the same as an SSRI's serotonin reuptake inhibition. Measuring both with the same instrument is a category error.

The research community is starting to acknowledge this. The Imperial College London team has been advocating for "meaning-centered" outcome measures in psychedelic trials, though the field hasn't yet agreed on what those would look like operationally. The problem is fundamental: how do you quantify existential revelation?

From a neuroscientific perspective, what's happening during a productive psychedelic session is a temporary dissolution of the default mode network's self-referential processing. That dissolution creates a window — a period of reduced ego-boundary rigidity during which new narratives can form. But whether those narratives are meaningful rather than just novel depends entirely on the inner work of the individual. The compound opens the door. The person has to walk through.

Your Tower card reading is apt. The Tower doesn't protect you from the fall. It ensures the fall happens so the reconstruction can be authentic.

"What psychedelics actually do is generate meaning"

I keep going back and forth on this, but honestly? Sometimes they just generate really convincing feelings of meaning — and as someone who overthinks everything, I can't always tell the difference.