Psychedelics can be powerful tools for exploration, self-understanding, and personal growth when used appropriately. However, certain mental health conditions and personality traits may indicate that psychedelics carry substantial risks for some individuals and it’s important to recognize when psilocybin might not be the best choice. This article explores factors that could necessitate caution or avoidance of psychedelics while acknowledging evidence-based benefits in guided, therapeutic contexts.
Mania: Risks of Exacerbating Symptoms in Psychedelic Therapy
Mania is characterized by elevated mood, racing thoughts, heightened energy, inflated self-esteem, impulsivity, and risk-taking behavior. This presents unique risks regarding psychedelic therapy and can be a strong indicator of when psilocybin might not be the best choice.
Psychedelics produce novel perspectives, energy, and euphoria. For those prone to mania, psychedelic effects may amplify problematic symptoms like impulsivity, delusions of grandeur, and disregard for personal limitations.
As psychologist Robin Carhart-Harris explains, “The psychedelic experience could feed into and reinforce manic tendencies towards unrealistic confidence, goal-setting, and entitlement.” Those in a manic state already have impaired judgment regarding boundaries and limitations. Psychedelic effects could further dismantle inhibitory control.
This combination makes careful screening for bipolar disorder essential. Psychedelic therapy may need to wait until the mood is stabilized. In sessions, guides must provide grounding and ensure the setting minimizes triggers for hypomanic escalation. With proper precautions and integration support focusing on realistic goal-setting, psychedelic therapy could benefit those with managed bipolar disorder. However, uncontrolled mania could present too great a risk.
Schizophrenia: A Nuanced Risk Profile for Psychedelic Therapy
Schizophrenia is a complex condition involving distorted thinking, emotions, and perceptions. While psychedelics present risks for those with schizophrenia, recent research also hints at potential benefits in controlled settings.
There are legitimate concerns about psychedelics worsening symptoms like hallucinations and delusions, especially at high recreational doses without medical supervision. As researcher Katrin Preller notes, “Psychedelics could exacerbate positive symptoms for those with pre-existing psychosis.”
However, some studies also show low doses of psychedelics like psilocybin could improve negative and cognitive symptoms under careful protocol. According to Preller, “There are early indications psychedelic microdoses may improve motivation and social functioning for certain schizophrenia patients when carefully managed.”
Extreme care is still required, given the vulnerability of this population. Guides must extensively screen patients, utilize low doses, and monitor for any worsening of positive symptoms. Set and setting should be optimized for feelings of safety and control. While more research is still needed, cautious, clinically supervised psychedelic therapy could one day play a role in schizophrenia treatment. But recreational use involves too many uncertainties at this stage.
Potential Benefits with Proper Guidance
A growing body of research indicates that psilocybin and MDMA can provide lasting relief for treatment-resistant depression, anxiety, PTSD, and other conditions when administered in a structured setting with guidance and integration support. The psychedelic state can allow people to temporarily view their lives, habits, and traumas with greater objectivity, potentially catalyzing insights, emotions, and shifts in perspective that persist after the acute effects wear off.
As researcher Katrin Preller notes, “Guidance and curation like music can shape the psychedelic therapy experience, providing a contained ‘teleology’ vs. the wilder, untamed trajectory of recreational, unguided use.” With proper set, setting, and integration, psychedelics offer powerful tools for healing and self-understanding. However, for some individuals, great caution is still warranted.
Emotional Detachment: An Impediment to Psychedelic Integration
Emotional detachment involves a sense of disconnection or numbness towards one’s own feelings and inner emotional landscape. This can manifest in many ways – difficulty identifying, expressing, or making sense of emotions; lack of strong reactions to emotional events; a flattened or constricted affect; avoidance of emotional intimacy in relationships; and a tendency to intellectualize experiences rather than processing them on an emotional level.
In the context of psychedelics, emotional detachment could pose challenges during the integration process. Psychedelic sessions often involve experiencing powerful emotions or gaining new perspectives on oneself, others, and the world. However, someone prone to emotional detachment may struggle to fully connect with and make sense of these emotions and insights after the psychedelic state passes. Psychedelic sessions are not inherently contraindicated, but one should be mindful of these personality traits as they can pose challenges.
Without the ability to access, comprehend, and learn from the range of feelings unearthed, the potential for long-term growth and healing may be limited. As psychiatrist Dan Engle explains, “Psychedelics lower defenses and reconnect us to suppressed emotions, but if you’re numb to core feelings in day-to-day life, you won’t fully benefit from this unleashing during sessions.” Emotional detachment could act as a barrier between one’s conscious mind and the novel emotional information wanting to emerge into awareness.
