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Comment by wincy | Hacker News Reader

I’m really worried about the subset of the population with preexisting mental disorders such as manic depressive disorder, schizophrenia, and depression who will suffer a psychotic break from the use of these substances. Maybe I’m wrong, but from what I’ve heard and read it seems like there’s no way to know what will happen until you try it. A certain percentage of the population goes to hell in the most literal sense of the word possible. Anecdotally, the people I personally know who have tried psychedelics (maybe 6 or 7 people, all who did no know one another) seem to have a weird mental frailty to them, where because their ego disappeared(?) briefly and psychedelics were allowing mental connections that wouldn’t have arisen without psychedelics, they begin to question everything, almost like a rebuilding of their fundamental axioms from scratch. There’s also a strange fervor for others to try it, even from people who have had bad trips.

Joe Rogan had Michael Pollan on recently[0], who wrote The Omnivores Dilemma and a new book How To Change Your Mind[1] which talks about the benefits of hallucinogens. They also briefly talk about the psychotic breaks some people will experience as a result of widespread use and shrug it off like it’ll be fine. Aldous Huxley wrote a book about his use of mescaline called Doors of Perception[2] which felt almost unintelligible and very strange to me as a person who has not (and will not, as my mental health is great but I’m certain I’m at risk of a psychotic break from hallucinogens due to family history) done psychedelics.

[0] https://m.youtube.com/watch?v=tz4CrWE_P0g

[1] https://www.amazon.com/Change-Your-Mind-Consciousness-Transc...

[2] https://www.amazon.com/Doors-Perception-Heaven-Hell/dp/00617...

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If it helps, here are a couple of things that you might consider:

- you likely know a lot of people who actively or in the past were experimenting with psychedelics, but you don't know that you know them because it is socially taboo and their experiences aren't super relavent to how you are interacting with them

- if you can accept that idea, then you might also consider that given a larger population of people who've tried it with few ill effects your anecdotal sample might not be an accurate representation of the psychedelic experience.

That second point would reconcile the "strange fervor for others to try it, even from people who have had bad trips."

There are indeed plenty of people mental health issues floating around, and while it's true that you may or may not know if these drugs will trigger a larger episode, that kind of life altering aspect of psychedelics not very common in my experience as a person who knows hundreds of people who have worked or played with these substances.

Those ideas are also based in my anecdotal experince, and perhaps it comes from a willingness to question some "fundamental axioms from scratch", but at the same time maybe that's a) not always a bad thing to do from time to time, and b) if your fundamental axioms are good there is no reason that you won't come back to them.

I have permanent visual disturbances and suffered long-term panic attacks and anxiety as a result of psychedelic use. Things got better over time, but not completely back to normal. I'm not advocating for the continuation of our current legal strategy, but I feel like these drugs need to come with strong cultural wisdom about their appropriate use and potential for abuse.

Anyone who's been in a psychedelic community for long(stoners, deadheads, etc) knows at least a few people who have been temporarily(1 day - 1 year) or permanently fried from having experienced one or many trips. I feel like there is often a backlash against our regressive legal approach which tends to accentuate the positives and diminish the negatives but really we need information. These drugs can permanently change your personality in some ways that will generally not be seen as positive. Yes, they can have many good effects but that comes with a small risk of extreme side effects.

Are these people "fried" because they used those substances, or because of how they used them, or how they viewed, integrated (or not-integrated) their experiences?

A visual distortion is a good example. When experiencing a visual distortion, it is possible to feel anxious about the appearance of such a distortion, or instead one could be indifferent to it, or even enjoy and welcome it. It need not be negative.

More research is certainly needed on the negative experiences people sometimes have with psychedelics (so far, most of the research has focused on the positives), but I have a strong feeling that how people approach their experiences, what they expect to happen, and how they interpret what happens plays a very critical role on whether the experience is positive or negative for them. This is the old "set" (or "mindset") part of "set and setting" that's critically important for their constructive use.

Also, it may be possible to work through any anxiety or negative effects one experience with a therapist. Panic attacks and anxiety, for instance, are things that therapists tend to be actually really good at treating.

