Introduction
The room suddenly took on a sense of special significance, causing even the most ordinary objects to hold a strange importance that I would not normally attribute to them.
My curiosity was sparked by a diverse range of individuals, occurrences, locations, and concepts that would typically not catch my attention. I did not try to comprehend the situation, yet I sensed a profound significance in it all.
This perhaps feels like an unsurprising similarity. The experiences of psychedelics and psychosis overlap in many ways. Psychedelics have fascinated humanity for centuries, opening us up to altered states of consciousness and profound insights about ourselves and our connection to nature. However, this seemingly obvious link between psychedelics and psychosis has sparked considerable debate and confusion. Previously, some scientists believed them to be variations of the same phenomenon, but now they are viewed as vastly distinct from one another. In this article, I will explore the similarities and differences between psychedelics and psychosis, debunking misconceptions and examining what the science says.
The Historical Perspective
In the mid-20th century, researchers believed that psychosis and psychedelics were intrinsically linked, perceiving them as alternate manifestations of the same experience.
The psychedelic experience was assumed to be nothing more than a temporary psychosis.
Detailed academic papers were dedicated to contrasting the experiences of patients diagnosed with schizophrenia and those who had taken psychedelic drugs. The resemblance between the descriptions led many to believe that psychedelics induced a temporary psychosis, providing a scientific model to study schizophrenia. Attempts were made to identify a common biological factor underlying both experiences, but these efforts proved unsuccessful.However, the 1960s marked a turning point as the unfortunate moral panic surrounding psychedelic drugs began, leading to a decline in psychedelic research. Simultaneously, the field of psychiatry shifted towards a more rigorous focus on evidence-based medicine, which posed challenges for continued psychedelic research. Funding and permissions for research on these substances dwindled, and for a long time, they were largely forgotten by the psychiatric community.
In contrast, research on psychosis continued unfettered, but with a transformed approach. The emphasis shifted towards neurobiological and genetic research, while investigations into childhood trauma and social factors received less attention and funding.
Psychoanalysis fell out of favour due to its incompatibility with the evolving models of evidence-based medicine.
Psychiatry embraced a neurobiological model, seeking explanations and treatments for mental disorders at the level of genes and neurotransmitters.The Current Landscape
After an extended period of inactivity, due to the legal restrictions on these substances, there is a resurgence of research on psychedelics. Johns Hopkins University in Baltimore, Imperial College London, and various other institutions, with a focus on exploring the potential of psychedelic-assisted therapy in treating different mental disorders. In many areas, including the United States and Canada, provisional approval has been granted for terminal patients seeking relief from end-of-life anxiety through the use of psilocybin-assisted therapy. In 2017, the US Food and Drug Administration classified MDMA-assisted therapy as a breakthrough, and trials for Phase 3 have been successfully conducted for individuals with post-traumatic stress disorder. Several studies have also investigated the effectiveness of combining psilocybin or ketamine with therapy for treatment-resistant depression. Additionally, there is ongoing research on the use of ibogaine for substance abuse issues and psilocybin for smoking cessation. Furthermore, there is a growing interest in the potential of microdosing for enhancing creativity and using psychedelic-assisted therapy to help individuals struggling to deal with trauma.
To gain approval from regulators, the medical community, and potential patients, psychedelic research must address its problematic past cultural perception, and prove that psychedelic therapy aligns with evidence-based medicine. This is a challenging task for a group of drugs with a lot of cultural baggage.
As a result, any perceived connection between psychedelics and psychosis is concerning.
Rick Doblin, the founder of the influential Multidisciplinary Association for Psychedelic Studies (MAPS), has proposed that we should stop comparing psychedelics to models of psychosis, as it suggests that:Psychedelic experiences can be dismissed as insane and distorted.
Similarities and Differences
It should be noted that while both psychosis and psychedelics can result in similar experiences, there are significant differences between the two.
The key distinctions lie in the voluntary nature of the experience and the duration.
Generally, psychedelics are taken by choice and their effects only last for a few hours. In contrast, psychosis often occurs without the individual's consent and can persist for days, weeks, or even months. Furthermore, the subjective experiences also differ; past research has observed that hallucinations and synaesthesia (the simultaneous experience of multiple senses) are more intense in those who have taken psychedelics compared to those experiencing psychosis.Some scholars have acknowledged these differences, others have exaggerated the similarities between the two experiences.
