Benjamin didn’t show up to his first appointment with me – but his mother Betty did. Betty expressed concern about her son’s mental health, explaining that Benjamin’s father had recently been diagnosed with pancreatic cancer and Benjamin took the news pretty hard. Benjamin couldn’t afford to see a psychotherapist and had strong judgements against pharmaceutical treatments, and thus began microdosing psilocybin-containing mushrooms to get to a “higher vibration.” That was when the trouble started.
Benjamin had cleared all the furniture out of his room and was denying his need for both food and sleep, stating he could live off the vibrations of the crystals he had placed around the room, along with the photos of John of God, Yogi Bhajan, and Adyashanti he taped to the walls. Benjamin told his mother that he was receiving “transmissions” from these teachers, and other spirits as well, and “was so close to breaking through.”
“Does Benjamin have a history of bipolar disorder or psychosis?” I asked Betty. “No, nothing, never,” she replied. But then she thought for a moment, “Well, there was that time after he took ayahuasca a few years ago.”
A similar episode – during which Benjamin became so paranoid about the government listening to his thoughts that he climbed up on the roof to place tin foil over the shingles. This episode had his mother worried, but it thankfully passed after a few days.
I explained to Betty that Benjamin was showing signs of mania and psychosis.
Mania is a state characterized by elevated mood (which can include euphoria and/or irritability), a boost in energy, increased activity, and a reduced need for sleep. It is commonly seen in people with Bipolar 1 Disorder (formerly known as Manic Depression), though manic states can also be seen in those without the condition.
Manic states can be triggered by extended periods of sleep deprivation and major stressors – like the death of a loved one, receiving a terminal diagnosis, or being under undue pressure at school, home or work. Childbirth may also be a trigger in women.
Drugs, too, can push people into mania. This includes both pharmaceutical medications, like some anti-depressant drugs, as well as psychedelics. For this reason, those with a personal history or a strong family history of Bipolar 1 or Schizophrenia are advised to avoid using psychedelics altogether or, at least from a harm reduction standpoint, to use very high levels of caution when taking substances like LSD, psilocybin, and ayahuasca. People who have Bipolar 1 or a strong family history of it should not take fluoxetine or other SSRI antidepressants – as it may push them into a manic state.
Manic episodes can lead to psychosis, a state during which a person has delusions (false beliefs), hallucinations (seeing or hearing things that others don’t), or a loss of touch with reality. A person experiencing psychosis has disturbed perceptions and thoughts, and they thus have difficulty distinguishing what is real from what is not. When Benjamin climbed up on the roof, or when he believed that he could hear his spiritual idols speaking to him, he was exhibiting symptoms of psychosis.
Betty admitted that she suspected this was the case. She explained that she and her husband had gathered some of Benjamin’s closest friends to stage an intervention. The group confronted him and confiscated his mushrooms and his phone, but he took off in his car. Two days later, Benjamin was back, full of apologies. Thankfully, the next few days were relatively peaceful in their home.
One week later, however, Benjamin seemed manic again, and Betty immediately searched his room and car, finding more mushrooms. Benjamin admitted he had eaten one that morning, stating that he had gotten so close to enlightenment that he would’ve gotten there if the group intervention hadn’t happened.
While I do not doubt that there were some positive moments in Benjamin’s “breakthrough,” it’s clear that this episode did Benjamin – and his family – more harm than good. Having a manic episode or even psychotic break can be a powerful, meaningful “awakening” for some people, but it is not the only path to healing, nor the ideal one.
Psychosis and psychedelics don’t mix
Part of how psychedelics work is by increasing the amount chaos in the brain. In fact, neuropsychopharmacologist Dr. Robin Carhart-Harris et al. explore this very nature of psychedelics in their paper, “The Entropic Brain: A Theory of Conscious States Informed by Neuroimaging Research with Psychedelic Drugs.”
They propose that conditions like depression, obsessive-compulsive disorder (OCD), and addiction result from too much order, or rigidity, in certain parts of the brain, and argue that psychedelics may help heal these conditions by disturbing that rigidity. Psychedelics “shake the snow globe,” so to speak, thereby disrupting the neural patterns upon which depression, OCD, and addiction rest.
