Commusings: Helping People Who Have Difficult Mystical Experiences by Jules Evans

Hello Commune Community, 

Psychedelics have long been celebrated as tools for self-transcendence. In the right circumstances, they can help us rise above the limited instruments with which we normally perceive phenomena and connect to something greater than ourselves. A good “trip" may provide a glimpse into what all the mystics and sages have been prattling on about for millennia: the self is an illusion. 

In the last decade, research into psychedelics has unearthed potential additional utility. Psychedelics may represent the biggest breakthrough in a generation for the treatment of cognitive dysfunction, depression and addiction. This activity has given rise to emerging funds, companies, and legislation in the psychedelic space.

While I have certainly stood atop mushroom mountain, I also remember, as a seventeen year-old rube, a most unfortunate psilocybin journey in which I visibly watched the oxygen disappear in blocks from the inside of the Madison Square Garden. This incident left me crumpled on the floor of the arena gasping for breath. Needless to say, I recovered. And while I certainly fancy an occasional peak experience, I am also quite content to find subtler moments of self-transcendence through meditation day-to-day. 

In this week’s missive, the brilliant Jules Evans explores the murkier side of psychedelics. His writing is always incisive, well-researched and tinged with quality British-isms. 

Drop me a line any time at [email protected] or follow my rantings on Instagram @jeffkrasno.

In love, include me,
Jeff

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Helping People Who Have Difficult Mystical Experiences

by Jules Evans

Every now and then, over the last few decades, survey companies like Gallup have asked Americans an unusual question: have you ever had a mystical experience? In 1960, just 20% of Americans admitted to having had one or more such experience, but by 2009, the number had gone up to 49%. 

What happened? The Sixties, and its long tail – drugs, Eastern wisdom, rock & roll, ecstatic Christianity, and a cultural shift in our attitude to the ecstatic, all made us less wary and more eager to seek such experiences, and tell people about them. 

There has been no national survey of mystical experiences since 2009, alas, but I would bet that the number is now way above 50%, for three reasons. First, the number of Americans who say they have meditated has tripled in the five years between 2012 and 2017. Second, the number of Americans who practice yoga went up 55% over the same time period. And finally, psychedelic use is rising sharply – LSD use rose 56% between 2015 and 2018, according to one paper. 

More meditation, more yoga and more psychedelic use means more people having mystical experiences. But not all those experiences are necessarily going to be easy, fun, or life-enhancing. Temporary journeys beyond your usual ego can be terrifying, and for a small percentage of people it can take time – days, weeks, months or even years – to return to a normal functioning state. These more difficult mystical experiences have been called ‘spiritual emergencies’, and we’re still learning what they’re like, and how to help people come through them to positive outcomes. 

Are we ready, then, for the coming spike in mystical experiences? 

• • •

We’re in a shroom boom. One company, Compass Pathways, which plans to offer magic mushroom therapy, debuted on the Nasdaq in November 2020 with a $1 billion valuation. New funds like Atai are raising hundreds of millions to invest in psychedelics. New companies are listing, new training programmes for therapists are launching, new states are preparing to legalize or decriminalize psychedelics.

Oregon looks set to be the first state where psychedelic therapy is legally available – the market is due to open in 2023. Other states, like Washington and Colorado, are set to follow. When I asked the CEO of one psychedelic retreat company how many new players are entering the market, he said ‘Too many. I’ve lost count.’  

It’s a nervy ascendance for long-term psychedelic practitioners dreaming of this moment for years. What if it all spins out of control?

Things will go wrong. Companies will go bust, investors will lose money, therapists will misbehave, people will have difficult experiences, some people will commit suicide, and there will be a media and regulatory backlash, just as there was in the Sixties. We can expect this. And the field should prepare for it now.

Companies can prepare by investing in public affairs and PR to plan for the backlash. But that’s not enough. The field should also prepare by investing a lot more in researching how psychedelic trips can cause psychological difficulties, and providing support for people when they do. How much is invested in this at the moment? Practically zero.

There is an assumption in the field of psychedelic therapy: ‘Yes, in the Sixties there were acid casualties, but they weren’t as careful as we are. If the set and setting are good, people don’t have difficult experiences. Or if they do, the experiences are still ultimately life-enhancing.’