Depends on the distortion. A visual distortion means that you aren't seeing things as they really are. That could be problematic for your ability to drive, or to ride a bike, or any number of other activities. You could be indifferent to that, but it could still be a genuine problem for your ability to function.

Even without visual distortions, none of us ever see things as they are :)

As a fun fact, you can drive on LSD if you’re experienced with psychedelics and know you can trust yourself, at least under doses <150ug. Absolutely not recommending it to anyone, but the visuals don’t really get in the way. (I’ve only driven on acid once, when I witnessed a really, really bad skateboarding accident and had to rush a stranger to the ER).

IME most people handle psychs fine, some can handle practically anything, and some will lose connection to reality and basically forget how rational thought works on an eighth of mushrooms. There’s little indicators that have given me an idea of how someone might react, but you never know for sure. Thus why the advice to have a trip sitter is always given - personally I’ve never needed a trip sitter, but I’ve seen people who absolutely did.

"you can drive on LSD if you’re experienced with psychedelics and know you can trust yourself, at least under doses <150ug. ... Absolutely not recommending it to anyone, but the visuals don’t really get in the way."

It's not just the visuals that are the problem. Temporal distortions are common -- you can feel like time has stopped or slowed down or sped up or gone backwards. Also, you might get disoriented or confused -- not understanding where you are or what you're doing or how a steering wheel works while you're on the freeway is probably not the wisest or safest thing to subject yourself or others on the road to. Or you might get irresistibly entranced by a fleck of paint on your dashboard, which could look like a whole animated world to you, while you should be keeping your eyes on the road, etc, etc, etc.

You know how there's a warning not to drive or operate heavy machinery on some medications? Well, that warning should be on psychedelics, only times 1000.

Visual disturbances affected my ability to read books for years. I am no longer a speed reader thanks to psychedelics. For years after my first big trip, walls breathed and floor tiles became 3d. It is hard to be indifferent to such things.

My set going into the trip was that I was expecting to have a great time with friends. I was young and very positive towards psychedelics. I did not have a 'bad trip'. The effects came later.

Yes, I experienced being 'fried' for a couple of years after excessive MDMA and LSD use. My experience mirrors yours.

MDMA is neurotoxic though. It's strange if only hallucinogens triggered problems in the other poster. LSD is not as far as I read.

Out of curiosity do you have colorblindness?

Nope(sorry I'm OP but using my home account). I'm nearsighted. I was eventually diagnosed as slightly bipolar(agitated depressed), but that was after my experience with psychedelics. FWIW, I believe the life changing experience was caused by something other than LSD. A friend got tie-dye blotter from the Grateful Dead parking lot around '90. I took two tabs. It lasted around 21 hours, which is odd for LSD. Definite LSD-like effects(time dilation, huge trails, tunnel-vision in the early stages...). It was blotter though, so it limits the number of RCs it could have been.

Also I ended up with essential tremor, ticks, and restless leg syndrome. That runs in my family though. I probably have mutations in my dopamine system.

"I'm really worried"

The first rule of psychedelics: don't worry.

How to not worry? Relax. Keep the body at peace. Be simple. Stay in the heart (stay with how you're feeling, not just with what you're seeing/experiencing). Let go. You cannot lose yourself because you are always yourself. Be grateful for the incredibly valuable experience you're having, even if it's difficult.

> I’m really worried about the subset of the population with preexisting mental disorders such as manic depressive disorder, schizophrenia, and depression who will suffer a psychotic break from the use of these substances.

I honestly don't think we have the capacity to test existing psychiatric medication to the extent that we can provably demonstrate that over the long term, psychiatric medication + negligence (or simply, variance - controlled lab conditions versus real world) in mental health care is not a direct cause (more nicely, a contributory factor) of psychotic breaks for patients.

So yes, it's a risk, but it's not one that doesn't currently exist with what we do now.

>"mental frailty...they begin to question everything"

As opposed to blindly "believe everything"? I would say the ability to question everything is evidence of a strong independent adult mind. The ability to just believe everything you are told isn't really "frail" (which I associate with old age and wisdom), but still weak in a childlike sense.

