Health The Big & Dandy Psychedelics & Mental Illness Thread

[One Thousand Words]

If someone had heart disease and high blood pressure no one here in their right mind would advise them to take cocaine. This woman has only just begun to get her life in order and you are suggesting she takes a mushroom trip just for shit and giggles? It may be fine if the OP even had an idea of how to dose her, or even some psych training to help guide her but instead they are just going to sit around home and get fucked up??

I'm glad I won't have to pick up the pieces if this goes astray, especially if I was tripping

 

[Purpureal]

I'd be interested if anyone could point me towards a written account of a schizophrenic patient taking psilocybin and being worse for having done so.

This is not the only issue though, is it? My personal opinion is, that, if anything, a psychedelic experience can be helpful in the long term for someone suffering from schizophrenia. In extremely poor taste, you could say that it is not likely to make them go any more crazy , while the benefits of going through an experience like that and its potential for healing are probably obvious to everyone in here.

At the same time, if we accept that psychedelics are mind-manifesting, and we also accept that the mind of a schizophreniac contains stuff that is obviously very difficult to work through (given that they were troubled by it enough to seek psychiatric help), the potential for short-term trouble during the experience is obvious.

I was once accompanying a friend diagnosed with schizophrenia while she tripped on LSD. It was very intense for her, but overall, she loved it, and even after several months have passed, was happy to have done it. At the same time, she also ran off away from the group during her trip and was found walking down the middle of the road, being quite loud as well. To clarify, she did not have suicidal intent, and was in good humour, she just did not think of the complications that might arise from such conduct as she was simply too busy taking it all in at the moment, so to speak.

All's well that ends well, it was nighttime and the parameters of said road were such that she was unlikely to be hit by a passing car, but if she ran into a police patrol before being found and returned to the fold, she would have spent the rest of the trip locked up and probably injected with antipsychotics for good measure, followed by a several weeks long stay in a mental hospital (not that it was neccessary, but she had a history with mental hospitals and would have been kept for observation. While being sedated with AP medication throughout, to stymie her rightful indignation at being deprived of her freedom. This passes for modern psychiatry in some places. But I digress.)

This could probably happen to anybody given the right (wrong) circumstances, but I stand by my claim that schizophreniacs are more likely to get into trouble on psychedelics. This has been my experience and it simply makes sense, IMO. This is no reason to treat people with schizophrenia like subhumans and deny them something you would otherwise happily share with them without any second thoughts if it weren't for their diagnosis, but it's prudent to be aware of the danger and take any precautions that might help avoid a train wreck scenario.

 

[any major dude]

Questions like this are always tough for me. While it's obvious you don't want someone to have a psychotic episode, I also feel it's wrong to make the decision for them & shut them out of what could be a really wonderful experience. An analogy that comes to mind is going on a hike up to a bluff or somesuch with an amazing view & not taking a friend with a physical impairment that would complicate the otherwise simple hike. Not a perfect analogy obviously, but it does convey the feeling i get, i think. The conclusion i've ultimately come to regarding these type situations is, provided they aren't on medication that's contraindicated, to make the best information available to the person in question and let them decide for themselves. To do otherwise, i feel, is effectively making a very personal decision for another human. All within reason of course though. Obviously if someone is acutely psychotic then they shouldn't be doing psychedelics or dissociatives, if nothing else just because that isn't a frame of mind in which one is capable of making a thoughtful decision.

I've come across a number of case reports of persons with schizophrenia/bipolar disorder showing up in the ER due to a difficult psychedelic experience, but those are case reports, not scientific studies. People who have such disorders & tripped without ending up at the hospital can't really be accounted for. Also, people without psychosis spectrum disorders can end up in the same situation because of a difficult trip. Does this happen more often for people with schz or bpd? I honestly can't say, haven't ever found any reliable data on the subject. I can say that people on lithium tend to have almost uniformly negative experiences, but most thinking on that is it is a drug interaction, but again, i can't say with certainty.

