On Psychedelics and the Risk of Delusions

In my interview for the website What Is It Like to Be a Philosopher?, the philosopher Clifford Sosis remarked, “I’m always disappointed by reports of drug fueled insights…merely seems like the effect of…I don’t know…the chemical disorganization of the brain?” I partly agreed (but not with the point about reducing all psychedelic insights to ‘chemical disorganisation’, as that seems to imply we should not trust any of them). I mentioned how “the hyperconnectivity and plasticity we see in the brain following psychedelic intake can help explain some of the wild theories and connections people make while on psychedelics.” Once back in the sober state, a profound realisation that one had while tripping can appear nonsensical. 

Indeed, while psychedelics can lead to helpful and therapeutic insights (which users also feel are true), the opposite is possible: the creation of delusions. (My personal view on what psychedelics can reveal as truth, as I said in the interview, “is that psychedelics tend to generate more true (and useful) insights regarding the self than they do metaphysics”. The philosopher Chris Letheby has similarly argued that it is these insights – those related to the self – that underpin the therapeutic benefits of psychedelic experiences.)

Psychedelics can lead to all sorts of delusional thoughts and beliefs. When they occur and become a source of intense distress, we could describe this trip as bad, negative, difficult, or challenging. Typically, delusions in these psychedelic journeys don’t outlast the acute effects of the drug, but sometimes, the delusion might persist. There can be other occasions when the journey itself does not feature the delusion; it instead manifests after the trip, often causing difficulty and trouble in one’s life.

In this post, I would like to describe two common types of psychedelic delusion, grandiosity and paranoia, as well as some subtypes of these. I will also mention some other forms of delusional thinking that can be triggered by psychedelics. My aim is not to encourage a fearful view of psychedelics. My aim is to raise awareness of the kinds of thoughts that should be recognised as delusional so that one is better able to identify them as such in oneself and others. The quicker you can identify a conclusion you reach on psychedelics as delusional, the better chance you’ll have of preventing it from spiralling out of control. (This might not necessarily eliminate the distress associated with it, but it will certainly reduce it.) I would also like to include in this piece some brief tips on how to minimise the risk of psychedelic delusions as well as ways to seek help if you or others are suffering from them.

First, we should begin with the basic question: What is a delusion? A simple definition is that it is any belief that does not match up with reality. But ‘delusion’ is also a term used in psychiatry, standing for a false belief featured in a diagnosable mental health condition (e.g. schizophrenia and bipolar disorder). These beliefs tend to be a source of emotional distress. Also part of the definition of delusion, both in everyday usage and clinically, is that the false belief is not amenable to evidence and information that conflicts with it. There is, therefore, a certain fixity to the belief; people with delusions struggle to let go of them, no matter what information is presented to them.

The last point may make the idea of helping people with psychedelic delusions seem futile. However, it’s not. People who hold false beliefs that are part of mental health conditions can receive treatment that allows them to see the delusory nature of those beliefs. This can take time, effort, and understanding, of course, but change is possible. With respect to psychedelic delusions – or strongly held beliefs that don’t map onto external reality – immediate help is possible. So long as the person can recognise that they need help, is willing to seek help and trust someone, and isn’t holding onto the belief too tightly, it’s possible for them to be talked down. They might even be able to talk themselves down.

When referring to ‘delusions’ that occur in the psychedelic state, some psychedelic users might feel that this term is presumptuous. Who’s to say whether a psychedelic-induced belief is a form of delusion rather than a profound insight? Perhaps this question is valid when it comes to certain metaphysical or existential revelations. Nevertheless, I am not using the term ‘delusion’ here in a way that can also refer to some philosophical belief that might be false. The delusions I have in mind are those that most reasonable people would agree are not grounded in reality; they are of the kind that may occur in people struggling with non-psychedelic forms of mental distress. I’m focusing on these types of delusions here, as I believe they deserve the most attention from a harm reduction point of view.

However, it’s important to stress that just because there can be similarities between psychedelic and non-psychedelic delusions, this doesn’t mean the former is a sign of a mental health condition. In some cases, an underlying condition can be present (or latent). In these cases, psychedelics can worsen pre-existing symptoms or trigger the onset of those symptoms in someone predisposed to them. But often the delusional belief is temporary, part of the temporary nature of the trip. Understanding this is crucial for calming oneself down during a distressing trip and ensuring that it isn’t exacerbated further by thoughts of ‘losing one’s mind’ or having damaged one’s brain forever.

Psychedelics might induce a psychotic-like state, but prolonged psychosis is a rare risk of psychedelics. The risk appears to be confined to those at greater risk of developing psychosis. For context, approximately 0.32% of people meet the diagnostic criteria for schizophrenia. Being aware of the signs of schizophrenia or bipolar disorder in yourself, or knowing that you have a family history of one of these conditions, may lead you to question whether taking psychedelics is worth the risk.