Over time people build up useful heuristics. There is a difference between questioning authority vs questioning why tuesdays exist and if maybe it's sunday for dogs.

>"questioning why tuesdays exist"

I don't see a problem with this line of questioning. There is lots interesting to consider there. Just some stream of thought:

What does tuesday mean anyway, why do we have weeks, why 7 days per week, what is the exact definition of day, could there be planets without "days", do dogs recognize a weekly cycle, would they if "freerunning" without human companionship, what about wolves who "howl at the moon", does that mean they recognize the lunar cycle, in that case maybe they also mentally divide it up into subsets greater than a day but less than a full month, how could we study wolf behaviour to try to figure this out, why exactly do I feel like there is a difference between sunday and tuesday, just because one is during the weekend or something more, do wild packs of wolves/dogs take regular days off from hunting/etc, what do they do in their free time?

> why do we have weeks, why 7 days per week

Because it is useful to divide up things into increments. 7 because there are 7 visible celestial bodies visible to the naked eye. Which the names derive from.

> What does tuesday mean anyway

Mars's day

> what is the exact definition of day

A singular rotation of the planet. Also known as a sidereal day. Or more simply put: sun goes up, sun goes down.

> could there be planets without "days"

Yes, these are known as tidally locked. Some planets have long days. Venus has a longer day than year (rotation of planet around parent star)

> I don't see a problem with this line of questioning. There is lots interesting to consider there.

Yes, but answers are also reasonably found. Don't just stop and think, but also seek. That's why we think differently about the person who is like "wow man, what even is Tuesday" and the person that discussed the historical reasoning and mythos that led to the naming of Tuesday and why having a seven day week is so pervasive throughout the world, leading back to ancients looking up at the sky (which was better than what most of us see, considering light pollution). Sometimes things are extraordinary and sometimes they are mundane.

There's a lot of usefulness into relying on historical knowledge. That's why we advanced so far. And by finding the breath of our current understandings you will find new and deeper questions.

Tldr: don't just question, find answers.

>"Yes, but answers are also reasonably found

You just picked the easiest questions and left out the rest...

>"the person that discussed the historical reasoning and mythos that led to the naming of Tuesday and why having a seven day week is so pervasive throughout the world, leading back to ancients looking up at the sky (which was better than what most of us see, considering light pollution)."

You should question this as well. Have you ever considered there was a period where the ancients could not see the stars, moon, or sun due to excess clouds, smoke or dust blocking the view? Perhaps an asteroid hit, or there was a lot of volcanic activity, or whatever.

Imagine if it was always cloudy, perhaps this even lasted for a generation or two so that no one alive had ever seen any of that, then suddenly the sun appears through a break in the clouds. This would explain why the bible claims that light was created before the sun.

> You just picked the easiest questions and left out the rest...

You were just saying you shouldn't directly trust people and I'm saying you should also dig. You asked a lot of questions, I don't have the answer to all of them, but somebody might. And that's why I say dig. Somebody might have already done the work. I for one am not omniscient, don't just counter everyone with "well you don't know everything", it isn't useful and is a non sequitur to the topic at hand. The answers were to illustrate a point, not to provide exactness. And your entire reply missed what I was saying because you were caught up in minutia.

> You should question this as well.

Are you talking about when the asteroid hit or are you suggesting a fictitious example? If the former I suggest looking at a timeline of human evolution and studying more about animal behavior. The latter, yeah thought experiments are fun. Who is saying they aren't? I'm definitely not. I'm not even disagreeing with your main point, I'm expanding on it. I'm literally saying don't just ask a question and stop. Ask a question and search for an answer! And you might like a story called Night by Isaac Asimov. It does discuss what is likely to happen with civilizations capable of communication, mythos (and included exaggeration).

> This would explain why the Bible claims that light was created before the sun.

We're taking about questioning things and you're taking the Bible as directly literal? Maybe you should question that.

Sure, I guess I don't understand why someone would only question without searching out answers... but you should dig, then dig further, then dig some more.

I mean there have been too many times when I learned about a topic (eg historical event) from one source and internalized it, but then another source that focused on different details (not even conflicting details) told an entirely different story.