I work on a secure psychiatric ward with the highest acuity patients in the hospital, and i've been there for a pretty good while now and have yet to see anyone come in because of psychedelic drugs. Seen quite a few patients who have schizophrenia come in after ingesting synthetic cannabinoids, and if that were the drug in question i'd definitely advise against it. Even seen a fair amount of similar patients come in with similar albeit less severe symptoms from smoking cannabis. And i've seen plenty of bipolar spectrum patients come in with stimulant/sleep deprivation psychosis. Seen plenty of patients with various diagnoses+alcohol/benzo/opiate withdrawal as well A friend of mine who works with a similar albeit less acute population has had a number of clients decomp from dissociative & cannabis use as well, but i don't immediately recall him mentioning psychedelics specifically. My speculation is that set & setting are more important than a diagnostic label, not that the latter is to be completely ignored though.

I personally have mild to moderate PTSD and am weirdly asymptomatic when i trip, more so than when sober or stoned. Dunno if this is the case for everyone, and if someone with severe PTSD asked me if i thought it would be a good idea for them to trip my instinct would be to say probably not & i would be very reticent to recommend it even though my experience has been uniformly positive.

My gut feeling is that people with more severe psychiatric issues may be at a higher risk of a bad trip, which could in turn cause a return or drastic increase in their symptoms. But i don't have any hard data to that effect. I certainly wouldn't advise anyone with such a condition to take a psychedelic drug, but i wouldn't physically stop them from doing so either. If they were going to trip, i would suggest they use the utmost caution & dose on the conservative side. However i would give that same advice to plenty of people who don't have a psychiatric diagnosis.

Basically i think that at the HR level, we shouldn't treat people who have or have had psychiatric issues any differently than anyone else. Just give them the best information so that they can make an informed decision themselves.

 

[rickolasnice]

It's well known that the use of psychedelic drugs can bring about a form of psychosis, depression, anxiety or whatever in seemingly healthy people.

This is playing with fire.

 

[Solipsis]

For me that doesn't change anything: the possibility that it might be fine or the condition could even improve in my mind does not weigh up to the possibility that such a condition be aggravated.

Yes people can make their own decisions but that hardly pertains whatsoever to what is wise or not.

In this case we are especially talking about a person who seems to be doing relatively okay now so this projects positively into the future without meddling with it.
Please remind me what it could make it worth taking this risk, instead of discouraging this person?
And there are several levels of discouragement, leaving the choice to someone else but providing the means is still cooperation. If I would consider myself a friend to a person such as the one in this matter I would refuse to help provide or co-participate in a trip and perhaps offer to be a sober trip-sitter if the person is adamant to proceed on his or her own.

I've been in situations where the principle was the same: someone apparently cannot be talked out of doing something bad / irresponsible / potentially bad (I am talking about serious shit here, not some minor thing i.e. someone seeking advice regarding suicide methods especially ones including drugs, and another person seeking my advice as a chemist, at the time interested in tricky stuff).
I found it very hard to deal with but what I did was keep an eye out so that I could step in and prevent someone from making a collossal fuck-up (in the case of this thread that would be eating the wrong kind of mushrooms, or way too much). I still guess that was the most ethical thing to do regarding harm reduction, since preventing something altogether was impossible in those situations I have been in.

I invite those who disagree, fixingahole in particular for now, to address the above question in bold and to elaborate truthfully and clearly on it.

If this is only about the idea that for any schizophrenic tripping would result in a tragedy 100% of the time, then there is no disagreement. I'm sure that it works out some of the time.
It is the risk that I think should be accounted for, a risk that should need no study because it is logical enough: just match up the symptoms of psychedelia, psychosis and schizophrenic delusion. (Otherwise: care to explain why psychedelics can occasionally cause drug-induced psychosis or delirium even in non-schizophrenics ?)

 

[any major dude]

a risk that should need no study because it is logical enough: just match up the symptoms of psychedelia, psychosis and schizophrenic delusion. (Otherwise: care to explain why psychedelics can occasionally cause drug-induced psychosis or delirium even in non-schizophrenics ?)

