James' World 2

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‘A sense of special significance began to invest everything in the room; objects which I would normally accept as just being there began to assume some strange importance.’

‘I became interested in a wide assortment of people, events, places, and ideas which normally would make no impression on me. Not knowing that I was ill, I made no attempt to understand what was happening, but felt that there was some overwhelming significance in all this …’

The first of these quotations is from an individual describing a psychedelic trip they took after taking peyote. The second is a person describing an experience of psychosis. While rarely looked at together today, experiences of psychedelics and psychosis share a lot of subjective territory. In the past, some scientists considered them to be different versions of the same experience. However, today, experiences of psychosis and psychedelics are seen as radically different. Examining the journey from that past approach to the current perspective reveals a great deal about our assumptions and values, and the limits and biases of the current day.

In the mid-20th century, researchers thought of psychosis and psychedelics as deeply entangled, and scientific comparisons between the two experiences were common; entire academic papers were spent contrasting detailed descriptions of experiences of patients diagnosed with schizophrenia and experiences of research participants who had taken psychedelic drugs. As a result of the close resemblance between these descriptions, many researchers believed that psychedelics induced a short-term psychosis, providing a perfect scientific model for those who wanted to learn more about schizophrenia. By inducing a ‘temporary psychosis’, researchers could observe biological changes in research participants who had taken a psychedelic, and compare these with measurements of patients diagnosed with schizophrenia. In the hunt for the mysterious ‘substance-M’ that could explain what was underlying both experiences, various candidates were considered, including adrenaline, norepinephrine, and serotonin. While the hunt for a common biological factor was unsuccessful, for decades many believed that these experiences were different versions of the same thing.

There was widespread scientific belief in the similarity between psychosis and psychedelics in the mid-20th century. But the years since have led to a remarkable divide between our understandings of these phenomena. In the 1960s, moral panic related to psychedelic drugs set in. At the same time, requirements for evidence in medicine were becoming more rigorous, and creating barriers for psychedelic research. Funding, access and permissions for research related to psychedelic drugs slowly dried up, and research into these fascinating substances was largely forgotten by psychiatry.

In the intervening decades, research related to psychosis has continued unfettered and changed shape radically. Gone is much mainstream interest in detailed descriptions of the experience of psychosis that psychoanalytically trained psychiatrists often sought out in the past. Instead, psychosis research today shares with the rest of psychiatry an often singular focus on neurobiological and genetic research. Investigations related to childhood, trauma, and social forces are given much less consideration and, importantly, much less funding. Psychoanalysis has fallen out of favor, in part because of the difficulty it had fitting into novel models of evidence being adopted across medicine (it’s difficult to conduct randomized control trials on the talking cure), and in part because psychiatry needed to prove it was consistent and replicable (these are challenging features to demonstrate in an approach as complicated and variable as psychoanalysis). In its place, a neurobiological model of psychiatry has been taken up, seeking explanations and treatments for mental disorders largely at the level of genes and neurotransmitters.

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