Psychedelics Must be Approached with Caution
By: Dr. Denise Renye
Psychedelics are often touted as panaceas for all that plagues us. The narrative goes like this: “Depressed? Anxious? Traumatized? Go on a psychedelic journey and you’ll find you’re cured!” However, that’s not necessarily true and it certainly should not be generalized as such. For some people, psychedelics are contraindicated and for a significant minority, their mental health declines after using these medicines instead of improves.
A recent paper out of Imperial College London by Alessia Marrocu and Robin Carhart-Harris found 16% of psychedelic users experienced diminished mental health in the weeks following the journey and personality disorders put people at even higher risk of psychological harm. This is very important considering how many people are seeking psychedelic treatment these days. Study participants self-identified their personality disorder or were diagnosed via a questionnaire so it’s hard to verify the accuracy but bipolar disorder, psychotic disorder, and borderline-personality disorder were the three that emerged.
To measure the effects of a psychedelic journey, the research team used questionnaires to assess psychedelic-induced mood changes, baseline demographics, post-session subjective experiences, and well-being before and after psychedelic use. Then four weeks after their journey, participants were asked about interpersonal relationships, emotions, functioning, the pursuit of pleasure, and self-actualization. If their responses were negative, they fell into the adverse outcome group.
Nearly every cohort, including the “healthy normals” had a sizeable portion that responded negatively. However, a personality disorder was the single most significant predictor of mental harm (31.2%), followed by psychotic disorders (25%). Overall, about 132 out of 807 people's psychological health worsened in the four weeks post-journey.
The authors also found that by controlling for confounding factors, people with personality disorders were four times likelier to experience mental decline than the remaining population! That number might be even higher because many people dropped out of the study.
To be clear, the likelihood of negative consequences from psychedelic use is minimal, it does exist and should be taken into consideration. I mention this because using these sacred medicines comes with risk, as is the case with any treatment modality. The avantgarde, “everyone should take it” ethos we’re seeing flying around is simply not true. It’s also important to point out the study authors said while there are risks for folx with personality disorders taking these medicines, that doesn’t mean they can’t benefit from psychedelics, especially if coupled with psychological support.
Therapy isn’t just navel-gazing. It creates a container, a special relationship, that allows healing to occur. Coupling therapy with psychedelics can be powerful. The human element is necessary and is one reason why I don’t support the creation of a psychedelic integration app. Outsourcing the process to an app is trying to find a shortcut for something that requires extensive preparation, direct support, and specialized training. Especially for someone with a personality disorder, if they choose to use psychedelics for their healing, they need to work with a human that has training in trauma, the human psyche, somatic-oriented understanding of the human experience, and psychedelics.
I know how to hold the depths of the realms that people go to and can adequately conduct in-depth integration after the psychedelic journey. I was trained through the Multidisciplinary Association of Psychedelic Science and the California Institute for Integral Studies’ (CIIS) Center for Psychedelic Therapies and Research (CPTR) certification program. I also have decades of training in depth psychology and psychoanalytic psychology in order to know the intricacies of complex trauma and personality disorder diagnoses. But not everyone has the training I do and for folx with personality disorders or other mental health concerns, I would urge discernment when considering who to work with and what treatment modalities you want to explore.
Psychedelics, as with everything else, are not one-size-fits-all and instead require personalization and a tailored approach. One of the reasons I have this blog is I want readers to be as well-informed as possible. In the case of psychedelics, that means being aware that there are some risks involved.
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Journal Prompts
Reflect on any preconceived notions you may hold about psychedelics as a cure-all. What experiences or information have shaped these beliefs, and how might acknowledging their limitations contribute to a more realistic perspective on their potential benefits?
Explore your personal readiness to engage in the inner work necessary for psychological healing. What barriers or hesitations do you encounter, and how can you cultivate a mindset that embraces the complexity of the healing process, beyond relying solely on psychedelics?
Consider instances where you or others may have underestimated the importance of personal responsibility in the healing journey. How can a more nuanced understanding of the role of psychedelics inspire a deeper commitment to self-reflection and the ongoing work required for sustained psychological well-being?
Reference
Marrocu, Alessia; Kettner, Hannes; Carhart-Harris, Robin; et al. “Psychiatric risks for worsened mental health after psychedelic use.” PsyArXiv. Oct. 17, 2023. https://osf.io/preprints/psyarxiv/2e34t/