I mostly agree with you Soli. But a risk that should require no study? Tisk Tisk, precious few things are simple it the realm of psychopharmacology or mental health. I definitely think it should be studied. Granted that might be difficult to do, but I'm almost certain it would yield some useful info, or at least raise some questions we haven't thought of yet.

I also find it a bit prejudicial to say that no one with a certain diagnostic label should ever trip. This type of thing should be considered on a case by case basis.

And lastly I'm generally opposed to absolute statements. In most cases causality is too complex to be adequately addressed as such.
But yeah, I agree it sounds like a questionable decision at best.

 

[kidklmx]

While this might be a very bad idea, what about a true shamanic setting (i.e Peru)? Those people seem to have some information about the human psyche that the western world doesn't (maybe not the right wording, but they have a much greater control of such symptoms without messing with serotonin antagonists), and their rituals seem very consistent in terms of the reactions they produce in people.

I don't exactly know what a shaman goes through in their training, but it does not seem like they become worse nor are they overly introverted like schizophrenics in the western world. Could be that you never hear about the bad side of things, but there is definitely something here that asks for a deeper look

That, at least for me, is a case in proof for psychedelic treatment of schizophrenia. Why is it that western research has been so unsuccessful? I think because they want to turn schizophrenics in to regular people, and IMO that's not the right approach.

 

[rickolasnice]

^ Or..

http://www.nhs.uk/Conditions/Psychosis/Pages/Symptoms.aspx

Psychosis normally comes hand in hand with self damaging beliefs causing anxiety, depression, paranoia, etc.. or just general lack of being able to cope with reality..

 

[kidklmx]

Yeah but you can ask the question, where does that self-damaging behavior come from? Does it really have to be schizophrenia, or is it just the social troubles schizophrenics have in our society? Like I said, shamanism seems to deal with schizophrenia fairly well (better than here at least)

Don't forget that a lot of people get demonized for just being different: women, homosexuals, people of a different ethnicity, etc. Mental illness fits right in there, though not without nuance. Yes, there is something "wrong" with them (even me, I'm depressed to the point where I'm non-functional. I'll get there though ) but does that mean they need to either be put away/their behavior "fixed" in some way or does that mean they need to find some function? I think schizophrenics could be very valuable in psychotherapy for example.

It's hard to cope with reality when, according to the general public, your form of reality is false. Even at a young age when you're probably not even diagnosed yet, you're treated differently because you might react differently. You're just not understood, and living like that is tough.


EDIT: None of this has to be true though, it's something that really needs research IMO

 

[kidklmx]

That research is severely lacking though (see Dondante's post), and I don't think we can even begin to comprehend the results of far more scientific research. First we need to really understand the transformation of matter to reality and such.

And there is also the other side of the coin, Shamanism/Psychedelics might just give their experience a context, which could be somewhat useful for coping, but will never let them become "useful" to us or anything. A delusion within a delusion (we must go deeper!) of sorts, and it wouldn't allow them to integrate with society.

 

[Solipsis]

I mostly agree with you Soli. But a risk that should require no study? Tisk Tisk, precious few things are simple it the realm of psychopharmacology or mental health. I definitely think it should be studied. Granted that might be difficult to do, but I'm almost certain it would yield some useful info, or at least raise some questions we haven't thought of yet.

I also find it a bit prejudicial to say that no one with a certain diagnostic label should ever trip. This type of thing should be considered on a case by case basis.

And lastly I'm generally opposed to absolute statements. In most cases causality is too complex to be adequately addressed as such.
But yeah, I agree it sounds like a questionable decision at best.

Well I didn't say it need not be studied, I meant that before we ever get to see any results (which as is previously pointed out would be extremely hard to pass through an ethics board) it is best to use extreme caution and use the logic I suggested for lack of better evidence. If you approach it the opposite way (i.e. assuming harmless until proven harmful) that is playing with a person's life and mental stability and again I must refer back to my main question: how is that worth it?