Regarding the bible passage. I just cannot imagine a mindset that fails to make the connection between the sun and the source of light, so what in the world does that passage mean? Perhaps its just another bad translation (another way to totally change a story).

It’s incredibly mentally exhausting and you’ll miss several things that flag you as a comfortable human being in your own existence to others, thereby shortening your ability to function as a socially wholesome creature. (Note: I have an illness on the schizophrenia spectrum that works in a way requiring me to thoroughly examine fundamental aspects of reality. It is utterly exhausting.)

>"I have an illness on the schizophrenia spectrum that works in a way requiring me to thoroughly examine fundamental aspects of reality. It is utterly exhausting."

Being forced to do anything will be exhausting, it is totally different from having the ability to do so if you so choose.

Some questions are purely abstract without any relation to self, personal identity, self image from others, affect on others as well as neither being interpretations of the past or predictions of the future.

I find those types of questions to be relaxing and interesting. As soon as I begin to connect those questions to either, their relation to my own awareness as a social being, that's when they become exhausting. That's because I stop thinking about the question as a pure question, and I begin believing I can know how both I and others think about it, in addition to any other number of details present (of which, not only are there thoughts to be had about how others think of those details, but how all of those thoughts will eventually influence how others think about all the minutia in addition to original thought, and how that will affect how you think eventually, and thinking about all of that - if you choose to, it doesn't end!).

When oneself thinks about how others think, oneself is still thinking about how oneself thinks. Not in the direct way, where oneself knows exactly how another thinks at a precise moment, but the thoughts oneself has about others influence the thoughts oneself has about oneself, eventually, even if you've thought all the thoughts you can besides the thoughts you've worked ridiculously hard to avoid, eventually oneself has to confront all the thoughts that remain, lest they prefer to just chant 'om'.

So gimme all the ridiculous, disconnected from reality problems you have. Because I absolutely loathe having to think about how my thoughts affect my thoughts and how my thoughts affect how others think their thoughts and how their thoughts affect their thoughts in the future and how those thoughts will eventually affect my thoughts. That's exhausting, you can't keep up with it. Even if you are right about how someone else thinks, they can always change how they think, for no reason besides they either know how you think, or they think they know you think they know how they think.

But otherwise. yea, I get that it seems like it can't be avoided. Because people seem to expect some degree of you thinking for them if they think for you, that's socially wholesome, I suppose. It's all absurd to me. Tuesdays.

Tuesdays are weird indeed.

It becomes not optional and is a waste of time. People get stuck questioning everything and become useless piles of flesh. It happened to me for a couple of years after too much LSD.

Clearly it is always Sunday for dogs.

Questioning everything is also child-like. It's more of a normal adult quality to learn what lines of questioning prove fruitful and what do not.

tbh many of the adults i know have no ability to judge which lines of questioning are fruitful or not specifically because they're so "on rails" or "adultlike".

for them a fruitful question is defined as something along the current trajectory. but they never ask if they're on the right trajectory because that wouldn't be something on the current trajectory.

see the issue?

Its not so much questioning everything that is childlike, instead that would be not knowing enough to avoid talking about it with people who don't know or care.

I don't think that's true. Think about the adjectives associated with curiosity and wonder - 'childlike' definitely comes to mind. 'Interest' is an adult word, though - that implies a trajectory and a path, where curiosity and wonder are general.

Clearly you've never experienced a psychotic break....

So you haven't done it, you have no studies to back this idea, but you just assume it's going to be a problem somehow..

So-called "bad trips" can be tremendously beneficial afterwards. They're "bad" because you get into the kind of deep, uncomfortable introspection that most people would want to avoid naturally. You learn things about yourself and the world that you probably wouldn't have wanted to know. That doesn't mean that you're going to go crazy afterwards. A lot of people come out better on the other side.

Bad trip: Despair. Good trip: Delight.

Aren't these both apart of life?

"So-called "bad trips" can be tremendously beneficial afterwards. They're "bad" because you get into the kind of deep, uncomfortable introspection that most people would want to avoid naturally."

