Some Psychedelic Users Are Unbothered by HPPD (and Might Even Enjoy It)

Hallucinogen persisting perception disorder (HPPD) is a condition – characterised by chronic visual distortions – that can be triggered by psychedelics. It is considered a rare risk of psychedelic use, although the actual incidence of it is unknown (studies are limited and offer differing incidence rates). Many psychedelic users experience post-trip visual changes, but these may be minor, and even when they’re more noticeable, they might not last for very long.

People’s reactions to developing HPPD differ. Some people experience intense visual changes, leading to psychological distress and sometimes disruptions to normal functioning (e.g. inability to drive or concentrate on everyday activities) because of the visual effects. It can also co-occur with other conditions, such as anxiety, derealisation (where the world doesn’t feel real), depersonalisation (where you feel unreal and detached from your body, thoughts, memories, and emotions), and PTSD. The Perception Restoration Foundation was set up to help people struggling with HPPD through research, support, and harm reduction.

For most people, the experience of post-trip visual changes after taking psychedelics is felt to be slightly distracting, neutral, or even enjoyable. It is this latter group of people I want to focus on. Hearing the stories of people badly affected by HPPD – and trying to find ways to help them – is crucially important. But when discussing the risks of psychedelics, it’s also necessary to give a broad and balanced picture of the post-trip extended effects that may occur. While persistent visual changes after a trip sounds inherently concerning – a clear sign that something has gone wrong with the person’s brain – people’s subjective experiences tell a different story. 

(For clarification, HPPD technically refers to post-trip visual changes that are a cause of distress and/or impairment to functioning, thus making it a disorder. Using HPPD to refer to neutral or positive experiences related to these changes may, therefore, seem to confuse matters. However, I recognise too that HPPD is colloquially and more commonly used to stand for persistent visual distortions after taking psychedelics, which may or may not affect the person’s quality of life. So I will use HPPD to cover extended visual changes, in general, for the sake of ease.)

Some people aren’t bothered when, after a psychedelic experience, they continue to experience visual effects (e.g. halos around objects, visual snow, trails, geometric imagery, flashes of light and colour). According to a web-based questionnaire involving just under 2,500 respondents, around a quarter of those surveyed experienced at least one persistent visual change. 4% found the symptoms distressing or impairing enough to seek medical help. But many of those who didn’t seek medical treatment will be able to tolerate the visual disturbances, sometimes because, as writer Ed Prideaux says in an article for the BBC, “not everyone is necessarily bothered if it happens to them”.

The fact that some people don’t mind these persistent changes may seem strange, especially in light of fears surrounding ‘flashbacks’, a term originating in the 60s, standing for the re-experience of a psychedelic trip, without having taken the drug. As Prideaux points out:

Public perceptions changed in the late-1960s, and stigma grew. Based in the Haight-Ashbury district in San Francisco – the epicentre of LSD culture on the American West Coast – the psychiatrist Mardi Horowitz coined the term "flashback". This word would take on a life of its own in lexica and competing propagandas around psychedelic drugs. Diane Linkletter, the daughter of a famous TV host, killed herself in the throes of an alleged LSD flashback, making national news (however, the claim that drugs were responsible for her death is false, according to the fact-check service Snopes).

Majić has found that many people who report HPPD in his clinic do not, on close examination, really meet criteria for the disorder: the kinds of visuals they consider aberrant may be normal things like floaters and light static in the dark, to which they're now more attuned since their trip and the surrounding anxiety.

• The effects are mild enough that they are not likely to be a cause of distress or impairment.
• The effects only manifest on occasion, which would make them fall under the category of ‘Type-1’ HPPD: episodic flashback experiences. For some users, so long as the symptoms don’t happen that often, aren’t intense, and are related to controllable triggers (e.g. sleep deprivation, cannabis, stress) they don’t seem worth worrying about.
• Someone could find ‘Type-2’ HPPD – constant or recurrent visual symptoms – more tolerable than Type-1. Type-2 could be easier to adjust to. The visual effects simply become the norm – expected and predictable – rather than surprising the person now and again.
• The effects are noticeable, but they only last for a few weeks; so they don’t last enough to become a cause of concern or distress.
• The effects are noticeable and have persisted for longer than a few weeks, but they don’t cause psychological distress because the user, for one reason or another, doesn’t find them distressing. One reason could be that they educated themselves on the possibility of experiencing HPPD, and didn’t buy into the stigma surrounding it, so they didn’t view themselves as ‘damaged’ or ‘going insane’.
• The person was previously distressed by their symptoms, but they have learnt to live with them and not feel anxious about them, perhaps after realising (or learning) that being anxious and obsessive about the symptoms can worsen them.