Also, people with psychotic issues only make up a part of the diagnoses. I probably have a label myself but it doesn't have anything to do with keeping your sense of reality in check. I find it okay to keep tripping (well at least when I am not on mirtazapine for sleep and stuff which I went on recently, and it is not really helping) because it seems I have a very resilient sense of what is real and what is not and I have checked this with people around me including impartial professionals. If that wasn't the case I would or should feel like it is quite dangerous to exacerbate. Many drugs can be destabilizing (a stim binge is probably also quite a bad idea in such a case) but psychedelics have distortion of sensory data, sense of reality and sense of self virtually as a main action. It would be like a person with depersonalisation using dissociatives or something.

And trying to question the definition of madness a la Foucault appears to me like grasping at a defense by destabilizing tangent premises. If a person is a bit 'out there' and others would have him committed but this person refuses and has no discernable reasons why he/she would be a danger to himself or others... yes then taking psychedelics would be a complex question, as complex as whether this person is mentally ill or not.

But for the sake of argument I assume in this case that if the premise is given that the person in the OP is a schizophrenic who had severe coping issues then it is not really anymore about the validity of the ideas / theories / thought patterns of this person but about the apparent fact that they make this person unable to cope with life. Then it is not about madness but dysfunction and not about psychedelics provoking madness but rather the ensuing of this dysfunction (or risk thereof).

 

[any major dude]

fixingahole: the instances you cited were case studies, different from research, though the short term results did seem positive. And even if it were research, n=12 isn't nearly enough data to go making broad recommendations on. Plus it was with children with varied diagnoses, whether that would translate to adults with schizophrenia/bipolar disorder/PTSD/etc would be unknown.

Regarding shamanism: I'm not terribly well versed on the subject, but it's arguable that the cultural milieu in which it generally occurs is different enough from our western sensibilities to be non transferable. Some shamans may meet criteria for schz etc, many would not. Many are just guys wuth extensive knowledge (accurate or otherwise)of local flora. Many are also charlatans & hucksters, and some are surely helpful as well. But we should be careful to avoid the soft bigotry of the "noble savage" stereotype, as well as completely dismissing folk & indigenous knowledge.

Schizophrenia is a somewhat loose symptom cluster at best. In the next few years current diagnostic criteria will likely have fallen by the wayside in favor of more accurate genetic & biological models that will be more accurate & useful. The term schizophrenic may someday be viewed like we view words like retarded. This makes it even more difficult to categorically say whether or not someone should have the option of taking a drug.

Soli: definitely agree with regards to the bit on dysfunction. In our society you can be as mad as you wanna be as long as you can pay your bills & stay outta the jail. However, people with more severe psychiatric diagnoses hardly have a monopoly on post trip dysfunction. I'm sure most if not all of us know someone who had a difficult time for a while after a hard or bad trip. Many of us know someone I who's ended up in the ER & was possibly sectioned for a bit due to a psychedelic experience gone awry. Some of us have had these experiences personally. And I have yet to come across any hard data or anecdotal evidence that 5-HT2a psychedelics are are any more likely to cause this in those with a diagnostic label than those without. I have however, come across such info for stimulants, dissociatives & cannabinoids. Thusly it seems the most appropriate advice in the interest of both HR & cognitive liberty is to give them the same advice as a psychedelic naive person. And as per general HR, we're not here to advocate for drug use, but to make sure those using drugs do so as safely as possible. Which is basically what the OP asks anyway.

And clearly all this is to be taken within reason as well. If a diabetic friend of mine is gonna eat a donut, I'm not gonna be the sugar police. But if he's chowing down a box of them of course I'd say something. Things are rarely black & white. It's all about degrees. Someone with a traumatic past who has ended up with a schz diagnosis& recovered now functions well in daily life wanting to try mushrooms in a safe
Environment is much less risky than an acutely manic teen dropping some mystery blotter in the parking lot outside a dubstep show.

Clearly that example is a bit extreme but not too unrealistic, hopefully.