While such uncomfortable introspection could certainly occur in a bad trip, it's far from the only kind of experience that could make a trip bad. You could also find yourself imagining you're in something like a horror movie or in hell, dead, or dying.

Terrence McKenna and Rupert Sheldrake coined the term "necrotogen" (a play on the much more common term "entheogen") for the common effect that psychedelics have of being confronted with death. Such an experience often feels very real, sometimes even "more real than real".

That kind of experience is much more than simply uncomfortable introspection, especially when it's combined with temporal distortions and confusion that is also common in psychedelic experiences -- where one feels like what one experiences takes years, decades, centuries, or millennia, or that one is stuck in a temporal loop of doing the same thing over and over again, or that one can't escape from the distressing situation that one is in, or that one doesn't know who one is or where one is or what is happening or what is real and what isn't.

Are you really dying? Did you just murder someone? Or are you being murdered or threatened in some way? Did someone call the police or ambulance? Are you in jail or being tortured or abducted by aliens or dead and experiencing decomposition, etc.

Despite all that, I fully agree that one could learn a lot from such very negative experiences -- for example, how to cope with them -- and the "bad" trip could wind up being one of the best trips one ever had because of what it revealed to you about yourself and the world.

Also, it's quite common for such a "dark night of the soul" experience and/or ego-death to be followed by an experience of rebirth and of very positive, life-enhancing and life-embracing revelation (incidentally, such psychedelic experiences bear strong similarities to shamanic initiation experiences, where sickness, bodily dissolution, and death prefigure and even legitimize the abilities and status of the shaman). But even without the latter, it could still be very constructive, and one could learn a lot.

I am not sure about the percentage affected or what the preconditions have to be, or what other measures to detect them are, but personally I never tried psychedelics recreationaly due to their extremely long duration of effect.

I know there is a good argument about setting, mindset and support being the relevant factors, but the possibility of multiple hour horror trips always made me think again. And again. Which in itself is a huge problem for people who get complications because of that fear.

There are some drugs who work similar to an "allergy test". Salvia divinorum for example has an extremely short duration of effect. A few minutes (<10) in comparison to the same amount of hours. With proper supervision the potential to detect people at danger without lasting complications looks extremely promising to me. Sadly I dont think anyone will care for such safety measures as long as the whole benefit of psychedelic drugs is illegal at the moment.

Everyone who smokes Salvia is at danger. Salvia is the worst.

The general consensus is that this is an extremely small portion of the population, and that psychedelic use is only typically a premature trigger for a preexisting condition rather than a prime cause for these types of mental issues.

Do you have citations for the following?

• extremely small portion

• trigger for a pre-existing condition

I don't. I'm simply restating what seems to be general consensus amongst both users and mental health professionals. Actual data is hard to come by, since actual research has only recently begun to happen.

At this point though, any assertion that psychedelics cause anything more than a very slight increase in the background rates of diseases like schizophrenia would need a serious amount of evidence to back it up. Psychedelic use is common; something like 15—20% of the American population tries them in their life. And the general understanding of diseases like schizophrenia right now involves actual structural changes that simply aren't plausible consequences of infrequent psychedelic use. I won't speak toward long-term, frequent use, but by all the evidence I've personally seen, LSD in particular is extraordinarily safe for the population of people without a family history of schizophrenia.

I'd also like to point out that the original assertion—that psychedelics trigger psychotic breaks—itself doesn't come along with that much in the way of evidence. The original notion came about in the '70s when mental health professionals started seeing a higher proportion of their patents coming in after having tried psychedelics. I'm not sure if hard data was collected (or at least, I haven't been able to find any), but the most straightforward explanation for this is that this likely simply mirrored the increase in the background rate of people using psychedelics. If the background rate went from 1:10 to 2:10, then you'd expect that the number of people coming in with mental health issues will show a doubling in psychedelic usage rates. And in the fifty years since then, I've not seen much additional evidence for a causal link between the two.

> The general consensus is

Your consensus might be general among irresponsible psychonauts that are either lucky or accept psychosis.

http://slatestarcodex.com/2016/04/28/why-were-early-psychede...

The general consensus is to use psychedelics only as part of a therapy under supervision of a medical expert.

https://www.livescience.com/16287-mushrooms-alter-personalit...

