“‘A sense of special significance began to invest everything in the room; objects which I would normally accept as just being there began to assume some strange importance.’
‘I became interested in a wide assortment of people, events, places, and ideas which normally would make no impression on me. Not knowing that I was ill, I made no attempt to understand what was happening, but felt that there was some overwhelming significance in all this …’
The first of these quotations is from an individual describing a psychedelic trip they took after taking peyote. The second is a person describing an experience of psychosis. While rarely looked at together today, experiences of psychedelics and psychosis share a lot of subjective territory. In the past, some scientists considered them to be different versions of the same experience. However, today, experiences of psychosis and psychedelics are seen as radically different. Examining the journey from that past approach to the current perspective reveals a great deal about our assumptions and values, and the limits and biases of the current day.
. . . While we might accept that experiences of psychosis and psychedelics are different in important ways, we might also acknowledge that their phenomenological (‘what it’s like’) similarities make them worth looking at in tandem. Both kinds of experiences are highly variable, but can involve a number of overlapping psychological and physical sensations, including changes in sensory experiences related to vision, hearing and smell, as well as one’s sense of self, as ego dissolution and depersonalisation are common. A variety of emotional responses are also common across psychosis and psychedelics, including feeling paranoid, scared, euphoric or withdrawn.
Examining how a science approaches its targets of investigation can be highly revealing of assumptions and values guiding the field . . .
Take what we choose to measure as an example. Psychedelic scientists often focus on meaning and mysticism, asking participants how spiritually significant their experience was, or whether they had an experience they ‘knew to be sacred’ or if they ‘felt at one with the universe’. Headlines frequently refer to research participants describing their psychedelic experiences as among the most meaningful in their lives, helping them cope with past traumas or face impending ones. This contributes to a view of psychedelic experiences as intense, but also meaningful and transformative.
In contrast, headlines related to psychotic experience focus not on the magical or ineffable qualities but rather the challenging and fearful aspects of the phenomenon. In part, this is because research related to psychosis has little interest in the meaning or mysticism that may arise within the experience. Instead, research overwhelmingly focuses on how to reduce symptoms and help individuals return to work or school. Research that looks closely at the qualitative aspects of experiences of psychosis, and makes space for individuals to share positive, negative and elusive components of such experiences, is quite rare.
Inevitably, these different focal points shape what scientists, and the public, see when thinking about psychosis and psychedelics. Psychosis often brings to mind delusions and hallucinations, characterised as symptoms that ought to be reduced at all costs. In contrast, the hallucinations induced by psychedelics may be seen as a way to access remarkable, life-changing experiences.
Another example can be found in the kinds of causal variables we look at in relation to psychosis and psychedelics. Research related to psychedelics expresses a considerable amount of interest in how experiences are impacted by various factors particular to the individual and the context they are in. The notion of ‘set and setting’, popularised by Timothy Leary, is widely accepted in psychedelic communities; it refers to how emotions, expectations and environment can have an enormous impact on psychedelic experiences. Ongoing research focuses on how factors like music and nature can influence psychedelic experiences.
No parallel concept similar to ‘set and setting’ exists in psychosis research, which continues to search for the elusive physiological substance-M. Questions related to how psychosis is shaped by beliefs, culture, environments or relationships are rarely asked within psychiatry. Instead, the focus is largely on what causes psychosis and how it can be reduced, rather than what contextual features might give rise to more difficult or more positive experiences of psychosis.
. . . Perhaps the most alarming contrast is between how we currently respond to those having challenging experiences as a result of psychedelics or psychosis. Underground psychedelic communities have been developing forms of ‘psychedelic first aid’ for decades, approaches characterised by warmth and compassion, and that prioritise safety, comfort and nonjudgmental regard for someone having a bad trip.
. . . Such a picture contrasts sharply with the usual responses to those having a challenging psychotic experience. Those experiencing psychosis, or other mental health crises, are often met with restraint, seclusion and, far too often, violence. Police with little training are often sent to respond with force to those in mental distress – very rarely, those in crisis are supported by peers who know what it’s like and what might help, or even professionals who have been trained in empathic and nonviolent forms of care.”
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