I also want to make it clear I'm not encouraging people with severe psychiatric problems to take drugs. I just don't like to see things taken as a given sans evidence. I'm a bit of a stickler for empiricism I suppose. If this were to be studied it would likely have to take the form of a broad survey of psychedelic users as opposed to an RCT. Which is less than ideal from an empirical perspective, but much less tricky ethically. In fact there may already be some data out there that could be analyzed to such an end. I may look into this if I ever get some free time.

Sorry for the typos. Mobile is still a little buggy.

 

[any major dude]

Is 'drug use' intrinsically harmful? Does Nancy Reagen own this forum? Is her message 'the reasonable approach'? I've found myself amongst sharks. I'll leave you prohibitionists to it. Discourage use at all costs? Deny knowledge of any benefit and dismiss personal experience in favor of ignorant conjecture based upon knowledge of "psychotomimetic" labelling by governemnt scientist in the 1950's.

Just say no... to trolling...

And everyone knows the psychotomimetic model was dropped before you were born. Please don't be needlessly hyperbolic. One of the most common sayings here on BL is YMMV because we readily acknowledge that one persons experience may or may not translate to others. Do psychedelics help some people? absolutely. Are they for everyone? Clearly not.

 

[rpm]

Perhaps we should all read how to deal with (supposed) trolls.

 

[any major dude]

No, calling a bunch of BL PDers Nancy Reagan & prohibitionists is trolling. Everyone's discussing this, whether in agreement or not, without insulting each other. Except you. Clearly you're entitled to your opinion, and we encourage healthy debate, but not insults & ad hominem BS. Please keep things on topic & civil. Repeated rule breaking warrants infractions.

Back on topic, yes there is some evidence to support your claim, but it is old & sparse. I think we should reserve judgement, especially in an absolute fashion, until there is more & better data.

 

[rickolasnice]

I really don't think he's a troll.. His view isn't even wrong, so to speak..

I'm sure most people in this thread are not claiming it will definitely end in disaster? Simply giving their opinion that potentially it could be seriously harmful. I've seen what happens when schizophrenics take psychedelics. They start talking about how the universe is just a smoke box and having deluded beliefs that a boy they have a crush on that they hardly know is destined to be their lover, that they are just like Adam and Eve.. and bombarding them with creepy messages telling them so. Often talking incomprehensible gibberish or of his latest obviously very deluded thoughts..

This guy was always a bit nuts but it went really fucking bad when he took psychedelics or smoked cannabis.. He was sectioned and his condition got a lot better.. he come out.. took some drugs and went loony again.. last i heard he was still locked up on some psyche ward.

 

[kidklmx]

Regarding trolls: you just don't feed em. No need for a whole page (seriously, that much attention to not feeding trolls? looks like they succeeded)

Anyway, yeah, he was just overly defending his view. The term troll has been taken way out of context nowadays, anyway. A real "troll" goes on internet-sites for the sole purpose of making people angry. I don't think he was doing that.

And great post, Any Major Dude. I guess you just finished the thread

(P.s, Tapatalk works wonders if you have a smartphone)

 

[steve022]

that could be I mean mental illness really is just a different way of perceiving the world

 

[Solipsis]

Again, disorders should not be diagnosed with people who just have a different outlook, the definition relates to dysfunction. I think you can only say that someone has dysfunction of mental faculties if their symptoms cause them to be unable to do things in life that they either want to do, that need to be done to make your life sustainable (such as say: eating enough), and the most difficult one: that makes a person behave in a way that is legally and socially reasonable and acceptable. For example if a guy is waving his junk around in front of children because that is his idea of freedom, it goes beyond quirks or outlooks.

An issue is that people don't typically visit a psychiatrist if there is nothing wrong with any of the above things. And once you are there it is assumed by pure logic that there is something that needs fixing, an ailment. They categorize you the best they can and treat you accordingly.
However there are difficult situations where the person in question disagrees entirely, for example if a teenager is sent by his/her parents for being problematic in a certain way. There can be misunderstandings and misdiagnoses.