At the same time, we may have reason to challenge the common narrative surrounding psychedelics and these conditions. Researchers have suggested that non-psychedelic derivatives of psychedelics and microdoses might be helpful for patients with schizophrenia. One study also found that for those with a personal history of psychotic disorders, psychedelic use was associated with a decrease in the number of psychotic symptoms. And a 2023 study found that psilocybin can alleviate symptoms of bipolar II disorder (featuring depressive and hypomanic episodes, hypomania being a less severe form of mania), without increasing hypomania or mania.

Grandiose delusions (also known as delusions of grandeur) are characterised by a belief in one’s extraordinary nature, i.e. the belief that one is very powerful or enlightened. These delusions often have a religious, supernatural, or science-fiction theme. Grandiose delusions are common in bipolar disorder, manifesting in the manic phase of the condition. Mania involves an extreme elevation of mood and energy, resulting in lack of sleep, excessive talking, grand plans, distractability, and – in some cases – grandiose beliefs.

Patients with bipolar disorder are typically screened out of psychedelic clinical trials, due to the risk of psychedelics triggering a manic episode. Indeed, this effect has been observed in patients. Grandiose delusions are a possible adverse effect of psychedelics, which is a greater risk for those with bipolar disorder, although these delusions can occur in those without a personal or family history of the condition as well.

A common psychedelic delusion of the grandiose variety is the messiah complex (which both bipolar and schizophrenic patients have been known to experience). This is a mental state in which a person believes they are a messiah, saviour, or prophet, such as the second coming of Christ. They will feel a strong conviction about how their purpose is to save humanity. It’s an exaggerated sense of importance, power, or identity. It can be summed up in the lyrics from Tool’s track ‘Rosetta Stoned’, which is about a man retelling his LSD/UFO abduction experience to a doctor:

E.T. revealed to me his singular purpose. He said, "You are the Chosen One, the One who will deliver the message. A message of hope for those who choose to hear it and a warning for those who do not." Me. The Chosen One? They chose me!!! And I didn't even graduate from fuckin' high school.

• The sense of understanding fundamental reality (the noetic quality)
• Ego dissolution
• Universal compassion and love
• Pure bliss and peace
• Meeting God
• Seeing into the past and future
• Reading other people’s minds
• Accessing other dimensions
• Making contact with entities and spirits
• Talking to the dead

Other varieties of psychedelic delusions of grandeur include the belief that one has been gifted special or supernatural abilities (e.g. telepathy, telekinesis, psychokinesis, clairvoyance, precognition, psychic powers) or that one is more important than others. After a powerful psychedelic trip, a grandiose delusion may include the belief that one deserves guru status or has special access to the divine – the unique ability to communicate directly with God or the spirit world, which others lack.

Another delusion of grandeur may be the belief that one can spot all the hidden meanings and connections in the world, perhaps seeing the reality of grand conspiracies that others are blind to due to their conditioning. This kind of grandiose delusion can result in social isolation; it can lead to feelings of disconnection from others and lead people to distance themselves from the person experiencing this unhealthy ego trip.

One grandiose delusion, common in spiritual circles, is the belief that one is God. On the one hand, this isn’t necessarily problematic or pathological. It can be a legitimate (although questionable) spiritual belief that everyone is God, or has an aspect of the divine. But the grandiosity comes when one is excessively focused on one’s supposed divine nature, to the exclusion of seeing others as having this divine nature. Thus, this grandiose delusion, perhaps influenced by psychedelics, is the sense that one is the ultimate divine being, possessing qualities like omnipotence, omniscience, and omnibenevolence.

A potential aspect of grandiose delusions is false memories, which are a possible effect of psychedelics. This potential effect makes working with psychedelics tricky, particularly in cases when a person remembers, or claims to remember, a repressed traumatic event, such as sexual abuse. The psychedelic researcher Manoj Doss told Big Think, “Memory research doesn’t really provide evidence for the idea of recovered memories, particularly recovered trauma memories. The problem with PTSD is not that people can’t remember their trauma; it’s that they can’t forget it.” Similarly, the philosopher Aidan Lyon states that “psychedelic-induced recollections of real memories may be the exception rather than the norm.” Nonetheless, Doss believes that “regardless of the veracity of a recovered memory, if it helps someone, that’s usually all that matters, though I do think we need to be careful when it comes to things like accusations or even delusions of grandeur in past lives.”