> an extremely small portion of the population

https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

> typically a premature trigger for a preexisting condition

How does this reduce the danger of psychedelics in any way ? It increases the danger because you do not know in advance if the drug will trigger a mental disorder that you do not have yet.

A bad trip triggered by psychedelics might be your first trauma with PTSD.

https://www.reddit.com/r/Drugs/comments/36gj2h/can_ptsd_be_c...

> Your consensus is only general among irresponsible psychonauts that were lucky enough in the past.

You're using the words "irresponsible" and "lucky" here to trigger an emotional response that these kinds of risks are anything but rare, which simply isn't supported by any data. I "irresponsibly" crossed the street today. Am I "lucky" I wasn't run over by a bus?

> The general consensus is to use psychedelics only as part of a therapy under supervision by a medical expert.

And the general consensus is to always consult your doctor before beginning any kind of exercise program. This is a standard CYA position adopted by the medical profession.

> https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

Nobody is denying that mental health problems are real and prevalent. The link between psychedelics and the onset mental health problems is what's at issue. 15%–20% of the US population tries psychedelics in their lifetime, and 5% of US adults experience a serious mental illness each year. Mental illness is clearly a huge problem with or without psychedelics, and the zeitgeist of research into these substances in the past decade has been almost universally uncovering the ways they can be used to help the situation.

> How does this reduce the danger of psychedelics in any way ? It increases the danger because you do not know in advance if the drug will trigger your mental disorder that you do not have yet.

Many people have the underlying structural changes in their brain that indicate an imminent onset of symptoms of schizophrenia. In cases like this, it's theorized (but again, data is scant) that psychedelics like LSD can be a triggering event that brings about an onset of symptoms, but ones that were all but inevitable anyway. That's not to say that the loss of even a month or week of sanity isn't tragic, but I've seen very little in the way of evidence that occasional LSD use in particular is substantially more risky for the average mentally healthy person than any other recreational activity one might engage in.

Crossing the street is dangerous but mostly under your control. Unlike a trip. Anyway the comparison is lame.

The comparison with an exercise program is lame too. Of course an unusual big effort or training load is bad and might harm you or kill you.

A bad diet like paleo or keto might lead to an early death as well.

The numbers show that many people are prone to mental issues or have them. Not a small percentage but a big percentage concerning many millions.

Even responsible psychonauts warn against psychedelics in the wrong setting. But you do not know in advance if you will have good or bad trip.

All noteworthy positive studies are published by medical experts.

All medical experts warn against the casual use of psychedelics. Psychedelics should be considered as medicine and not as easy harmless miracle drugs or party drugs.

Here's a podcast episode of a guy who tries microdosing http://www.gimletmedia.com/reply-all/44-shine-on-you-crazy-g...

It's very likely the benefits being reported on in the article are present in doses far lower than the high recreational doses you're referring to.

Your concerns are more relevant to the higher, hallucinogenic doses.

All medicines have a dose:response curve with a dangerous response zone starting somewhere along the increasing dose axis.

As a person who has been to psychedelic hell, I can say a nice part about it is that it ends. Having people around you to help you assimilate complicated experiences is key. If you're on the edge of a manic episode, it can definitely be a catalyst, and I've seen difficult things come of it but sometimes difficult things are manifestations of things we need to deal with.

The benefits of responsible psychedelic usage greatly outweigh the risks. I haven't seen any evidence that permanent psychosis after psychedelic usage is statistically significant compared to psychosis in the general population. Honestly, riding your bike to work is more dangerous.

Something that's hard to quantify (because it's been illegal to study) is that people who use/abuse psychs before slipping into a permanent psychosis may have been on a manic upswing that led to the risky usage of the drugs. I've seen that happen to people in hypo mania with weed, alcohol, shopping, and the greatest offender and most predictable, cocaine. This can lead to PTSD and further self medication that can become a race condition that lasts a lifetime. The fear, shame, and personal loss can be crushing without the support to handle it.

