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Comment by JohnMakin | Hacker News Reader

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Around 1% of people have schizophrenia. This holds over a lifetime - there's a structural, unavoidable component to the person's neural wiring or physiology that will result in a schizophrenic break. Prior to the break, they may seem more or less normal, but after, they will experience deficits in cognition and perception, and may have significant barriers to living a normal life.

Schizophrenics, as a rule, will have a psychotic break before they turn 45. Psychoactive substances, and high doses of psychedelics, will trigger breaks from reality earlier than they might otherwise happen. Stress, caffeine, trauma, or significant excitement can also be triggers, but psychedelic drug trips are a reliable trigger, and in conjunction with other effects, can spiral a "bad trip" into a much worse trauma.

Another 3 to 4% of the population have significant mental disorders, ranging from those we know, to those we can observe but don't have a good diagnostic criteria for. In these cases, it can be very detrimental to use psychoactive substances generally, and psychedelics in particular.

It's crucial to visit with a doctor to rule out the likelihood that you're in the roughly one in twenty people that might have a significant negative reaction to psychedelics. Some of the people in that camp might be safe from harm later in life. I know a person with significant family history of schizophrenia and earlier life indicators he was at risk, who then started using mushrooms in his 50s and seems very stable. He talked things over with his doctors before deciding to take the risk - apparently after you turn 45 it's incredibly rare, even with significant trauma and stressors, for schizophrenic breaks to occur, so if that's your main threat, it might be safe to engage in psychedelics when you're older.

If you're not in the high risk camp, you should still have at least one frank discussion with your doctor about pitfalls, and do a metric ton of personal research about any substance you intend to use. It can be a profound and wonderful departure from the norm, or a mildly unpleasant experience, or a stressful confrontation with your inner demons, depending on the dose and preparation.

As I said in another post, the mental illness is not the issue here, the immediate access to a gun while blasted on shrooms is.

> In all the studies included in our review, we identified 11 deaths presumed to be completed suicides that can be fairly confidently linked to classic psychedelic use in a non-clinical context (four jumping from a height [of which one of these individuals was also intoxicated on alcohol], one walking into traffic [unclear intent], one drowning [alone on the beach with unclear intent], two self-stabbing with a sharp object or knife, and three with unclear methods). This supports the notion that noncontrolled environments where individuals are by themselves and have access to means for suicide, such as heights with no barriers and objects that can lead to hanging or self-stabbing, are likely unsafe contexts for psychedelic use, especially among individuals presenting with prior suicide risk. There is much evidence suggesting that restricting access to lethal means is a key method for suicide prevention in general, and it stands to reason that for those using psychedelic substances in non-clinical settings, the pre-emptive restriction of lethal means could help reduce the risk of suicide.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033757/

I would extend this and suggest that anyone using these should have someone or multiple people who can be sure that all dangerous things are out of reach, including cars.

I've witnessed heavily drunk people abuse microwaves, and people deep in chat addiction catch a kitchen on fire boiling water.

I've heard many people believe they can fly and other stories, but it's not just hallucinogens that convince people the really dangerous thing they are about to do it totally fine.. but I would suggest that with the use of such removing all possible danger things and having shifts of responsible people in the vicinity maybe should be required.

At least 42% of Americans live in a household with a gun so it isn't particularly useful to write off the anecdote.

This percentage is much smaller in other countries, so actually it is... if you don't live in the USA, which is a large majority of the world's population.

Many countries in Europe have tons of older hunting guns, on top of newish guns for... personal protection? Sport? Or whatever reason people feel the need to have them.

Tens of millions as per wikipedia [1]. Also check other countries and continents. A very valid argument.

[1] https://en.wikipedia.org/wiki/Estimated_number_of_civilian_g...

In most European countries you have to store the firearm in a locked safe, often with the bolt removed or the weapon disassembled and - quite often - with the ammunition stored separately in another locked container/safe.

It’s a lot more “steps to take” to commit suicide than “take the weapon from your nightstand and shoot yourself”, given you have to unlock usually more than one safe/lockbox.

I assume that's not any of the concealed carry countries as that would completely defeat the point of having the gun. Definitely not the case where I live.

The countries allowing CC are - unfortunately - in the minority in Europe.

Among the ones that do allow CC, most of them that’s a special permit that seems to have an exception to the storage requirements for personal protection.

Personally I wish more of Europe would emulate the Czech Republic in this matter…

And that's the problem. It's not particularly useful to write it off, particularly absurd that you do so on the grounds that it's an extremely prevalent problem.

Not really, here in Amsterdam we had tourist jump of bridges and buildings on shrooms.

Thank you for this. I thought this was a very informative comment; I am worried about schizophrenia as a disease that might impact my kids. I wanted to ask you for more information, but that is a burden, so I asked ChatGPT instead so at least you wouldn't have to go find links. If you have Other reading besides what is below I would be happy to hear about it.