A proper set and setting can help foster emotional openness and expression during psychedelic sessions. However, integrating these experiences also requires doing ongoing psychological and emotional work to become more attuned to one’s inner landscape outside of psychedelic states. Otherwise, the insights gained risk fading back into detachment. With care and intention, psychedelics can catalyze this deeper process – but only for those willing to courageously face their full spectrum of emotions.
Escapism: The Risks of Using Psychedelics as an Escape in Therapy
In therapeutic contexts, there is a risk that those prone to escapism may use psychedelic sessions as a temporary diversion or fantasy rather than doing the deeper personal work required. Escapism involves avoiding unpleasant realities, responsibilities, or challenging emotions by escaping into fantasy worlds, daydreaming, addictive behaviors, or other distractions.
Someone with a strong escapist tendency may focus mainly on the sensory effects, visions, and euphoria of the psychedelic experience, without confronting their underlying issues or integrating insights after the session. They may even romanticize the psychedelic state as an escape from normal life struggles. As psychologist Noa Kageyama explains, “Psychedelics can open us up to new perspectives, but we have to put in the work to integrate those perspectives into our lives. Without that effort, it’s possible to just use the experience as a temporary escape.”
Escapism during sessions can prevent this deeper therapeutic work from unfolding. As guides, it is crucial to recognize this tendency in clients and encourage them to fully confront rather than avoid inner challenges requiring healing. With care and courage, psychedelics can catalyze understanding rather than provide an outlet for escapism. The presence of these personality traits doesn’t automatically rule out psychedelic sessions, but they do bring about challenges.
Narcissistic Anxiety: Challenges for Vulnerable Narcissism in Psychedelic Therapy
Narcissistic anxiety often stems from fragile self-esteem and intense fears of imperfection or criticism. This manifests in hypervigilance around image management, outward perfectionism, and extreme defensiveness. Psychedelic therapy can uniquely challenge these tendencies.
The open vulnerability and lack of control induced in psychedelic states counter the rigid self-protection and outward confidence of narcissistic strategies. Unusual effects like visions or synesthesia may be perceived as defects exposing flawed self-image.
As psychiatrist Julie Holland explains, “Psychedelics can powerfully disrupt a narcissist’s sense of stability and invulnerability, exposing the fragile self-esteem underneath.” This can evoke defensive behaviors aimed at denying any imperfections and reestablishing an image of superiority.
Guiding those with narcissistic anxiety requires recognizing these vulnerability triggers. With care and compassion, guides can encourage self-acceptance and relinquishing of false self-constructs. However, for those unable to move beyond deeply rooted narcissistic worldviews, psychedelic therapy may offer limited benefits or even exacerbate anxiety. Mindfully screening clients and fostering an open, non-judgmental space is key. It’s not a strict contraindication, but progressing with this personality trait can be extra challenging.
Conclusion: Optimizing Psychedelic Therapy Requires Careful Evaluation and Implementation
When carried out responsibly, psychedelic therapy offers tremendous potential for healing trauma, addiction, and other mental health conditions. However, realizing these benefits requires a thorough evaluation of risks and careful implementation to recognize when psilocybin might not be the best choice.
As with any powerful intervention, psychedelics must be approached with respect and caution. Certain pre-existing conditions like mania and escapist tendencies can limit potential benefits and amplify harms if not properly addressed. Careful screening, dosing, and integration support are crucial. It’s important to note that some of these symptoms can be the result of another underlying condition and should not be understood as absolutely excluding a person from enjoying or benefiting from psychedelic experiences. For example, people living with chronic pain may develop avoidant or escapist coping mechanisms or appear emotionally detached as a way of dealing with the underlying pain condition. These coping mechanisms might similarly be employed as approaches to handle the frequent psychedelic sessions, which are often necessary to maximize the physical advantages of these substances. In these cases, it should be acknowledged that the symptoms are a normal response to the suffering they are experiencing. In these cases, psychedelics may be uniquely helpful addressing both the underlying pain as well as the associated psychological symptoms, allowing people to reconnect with their body and emotions in a healthy and more fully actualized manner.
The psychedelic experience also needs to take place in a contained therapeutic context, not recreationally without support. As researcher Katrin Preller explains, “Guided psychedelic therapy has a different teleology than unguided recreational use. Music, guidance, and integration support can help lead to meaningful wellness outcomes.”
At Eleusinia we recognize the potential risks of the mindless enthusiasm that permeates the psychedelic therapy industry. We also take great care to be mindful of emotional detachment, escapism, narcissistic anxiety, mania, and the specific risks they present. While psychedelics like psilocybin can offer lasting relief in guided, therapeutic contexts, certain mental health conditions and personality traits may necessitate extreme caution or avoidance. To maximize the benefits of psychedelic therapy, it’s crucial to approach it responsibly. The future of this promising field lies in mindfully and ethically fostering human growth and healing.