Positive Experiences Related to HPPD

Even more surprisingly, some psychedelic users enjoy the experience of HPPD. Most people are comforted when taking psychedelics by the knowledge that the trip will come to an end. In fact, one of the most distressing thoughts one can have on psychedelics – leading to a bad trip – is that the experience will never end. The idea of being stuck in this psychedelic space can feel distressing. However, depending on how the HPPD symptoms manifest, and to what degree, some people can find them enjoyable. They can feel like a ‘free trip’. As Ed Prideaux writes in an article for Ecstatic Integration:

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It’s been noted since the earliest ‘flashback’ literature, though, that these symptoms can be entirely benign. Type in ‘enjoy HPPD’ on Reddit, and you’ll find quite a few results; likewise take a look at r/HPPDCirclejerk or r/HPPDPositivity, which (while relatively inactive) were founded to counter the hypochondria and negativity that can surround and dog the condition.

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Let’s take a look at a couple of these positive reports about HPPD from one Reddit thread. The original poster said, “Besides dissociation when having those, I learned to enjoy and use to pass some time when I’m bored. It’s just stare something that the show begins. I have this since late 2020 or 2021. I feel that after I did MDA two months ago, it got more intense but that don’t really bothers me. I learned how to live with it and kinda “enjoy”.” In response to the post, a user said, “im able to keep myself entertained for hours if i have to, and its been enjoyable for me if im around people who are tripping, because im experiencing the same thing”.

I once got chatting to someone at a party who has been living with HPPD for years. He still had noticeable symptoms. However, he talked about how HPPD helped enhance his creativity when painting. It allowed him to see more variations of colour, thereby providing more inspiration for his art. Nevertheless, Prideaux rightly stresses the following point:

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Even if one does enjoy these visuals, however, and would rather they stayed, there’s no guarantee that this attitude will last over the long term. A recent study asked individuals just four weeks after a trip to see how they felt about their lingering visuals. Most were fine with it, but give it time, I say: this shit gets old.

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Indeed, as some users commented in the Reddit thread referenced above: “For the first month I loved the closed eye dmt visuals lmao”. This might be enjoyable for a month, but what if this persists for years? Someone else wrote, “It got pretty tiresome not being able to choose to have them or not after like six years. After ten years it became very tiresome. I can kind of enjoy it on rare occasions but overall no.” In summary, there will be different reasons as to why someone might view their HPPD in positive terms:

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• The visuals are aesthetically appealing rather than disturbing (it’s possible to experience unsettling visuals; one case study looked at a patient who abused LSD and thereafter experienced visual hallucinations of faces, reliably triggered when they looked at trees).
• The visuals are mild, making it more likely for them to be enjoyable than distressing.
• The HPPD symptoms last for a short enough period of time to be enjoyable and not long enough to become tiresome.
• The visual effects (e.g. colour changes and geometry) become a source of artistic inspiration.
• One appreciates the visual effects of psychedelics and finds that they enhance the aesthetic aspect of one’s environment, which may be especially true in natural surroundings.
• If the HPPD symptoms are somewhat under one’s control (i.e. related to one’s lifestyle and current physical and mental state), then one may decide to make the most of them when they occur. Such users may feel safe in the knowledge that the visuals will pass, reduce in intensity, or go away based on actions taken.
• If the symptoms seem to be clearly improving over time, and in a matter of weeks or months, then one may come to expect a full recovery from the condition. This can also make it easier to enjoy the visuals that remain.
• The persisting visuals may be valued for reminding the person of a profound psychedelic journey they had, which may help with integrating that journey.

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It might also be possible to find some other silver lining in the symptoms; for instance, they can act as an indication of one’s mental health. This doesn’t make them necessarily enjoyable, but it means they might have some pragmatic value. As one Redditor said,

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They've become a gauge for me to tell how stressed or fucked up I am. The spicier the visual snow, the more stress I'm putting on my system in some shape or form. I found that by integrating it into my bio feedback, it's now more useful than it is burdensome.