This is a false assumption. People can still have difficult experiences — experiences of emotional disturbance and / or quasi-psychotic disorientation lasting several days or weeks — in very ‘held’ settings.

I personally experienced a week of profound dissociation, in which I thought I was either dead or in a dream, following a 10-day retreat at one of the best ayahuasca centres in the world. The actual retreat was very well run, but I still descended  into difficulties in the days after the retreat, and the centre provided little in the way of support. Luckily my friends did, but it could have gone much worse.

I also have a friend who got into an extended hypomanic / sleepless state for a month or so, and was put on anti-psychotics short-term, following a university’s psychedelic trial. Anecdotally, I hear about other people who got into psychological difficulties following participation in clinical trials. Not loads, but some.

Difficult trips can happen to novices, but they can also happen to experienced trippers. Tim Read, a psychiatrist who consulted for Imperial’s psychedelics lab, and the co-editor with me of a book on spiritual emergencies, tells me:

There is a tendency for people to access the really difficult layers of psyche (where healing potential is greatest) after some initial openings. Even quite experienced psychonauts may open in a safe setting to the point where they access their deepest wounds — and this can be overwhelming. These deeper layers are difficult and can feel hopeless or impenetrable.

Psychological problems following difficult experiences can last a while. In a Johns Hopkins survey of 1,339 participants who reported a ‘bad trip’ a year or more in the past, 24% said they experienced psychological difficulties (depression, anxiety, paranoia) for a week or more after the bad trip, and 10% reported these symptoms lasted longer than a year (all these trips were in non-clinical settings).

How can clinics or therapists best support people in the days, weeks, months and years after a difficult experience?

The answer is, we don’t yet know.

Matthew Johnson, one of the lead researchers at Johns Hopkins’ psychedelic research team, tells me:

I don’t think there is any research on this at all. I believe everything that is known really just falls into the category of clinical observation — basically what doctors have reported in case reports. A common thing is administration of anti-psychotics and/or benzos depending on symptoms. While I won’t say that is never called for, my impression is that these are way over used.

Tracy Cheung, chief communications officer at Compass Pathways, says: 

We still don’t know enough about how [difficult] experiences are integrated; there is definitely a need for more research, in clinical trials and through the collection of data from real world evidence.

While there is a lack of research on how best to support people after difficult trips, there is a lot of real-world experience, particularly among therapists working on ‘psychedelic integration.’ One of the most experienced integration therapists is Michelle Baker-Jones, who co-founded the Psychedelic Integration Circle in London. It meets once a month to help people process psychedelic experiences. Michelle tells me:

The current thinking is that difficult psychedelic experiences can generally be still useful unless happening in unsafe spaces where a re-traumatisation rather than healing of trauma occurs. In cases of spiritual emergency or ontological shock, again it is felt that with the right help, holding and acceptance of the experience these too can be beneficial. For the people that come to our integration groups…the group process really helps people to feel less stigmatised, alone and supported with these experiences.

Matthew Johnson agrees: 

My impression is that for the vast majority of people…what is needed is deep processing of the experience, basically a lot of discussion with a good therapist who does not just pathologize the fact that they took a psychedelic or had a challenging experience (I think that can really make things much worse). A therapist who knows psychedelics is likely important, but most others will pathologize the entire thing. 

• • •

Right now, the field does not have the support infrastructure in place to support the people who will inevitably have difficult experiences.

This is what I have found, so far. There is the TRIPP Network of therapists who are experienced in psychedelic integration work — this is 29 UK therapists, mainly in London and Brighton, who obviously have limited time and capacity to take on clients. MAPS lists 300 therapists who offer psychedelic integration on its websites. There are four UK psychedelic integration groups, all in London and Brighton. I found 15 or so other such groups in North America, via the website Psychedelic Support.

So there is zero clinical research on how to support people after difficult psychedelic experiences, and perhaps 20 psychedelic support groups in the UK and North America — and these are largely non-profit and run by volunteers. Compare that to the billions of dollars being poured into the upside of psychedelics — the miracle cure, the mystical experience, the ‘quantum healing’ you can expect over a weekend.

This is a case of investing entirely in the psychological upside of psychedelics, and barely investing a dollar in protecting people from potential negative effects. One sees a similar dynamic in other wellness markets.