Past life recollection, whether psychedelic-induced or not, often carries a sense of self-importance: people like to believe they lived as someone special – some powerful, wealthy, or highly spiritual individual, rather than (more likely) someone of much lower status. This idea then inflates their existing ego.

Paranoid delusions, most commonly associated with psychotic disorders like schizophrenia, involve someone experiencing an irrational fear that others want to harm or persecute them. They can occur in bipolar disorder as well. Simple paranoia (a general feeling of distrust and suspicion of others, or thinking that others are mocking you) can take on a delusional quality in the psychedelic state. This is when the feeling becomes a belief, a strong conviction that others are trying to harm you.

While tripping, common examples of paranoid or persecutory delusions include the belief that people around you (including friends and loved ones) are conspiring or plotting against you, perhaps trying to trick, poison, drug, or kill you. Another psychedelic delusion of this variety, likely influenced by the illegal status and stigma surrounding psychedelics, is the thought that the police or an intelligence agency are spying on you or are about to raid your home and put you in prison.

A science fiction variation of a paranoid delusion might involve extraterrestrials rather than people or human organisations. A person might believe that other people are aliens disguised in human bodies or that evil aliens are involved in a huge conspiracy against the human race. A persecutory delusion may also go beyond material reality and extend to the supernatural realm. On psychedelics, it is possible to feel persecuted by demons, evil spirits, or God Himself, or one may come to believe that other people are demonic and threatening.

Some might argue that the supernatural variety of persecutory delusion could involve genuine access to another reality or aspect of reality. However, we would normally recognise these states as detached from reality, unhealthy, and unnecessarily distressing in cases of schizophrenia featuring religious delusions. Similarly, on psychedelics, one can experience extreme fear, despair, and guilt when being persecuted for one’s sins. In this state, a person might feel that they’ve been sentenced to Hell. Most reasonable people, intending to help this person, would agree that this feeling is arising from an extreme (and temporary) mental state, not an authentic experience of eternal damnation in a supernatural realm.

While grandiose and paranoid delusions are the two most common types of delusional thinking related to psychedelic use, other forms of delusion can also occur. Here are some examples:

• Delusion of control: the false belief than another person, group of people, or external force (e.g. a malevolent spirit) is controlling one’s thoughts, feelings, impulses, or behaviours.
• Delusion of guilt or sin: an ungrounded and intense feeling of guilt or having sinned (this can be similar to some persecutory delusions wth religious themes, such as the one mentioned in the last section – it can feel like God, or an evil entity, is punishing you for your sins).
• Thought broadcasting: the false belief that others can hear one’s thoughts (in a psychedelic state, a non-distressing variety of this experience could be the felt experience of telepathy; but its emotional character can also be more like the distressing delusional variety, characterised by anxiety and a feeling of one’s privacy being invaded).
• Delusion of thought insertion: the belief that one’s thoughts are not one’s own but belong to someone else (I personally know someone who, when tripping, said they were thinking in their friend’s voice, as if the friend had inserted themselves into their brain).
• Delusion of reference: the false belief that insignificant remarks, events, or objects in one’s environment have personal meaning or significance, the meaning of which can be negative or grandiose. Psychedelics can trigger this type of delusion based on their meaning-enhancing effects.

Risk Factors for Psychedelic Delusions

Seeking Help for Psychedelic Delusions

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If you experience a delusion in a psychedelic state, and this causes persisting distress, or the delusion itself persists, you can find different forms of help. But it’s important you confide only in those who will treat you with understanding and empathy, not blame and judgement. Options include:

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• Finding an empathetic psychotherapist with training related to psychedelics and/or delusions
• Joining a psychedelic integration circle
• Joining a group focused on addressing extended difficulties related to psychedelics, such as the online support group that Jules Evans runs
• Calling or texting Fireside Support
• Talking with friends, loved ones, or other psychedelic users
• Temporarily abstaining from drugs that may worsen the delusions
• Focusing on leading a healthy lifestyle that enhances one’s mental well-being
• Journalling and meditating, so that one can create some distance between oneself and the delusional thoughts/beliefs

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Delusions can be highly distressing, especially when they’re of the paranoid or persecutory variety. This can feel like a horrifying reality that one is trapped in. Even when delusions don’t necessarily feel scary, they can still be disruptive and lead to interpersonal problems, as in the case of delusions of grandeur. The latter can be especially difficult to get help for, as the person experiencing them may experience an elevation in mood and high levels of self-esteem. So it may seem like there is no problem; in fact, the feeling can be one of all internal problems having been solved.

This is why it’s critical to be aware of the possibility of delusional mental states before jumping into those psychedelic waters. This will give you a better chance of noticing and keeping in check the mind’s capacity to magnify fearfulness or self-importance when it’s profoundly altered.