Permanent psychosis or schizophrenia are so poorly defined. One of the hallmarks of schizophrenia is that it doesn't get better. So if you had an episode and they diagnose you then it does go away, well they guess you didn't have it. The more modern thinking is that schizophrenia doesn't exist[1]. There are so many factors that lead into an unmanageable mental state, not the least of which is our bizarre modern environment. IMO it's a miracle most of us are able to pass as sane well enough to keep the trains running on time.

I just don't buy the "don't do it, you might go crazy" though. But if you feel like it's not for you, it's probably not for you. Thoughtful enthusiasm is so important. Also knowing what you're taking and where it came from.

If you or someone you know struggles with mental illness coupled with drug use, there is real help for it and free resources. Cognitive Behavioral Therapy and it's Dialectical[2] cousin are showing amazing results. SmartRecovery[3] is a fantastic free resource. With free daily online chat groups (audio, video, and text) as well as in person meetups all over the world.

[1] https://www.psychologytoday.com/us/blog/psych-unseen/201603/...

[2] http://www.millercounselingserv.com/uploads/9/0/5/1/90518949...

[3] http://www.smartrecovery.org

"The more modern thinking is that schizophrenia doesn't exist[1]."

One of the main points of the article you link to is that schizophrenia does exist, with the caveat that it exists not as a single disease but as a disease spectrum:

"when Dr. van Os writes that "'schizophrenia' does not exist," taking care to place quotation marks around "schizophrenia," what he's mainly saying is that the term "schizophrenia" doesn't represent a single disease entity and should therefore be replaced with "something like ‘psychosis spectrum syndrome.'"

and

"saying that "schizophrenia" represents a variety of distinct disorders with different causes doesn't mean that it doesn't exist at all"

It concludes with:

"In the end then, the argument that "schizophrenia" doesn’t exist is far from compelling. Schizophrenia is a word we use in medicine to describe a familiar set of co-occurring psychotic symptoms, with potentially different causes, just like "anemia," or "hypertension," or "headache." In some cases, it can be useful to think of it as a categorical disorder, distinct from other forms of psychosis. In others, it can be best thought of as a spectrum condition, lumping it together with other psychotic disorders. A more enlightened view of schizophrenia acknowledges that both can be true."

Sorry, I should have been more clear. What I was trying to point out was that people seem to think of it as a disease like cancer and it's problematic to distill it to such a fine point. The fear that somehow you can open a door to losing your faculties much like how you can open a door to cancer via smoking is a mix of drug war propaganda and the overwhelming societal stigma against mental illness.

I very much agree with the conclusion clinically. However I've seen how the imprecise nature and the scarlet letter stigma of the disorder can feed into itself. Especially when coupled with (a lot of times secret) drug usage.

There are issues with co-morbid problems like autism spectrum+PTSD+psychiatric medications with unreported usage of substances that very much exhibit like psychotic spectrum disorders and because of a failure to identify the difference, people get the wrong care and sometimes it kills them. I tragically saw this play out with a friend of mine and in hindsight it was totally preventable.

I am definitely not denying that people have mental illnesses that need to be treated. Just saying that crazy isn't what most people think it is and crazification when it comes to psychedelics is something that fails to appropriately address a lot of factors. To think of psychosis in terms of absolute doesn't help people that struggle lead better lives and doesn't really cover the bases for self discovery and personal awareness either. In the end, not being critical of this kind of talk related to psychedelics makes it much harder for us to explore their massive therapeutic potential.

"I’m really worried about the subset of the population with preexisting mental disorders such as manic depressive disorder, schizophrenia, and depression who will suffer a psychotic break from the use of these substances."

Psychedelics have been used to treat schizophrenia and depression before. Here is an excerpt from a paper on "Treatment of Childhood Schizophrenia Utilizing LSD and Psilocybin"[1]:

The first patient we treated [with LSD] was an eleven-year-old girl who was dying of something akin to marasmus. Marasmus is a condition of wasting away of the body, where nutrients are not assimilated. It occurs in infants who have no human contact. They go into such an isolated mental state that not even intravenous feeding is effective..

The girl was actively suicidal and would make every attempt to destroy herself. She was in twenty-four-hour restraint. When let loose, she would batter herself: smash her eyes, smash her head against the rails. She looked like an old, wizened lady -- nothing but skin and bones, and battered black and blue.