While it is common to use psychedelics as a model for psychosis in animals, some scientists argue against generalizing this research to humans. Other researchers have focused on the shared involvement of receptors for serotonin, dopamine, and opioids in both psychosis and experiences with psychedelics. Additionally, there is a suggestion that the initial stages of psychosis share a similar neurobiological state with that induced by psychedelic substances.Although we may acknowledge that the experiences of psychosis and psychedelics differ in significant ways, we can also recognize that their similarities make it valuable to examine them together. Both types of experiences are highly variable and can involve various psychological and physical sensations, such as changes in sensory perceptions related to vision, hearing, and smell, as well as alterations in one's sense of self, such as ego dissolution and depersonalization.
Additionally, both psychosis and psychedelics can elicit a range of emotional responses, including feelings of paranoia, fear, euphoria, and withdrawal.
Science and Culture
There is a significant disparity in the scientific approaches used to study these phenomena. The study of psychosis is currently focused on finding genetic or neuroscientific justifications for the symptoms associated with this condition. On the other hand, psychedelic research has taken a different direction, still incorporating various elements from its earliest investigations dating back over 75 years. This divergence can be attributed to the underlying beliefs and principles guiding each field.
By examining the various research programs focused on psychosis and psychedelics, we can gain a deeper understanding of the differences in our beliefs and goals regarding these two topics. This can also shed light on the distinct approaches taken towards psychosis and psychedelics.
As an example, let's consider what we choose to measure. In the field of psychedelic science, as we said, the focus is often on the concepts of meaning and mysticism. Researchers, therefore, may ask participants about the spiritual significance of their experiences or if they felt a sense of sacredness or unity with the universe. News headlines frequently mention research subjects describing their psychedelic experiences as incredibly meaningful, helping them deal with past traumas or confront upcoming challenges. This contributes to the perception that psychedelic experiences are intense, yet also profound and life-changing.
On the other hand, headlines concerning psychotic episodes tend to highlight the difficulties and distressing elements of the phenomenon, rather than its mystical or unexplainable qualities. This is largely because research on psychosis is primarily concerned with managing symptoms and aiding individuals in their return to daily life.
There is limited interest in exploring the spiritual or symbolic significance of these experiences. As a result, there is a scarcity of research that delves into the qualitative aspects of psychosis and allows individuals to openly discuss both positive and negative aspects, as well as those that are difficult to articulate.
So, psychedelic research recognizes the significance of individual and contextual factors in shaping the psychedelic experience. The concept of "set and setting," which encompasses emotions, expectations, and environment, plays a crucial role in understanding how psychedelics impact individuals. Researchers explore how factors like music and nature influence the psychedelic experience.
In contrast, psychosis research typically overlooks the influence of individual factors on the experience. The focus remains primarily on identifying the causes of psychosis and reducing symptoms, rather than exploring the contextual features that may contribute to positive or challenging aspects of the experience.
It seems obvious then that, due to the disparity of approaches, it may be beneficial to reintroduce some collaboration and exchange of ideas between the two fields.
Debunking the Acid Casualty Myth
The fear that psychedelics lead to widespread psychosis, often fueled by anecdotes of "acid casualties" in the 1960s, has been debunked by population surveys and scientific studies. Researchers analyzing data from large populations found no evidence linking psychedelic use to increased risk of mental health problems, including schizophrenia, psychosis, depression, anxiety disorders, or suicide attempts.
While individual cases of adverse effects can occur, they are rare. Conditions like hallucinogen persisting perception disorder (HPPD), characterized by persistent visual distortions, are often mistakenly attributed to psychedelic use. Studies have found cases of HPPD in individuals who have never used psychedelics, suggesting that other factors may contribute to its development.
Conclusion
The connection between psychosis and psychedelics has undergone significant shifts throughout history. While early researchers believed they were two sides of the same coin, the current scientific understanding recognizes their distinct characteristics. Psychedelic research is experiencing a revival, offering promising avenues for therapeutic applications, and improvements in our understanding of exactly how these substances affect us.
The differences in research approaches shed light on the assumptions and values guiding each field. Psychedelic research often emphasizes the meaningful and transformative aspects of experiences, exploring their spiritual significance and subjectivity. Studies frequently describe participants' psychedelic experiences as among the most meaningful in their lives, aiding in trauma processing and personal growth.
In contrast, research on psychosis predominantly focuses on symptom reduction and individuals' return to functioning. The qualitative aspects of psychosis experiences receive less attention, and research rarely explores their positive or elusive components. The emphasis lies on understanding the causes of psychosis and developing interventions, rather than investigating the contextual features that may influence the subjective experience.
By challenging stigma, addressing misconceptions, and exploring the individual and contextual factors influencing both psychosis and psychedelic experiences, we can pave the way for responsible research and the integration of psychedelics into evidence-based medicine.