I have said this before in this thread: what I can take from the OP makes me think that this is about some who is schizophrenic with a history of symptoms that go beyond "different ways of perceiving the world" because it results in problems for the person.

We can have an antroposophic argument about this but when it comes to managing a mismatch between a person who is markedly different in a certain way (illness or not) and the rest of the world, it is just quite difficult to expect the rest of the world to change. Even if our ideas of what is mentally healthy are completely thought up by society and even if there is no objective truth to that... it changes very little about what it means to function, and the fact that dysfunction typically leads to coping mechanisms and potentially incidents.

By the way, this is coming from someone who is diagnosed and who has a complex set of labels combined to make that diagnose.
So I am not representing the healthy part of society here.

 

[webbykevin]

Questions like this are always tough for me. While it's obvious you don't want someone to have a psychotic episode, I also feel it's wrong to make the decision for them & shut them out of what could be a really wonderful experience. An analogy that comes to mind is going on a hike up to a bluff or somesuch with an amazing view & not taking a friend with a physical impairment that would complicate the otherwise simple hike. Not a perfect analogy obviously, but it does convey the feeling i get, i think. The conclusion i've ultimately come to regarding these type situations is, provided they aren't on medication that's contraindicated, to make the best information available to the person in question and let them decide for themselves. To do otherwise, i feel, is effectively making a very personal decision for another human. All within reason of course though. Obviously if someone is acutely psychotic then they shouldn't be doing psychedelics or dissociatives, if nothing else just because that isn't a frame of mind in which one is capable of making a thoughtful decision.

I've come across a number of case reports of persons with schizophrenia/bipolar disorder showing up in the ER due to a difficult psychedelic experience, but those are case reports, not scientific studies. People who have such disorders & tripped without ending up at the hospital can't really be accounted for. Also, people without psychosis spectrum disorders can end up in the same situation because of a difficult trip. Does this happen more often for people with schz or bpd? I honestly can't say, haven't ever found any reliable data on the subject. I can say that people on lithium tend to have almost uniformly negative experiences, but most thinking on that is it is a drug interaction, but again, i can't say with certainty.

I work on a secure psychiatric ward with the highest acuity patients in the hospital, and i've been there for a pretty good while now and have yet to see anyone come in because of psychedelic drugs. Seen quite a few patients who have schizophrenia come in after ingesting synthetic cannabinoids, and if that were the drug in question i'd definitely advise against it. Even seen a fair amount of similar patients come in with similar albeit less severe symptoms from smoking cannabis. And i've seen plenty of bipolar spectrum patients come in with stimulant/sleep deprivation psychosis. Seen plenty of patients with various diagnoses+alcohol/benzo/opiate withdrawal as well A friend of mine who works with a similar albeit less acute population has had a number of clients decomp from dissociative & cannabis use as well, but i don't immediately recall him mentioning psychedelics specifically. My speculation is that set & setting are more important than a diagnostic label, not that the latter is to be completely ignored though.

I personally have mild to moderate PTSD and am weirdly asymptomatic when i trip, more so than when sober or stoned. Dunno if this is the case for everyone, and if someone with severe PTSD asked me if i thought it would be a good idea for them to trip my instinct would be to say probably not & i would be very reticent to recommend it even though my experience has been uniformly positive.

My gut feeling is that people with more severe psychiatric issues may be at a higher risk of a bad trip, which could in turn cause a return or drastic increase in their symptoms. But i don't have any hard data to that effect. I certainly wouldn't advise anyone with such a condition to take a psychedelic drug, but i wouldn't physically stop them from doing so either. If they were going to trip, i would suggest they use the utmost caution & dose on the conservative side. However i would give that same advice to plenty of people who don't have a psychiatric diagnosis.

Basically i think that at the HR level, we shouldn't treat people who have or have had psychiatric issues any differently than anyone else. Just give them the best information so that they can make an informed decision themselves.

here here !