This graphic, which I’ve adapted from a similar image found in Carhart-Harris’ paper, and which is shared here with permission, shows how some of us are on the rigid, or low chaos, end of the consciousness spectrum, and some of us are more on the entropic, or high chaos end:
Understanding psychosis and mania as high chaos states, it becomes clear that taking a chaos-increasing medicine like psilocybin or LSD might push somebody with a propensity towards mania or psychosis over the edge. After all, it doesn’t make sense to shake a snow globe in the middle of a blizzard.
Dr. Carhart-Harris and others at the Imperial College London have conducted other studies comparing the brain scans of people on psychedelics to baseline “sober” images. Their findings suggest that psychedelics enhance neural crosstalk – the phenomenon by which parts of the brain that don’t normally talk to one another can communicate.
Above is a simplified illustration of the connections noted in the brains of people at baseline (a), and after taking psilocybin (b). The participants who received psilocybin had many more neural connections than those who received placebo.
Somebody with depression whose thoughts are focused on a very tight loop of negative, self-loathing thoughts may indeed benefit from a little increased cross talk. More brain connections might allow them to realize that life can actually be pretty amazing, that nature is holding us, and that there is love to be shared between us. Increased brain chaos and cross talk may help us realize that it’s not so scary after all to take the risk of asking somebody out on a date, to read more about geometry, science, or spirituality, or to spend a little money on a stylish new haircut.
Somebody in a manic or psychotic state, however, does not need to be pushed in this way. In fact, these individuals are often already at high risk of seeing synchronicity where there is none, being overly familiar with strangers, becoming obsessed – with fractals, yoga, Jesus, or whatever has caught their interest – and racking up credit card debt on a whim.
For these reasons, most (if not all) of the studies on psychedelic medicines exclude those with a personal history of Bipolar 1 or psychosis from enrolling.
In the case of Benjamin, it’s clear (to me) that the bad news about his father’s diagnosis was a major stressor and trigger. In fact, this hard news may have been the trigger of Benjamin’s condition, with psilocybin being the amplifier. This, coupled with Benjamin’s history of post-ayahuasca psychosis, warrants a treatment entirely unrelated to psychedelics. Benjamin needs support, counseling, rest, and comfort – not chaos consciousness.
The right medicine, at the right time, for the right condition
We are all hopefully able to stay aware of our connection with reality and give our bodies, brains, and spirits the support they need. Our friends, families, and mental health professionals can also help us out when we got stuck.
Psychedelics, after all, are drugs. Like all medicines, they are not appropriate for every situation. Antibiotics, for example, combat bacterial infections and thus save lives. But antibiotics are not the appropriate solution to every kind of infection – many bacterial infections resolve on their own without antibiotic treatment, and viral and fungal infections cannot be treated with antibiotics. Antibiotics also carry risks, such disturbing the balance of good and bad microbes in the gut, and contributing to antibiotic-resistant superbugs.
Why, then, would we think that psychedelic drugs could be the right medicine for every kind of person going through every kind of ailment? Every medicine has its indications, and every therapy comes with risks.
When psychedelic explorers begin losing touch with reality, going days without sleeping, or showing other signs of mania or psychosis, the answer isn’t more chaos-inducing medicine. The answer is rest. This includes sobriety (including a break from stimulants, psychedelics, and rapé), de-stressing, taking time off from work/obligations, re-grounding, and self-reflecting. It’s also likely time to work with a therapist or integration counselor to make sense of what is arising, to connect with loved ones, to spend time in nature, and to get both feet firmly rooted – both physically and psychologically – on Earth.
- Carhart-Harris RL, et al. Neural correlates of the LSD experience revealed by multimodal neuroimaging. Proc Natl Acad Sci USA. 2016 Apr 26;113(17):4853-8. PMID: 27071089.
- Carhart-Harris RL, et al. The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Front Hum Neurosci. 2014;8:20. PMID: 24550805.
- Podvoll EM. Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis. 2003.
- Neural cross-talk image from: Petri G, et al. Homological scaffolds of brain functional networks. J R Soc Interface. 2014 Dec 6;11(101):20140873. PMID: 25401177.
- Chaos graphic by Erica Zelfand, as a simplified rendition of a similar image found in Carhart- Harris R, et al, 2014. Photos in chaos graphic by Ashim D’Silva and Alexandru Aceaon Unsplash.
Dr. Erica Zelfand is a licensed family physician trained in naturopathic and functional medicine and specializing in integrative mental health. She is also a medical writer, teacher, and international speaker, and offers courses on the medical applications of psychedelic medicine. To learn about Dr. Z, follow her on Twitter and Facebook, join her mailing list, and visit DrZelfand.com.