So the psychiatrist said, 'Why don't you start with this girl. She's going to die anyway, so there is nothing to lose.' It was quite a challenge to take as my first patient someone who was in such a terrible situation. I was afraid that maybe she would die during the session. But I didn't have any alternative, because this was who I was given.

We didn't use low doses with any of the patients. My guess is that she got 300 or 400 micrograms [of LSD], and she weighed maybe fifty-five pounds. She was just skin and bones, and was totally incoherent. She screamed, babbled, and spat if you got near her. She was not in contact with anybody, nor had she ever been since she was hospitalized.

During the session she started wailing like a wounded animal -- it was the most chilling sound. Then she started screaming, and the pitch would increase and increase. We tried everything to make contact with her, to no avail.

After about seven or eight hours I was exhausted, and so frustrated that I just yelled at her, "Nancy! When are you going to stop screaming! I can't stand it anymore!" [laughs] She stopped and looked at me. This was the first time she had made eye contact with anybody, and said, "I have a long way to go, so just stay out of my way." That was the first thing she ever said to anybody. Then she went back to screaming. That was our session.

Hers was an amazing story, which we subsequently published. Once she started speaking, it was possible to work with her more effectively. She was a very intelligent girl, perhaps an ancient soul. She was a challenge -- conniving and manipulative -- and she gave us a run for our money. Her bottom line was always that she had control over hurting herself; this became her ace in the hole. As she improved, she would eventually just carry a Kleenex around, put it on her hand, and say that the Kleenex was stopping her from hitting herself. So we would grab the Kleenex and hide it, and she'd say: "Damn you! Damn you! Give me that napkin!" There was a whole power struggle that went on for months.

Of course, during this time she was no longer in restraints, and she could move about on the ward. She struck up a companionship with one of the other girls in the program, and she was in constant contact with the staff.

She must have had eighteen or nineteen sessions spaced apart by two or three weeks, and every session was productive. Between these sessions, we had to develop a whole treatment program for managing her, as she was extremely bright and incredibly manipulative. One time she said to me, "Well, I can't fool the day staff, but I can still fool the night staff." Then as soon as she said it, I could tell that she was thinking, "Oh my God! I've given myself away!" I looked at her and said, "That's not going to last very long, is it?" And she said, "Damn you!" So, that night I got together with the evening staff and clued them in on what to do, because she was still manipulating the hell out of them. Talk about a tough patient! But she was no longer hurting herself. And although she remained in the hospital, she got well enough to attend school.

[1] - http://www.maps.org/news-letters/v07n3/07318fis.html

> She was a very intelligent girl, perhaps an ancient soul.

The author suffers from psychosis.

Many people accept psychosis as normal.

PS: Removed the word "religion" to prevent a religious flamewar.

Please don't break the site guideline against name-calling in arguments, and please especially don't take threads into religious flamewar.

https://news.ycombinator.com/newsguidelines.html

Sorry. I corrected my comment.

Can you uncensor it ?

Besides there is no "name calling" against the author of the post.

I know and appreciate that, but what we're trying to avoid is using pejoratives (which 'psychosis' is in this context) to make an argument louder without adding information. That's why that site guideline is written the way it is. It's about more than just avoiding personal attacks, though you're right that that's the most important thing to avoid.

i'm of the opinion that the psychotic breaks risk would be an engineering problem to overcome in the context of using psychedelics therapeutically.

besides, in a clinical context, it's highly unlikely any kind of psychotic break could get too far out of hand; an astute clinician would recognize the patient spiraling out of their control and administer a correcting dose of an anxiolytic, or, failing that, a trip-ender like an antipsychotic.

I agree in that psychedelics should be absolutely a last resort. That being said LSD was a miracle for me personally and saved my life.

So you are mentally ill. Yet you feel justified giving advice on the internet.

We've banned this account for breaking the site guidelines.

https://news.ycombinator.com/newsguidelines.html

the brain is a complex thing -- much mental illness is not well-understood, even though it is true that people suffer from dysfunction..

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