Psychedelic therapies have long been feared and avoided. We must acknowledge that there are clinical indications where these treatments are profoundly beneficial.
“Just so you know, this might cause GI-upset,” “If you develop a rash, please call me immediately.” Verbal scripts about the side effects of medications like SSRIs or mood stabilizers feel rote even in the early stages of training. The common woes that accompany medications are predictable and often only mild deterrents for their use by patients. The ubiquity of “necessary evils,” or side effects, is widely true for all pharmaceutical treatments across medicine. However, in anticipating possible future psychedelic therapies with substances such as MDMA or psilocybin, I’m at a loss for how I might one day prepare someone for “ego dissolution,” “mystical connection,” or “intense awe” that can occur following the administration of these substances.
Psychedelics such as psilocybin are being studied for their therapeutic potential across a range of diagnostic categories, such as mood and substance use disorders at Johns Hopkins, Yale, UCSF, and several other schools of medicine. Dr. Roland Griffiths and his team at the Center for Psychedelic and Consciousness Research at Johns Hopkins have found that psychedelic substances such as psilocybin reliably result in what have been labeled mystical-type experiences, based on reported feelings of unity and positive emotions.
While mystical experiences in the psychiatric clinic might sound outlandish to those unfamiliar with this emerging research, such phenomena are not uncommon in the psychological and psychiatric literature. A recent book, “The Varieties of Spiritual Experience: 21st Century Research And Perspectives,” written by John Hopkins’ Dr. David Yaden, illuminates how common and adaptive these experiences can be when they occur outside the context of psychedelic treatments. Inspired by the classic text “The Varieties of Religious Experience,” by Dr. William James Yaden (who, full disclosure, is my husband) and his co-author Dr. Andrew Newberg, describe how James provided the foundation for the study of meaningful altered states of consciousness and how contemporary research shows that such experiences have the potential to promote psychological health. In the case of psychedelic treatments, the authors argue that the mystical or self-transcendent experiences that can be occasioned by psychedelics clinically and may not be a cumbersome side effect, but rather one of the mechanisms of psychedelics’ therapeutic impact.
In psychiatric training, clinicians are taught to be vigilant against states of so-called transcendence. When a patient tells me they feel “connected to the world at large,” or have known “mystical euphoria,” instead of exploring a potentially meaningful experience, I may quickly redirect to assess their risk for mania. We code experiences like these as “religious preoccupation,” or even “grandiosity.” However, when considering that psychedelic therapies can induce experiences which might once have been mistaken for psychotic or dissociative states, clinicians are now challenged at times to reorient their language and attitudes to embrace instead of diminish discussions of self-loss and mystical connection. As this new field of psychedelic medicine emerges, I look forward to opening myself to the fullness of my patient’s experience even if it means deviating from my common script on side effects or illness.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.