Here is it's response from ChatGPT (Claude couldn't provide links). My contribution is that I checked the links and skimmed them to see if they supported the statement. They are repetitive (there are only 7 articles linked actually), but they generally support your comment. Of note the PLOS article does not support your comment, and it seems that it doesn't support what ChatGPT says (maybe I misunderstood when skimming it). The stuff in parens below (Looks Like This), was a link in ChatGPT, but the links didn't copy-paste, so I'm going to put all the articles at the top here:

https://www.nature.com/articles/s41380-023-02138-4 https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12... https://www.who.int/news-room/fact-sheets/detail/schizophren... https://www.nimh.nih.gov/health/statistics/schizophrenia https://www.psychiatrictimes.com/view/drug-psychosis-may-pul... https://psychedelics.berkeley.edu/qa/understanding-your-risk... https://journals.plos.org/plosone/article?id=10.1371/journal...

The comment you saw online contains some accurate points but also could benefit from additional context and nuance based on available research.

1. Prevalence and Risk Factors of Schizophrenia:

- The lifetime prevalence of schizophrenia is approximately 0.3% to 0.7% globally, which supports the 1% figure as an upper bound (Nature) (BioMed Central) (World Health Organization (WHO)) . - Schizophrenia typically emerges in late adolescence to early thirties, with men often experiencing onset earlier than women (National Institute of Mental Health) (World Health Organization (WHO)) . - Factors such as genetic predisposition, prenatal exposures, and psychosocial stressors contribute to the risk of developing schizophrenia (National Institute of Mental Health) (World Health Organization (WHO)) .

2. Triggers for Psychotic Breaks:

- The statement that high doses of psychedelics can trigger psychotic breaks in predisposed individuals is supported by evidence. Drug-induced psychosis, particularly from hallucinogens and cannabis, can lead to schizophrenia in some cases (Psychiatric Times) . - Other triggers include stress, trauma, and significant life changes, which can exacerbate underlying vulnerabilities (Berkeley Psychedelics) .

3. Impact of Psychedelics on Mental Health:

- Psychedelics can pose significant risks for individuals with a family history of schizophrenia or other major mental health disorders. It is crucial for these individuals to consult healthcare professionals before considering psychedelic use (Berkeley Psychedelics) . - Research has shown that about 25% of those with substance-induced psychosis may transition to schizophrenia, with the type of substance being a significant predictor of this transition (Psychiatric Times) .

4. General Mental Health Considerations:

- Around 3-4% of the population may experience significant mental disorders other than schizophrenia. For these individuals, the use of psychoactive substances, including psychedelics, can be particularly detrimental (PLOS) . [NOTE: This seems to be an error from ChatGPT, this PLOS article doesn't seem to support this conclusion. As I haven't done personal work on this yet, I don't know whether the statement is supported by other research.] - Mental health evaluation and professional consultation are recommended before the use of psychedelics to identify potential risks and ensure safety (Berkeley Psychedelics) .

5. Later-Life Considerations:

- The risk of new-onset schizophrenia after the age of 45 is indeed rare, which suggests that older individuals may have a lower risk of experiencing a first psychotic episode triggered by psychedelics (Berkeley Psychedelics) .

For further reading and to deepen your understanding, you may refer to sources like the National Institute of Mental Health (NIMH), the World Health Organization (WHO), and recent research studies on the global burden and risk factors of schizophrenia (National Institute of Mental Health) (World Health Organization (WHO)) (Nature) . Additionally, the Berkeley Center for the Science of Psychedelics (BCSP) provides detailed information on the safety and risks associated with psychedelic use (Berkeley Psychedelics) .

You don’t need to be a doctor or therapist to let people know that some people can have very bad reactions and it’s not all roses.

I see the same thing happening in people smoke marijuana where any claim that it can have harmful effects for some or with abuse is met with “yeah well what do you know, i read this other thing and i never had issues myself”.

It seems to me that in this case the issue was someone out of their mind high on shrooms had immediate access to a gun, not the “mentally ill person does drugs and dies” trope which is quite tired and I’m pretty sure not backed by any kind of science.

I only posted my reply because comments like these add to the stigma of mental illness and may make people who are suffering less willing to try these types of treatments.

This observation of fact is more interesting and nuanced than your initial defensive reaction

I appreciate that feedback, thanks.

>psilocybin is one of the few treatments in the wild right now showing any hope of treating long term PTSD.

CBT, EMDR and SSRIs are effective, empirically-supported treatments for PTSD. For people who don't benefit from established treatments, psilocybin is just one of dozens of different potential treatments currently being researched.

https://clinicaltrials.gov/search?cond=Posttraumatic%20Stres...

Psilocybin might be an effective treatment for some patients with PTSD, but there's a dangerous hype bubble surrounding psychedelics that simply doesn't match up to the evidence. We need to be extremely careful about generalising from anecdotal reports and small unblinded trials. Psilocybin might be a huge advance, it might be only marginally more effective than current treatments, or the risks might substantially outweigh the benefits in real clinical populations - we just don't know yet.

I think what you said is compatible with OP. It urged caution, not prohibition.

It’s okay to recognize that something serves a great purpose in a controlled, therapeutic setting but may lead to unpredictable results in an uncontrolled environment. People without experience should absolutely be cautious.

And to the original commenter: Thank you for sharing your story, I am very sorry for your loss.

Receiving a controlled dose of psilocybin in a supervised medical environment is not the same as tripping balls off shrooms you bought from the guy down the street. I think OP is cautioning vulnerable people against rashly self-administering psychedelics because they think it will solve all their problems. I do not think he believes all research and use of psilocybin should be stopped because of one tragic accident.

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