Take anti-depressants, a $30 billion global market. It’s been going since 1987, and now 17% of the British adult population takes antidepressants regularly (other developed countries have similarly high usage rates). Yet it was only late last year, 33 years after SSRIs were launched, that the Royal College of Psychiatrists admitted antidepressants can lead to long-term dependency and nasty withdrawal symptoms, and recommended patients be advised of this.

How much support is there for people who want to come off long-term antidepressant use? How much have governments, psychiatrists and pharmaceutical companies invested in it? Zero. No groups, no programmes, no leaflets, not even a support line. 

Or take the mindfulness market, now worth an estimated $2 billion in apps, training courses, academic research, corporate wellness programmes and so on. What percentage of the $2 billion invested in meditation companies goes into supporting and protecting people from the negative side-effects of meditation? Basically zero. There’s one person at Brown University trying to support the thousands of people who get into difficulties when they accidentally exit their habitual ego. Shouldn’t the people making fortunes from mindfulness invest some of that money into protecting people from the occasional side effects? (For a good new book on difficult experiences in meditation, see this).

Every medicine has unintended side effects. A responsible healing modality is aware of those side effects, doesn’t deny them, and actively seeks to mitigate them.

But that is not how the wellness world typically acts. Instead, healing or transformation programmes focus entirely on the incredible recovery stories, the Quantum Healing. You feel better? Tell your friends! Sign them up! And if people get into psychological problems? Not our responsibility. You were probably messed up to begin with.

If you’re offering any sort of medicine and you’re not aware of and prepared for the side effects, should you be offering that medicine at all?

• • •

Investing in a proper infrastructure of integration could mean psychedelic companies and research labs committing at least 1% of their capital to integration research and services, particularly for difficult experiences. If the psychedelic market is worth roughly $5 billion, that means investing 1% — $50 million — in support for and protection against negative side effects.

There are already examples of this sort of responsible psychedelic investment. Tim Ferriss, for example, didn’t just invest in the upside, he also invested in Zendo, a psychedelic harm reduction collective, and volunteered to be a sitter at Burning Man. Cody Swift, one of the heirs to the UPS fortune, also invested in Zendo via his Riverstyx foundation.

That $50 million could be used for:

• Investing in more psychedelic integration circles and supporting peer-to-peer training programmes to train laypeople how to run such circles (Zendo is launching such a programme this year).

• Investing a lot more in integration training and provision at retreat centres and clinics, and honestly sharing your results with the field.

• Supporting psychedelic support lines and web services (the first of which is launching this year).

• Supporting research to gather, analyse and share people’s personal accounts of what difficult experiences were like (both the variety and similarities), and what helped people integrate them. 

Finally, and this is the hardest part — we need a cultural shift in our attitude to the ecstatic. At the moment, psychedelic therapy offers Westerners a doorway to ecstatic experiences, but within a culture that is almost completely ignorant of such experiences, and prone to either rejecting them or fetishizing them. People are going through that doorway with their incredibly elaborate and well-defended Western egos, and unsurprisingly for some people the journey through the door and back is hard.

Ros Watts, clinical lead at Imperial’s trial on psychedelics for depression, and co-founder of the Psychedelic Integration Group, told Rebel Wisdom:

The current protocols we have are very short term. People experience a huge opening, they see themselves differently, they feel more connected and thin-skinned, life affects them more. Then they go back into their old life and they don’t have support. And it can be really hard for them, really destabilizing. We’re learning that this way of working needs such a solid interpersonal container and strong network of support, and we don’t have that in place yet.

Michelle Baker-Jones agrees: 

Ultimately it would be great if each city had a psychedelic integration group that could be attended, and funds were available to assist in this rather than being reliant on volunteers to provide a such a crucial service. These groups will become incredibly important not only for the help they provide but also for the potential they hold to create community and connection.

We’re a long way from that quilt of support groups yet. At the moment, psychedelics offer a very modern sort of religion — long on ‘experience’, short on community. That risks exacerbating the loneliness and isolation that cause a lot of our suffering in the first place.

• • •

Jules Evans is a philosopher, wisdom teacher, and the author of Philosophy for Life and Other Dangerous Situations (2012) and The Art of Losing Control (2017) and co-editor of Breaking Open: Finding a Way Through Spiritual Emergency.