At 48 years old, a full-time carer for her severely autistic daughter and a former “huge prohibitionist”, Dianne* isn’t your typical psychonaut. But for years she has struggled with how to treat her PTSD, which stems from child sexual abuse. She's never felt the antidepressants her doctor prescribed made much difference, and they came with “very off-putting” side effects.
Then, three years ago, Dianne came across a 2017 study on psilocybin-assisted psychotherapy led by Dr Robin Carhart-Harris, head of the Centre for Psychedelic Research at Imperial College in London. The study found that a single course of treatment could immediately reduce symptoms of depression by up to 50 percent, with lasting effects. She knew she had to try it. But a middle-aged woman in rural NSW doesn't typically have ready access to schedule-9 prohibited substances.
What she did have, of course, was Facebook, so she joined several groups set up for the seemingly innocuous purposes of mushroom identification. One day, a stranger in one of these groups identified the 50 grams of fresh mushrooms she had foraged in a friend’s cow field as panaeolus cyanescens, or “blue meanies”. That stranger instructed her to take them all in one go, and she did.
It’s a large dose, even by clinical trial standards. And it was those trials she was trying to emulate. Luckily, Dianne had a good experience. “It was amazing,” she says. “Oh my god, it was. For the first time in a very, very long time, I felt normal”. She says she felt changes in her character immediately: “Before, things were always so hard to do, even just washing the dishes. [But] afterwards it was like, I could wash the dishes. I could just go in there and just do it.”
Recent reports out of research centres like Imperial College London, Johns Hopkins University and St Vincent’s in Melbourne highlight the apparent efficacy of psychedelics in treating mental health conditions. But the slow pace of research and development, not to mention the legal obstacles and financial demands, has left those interested in the benefits frustrated. Some of these individuals are taking matters into their own hands, congregating on social media to identify, discuss, and then dose on magic mushrooms.
This is exactly what Dr Carhart-Harris hoped his research would not inspire, telling the Guardian that "I wouldn’t want members of the public thinking they can treat their own depression by picking their own magic mushrooms. That kind of approach could be risky.” So are the likes of Dianne putting themselves in danger by self-medicating in this way? And how many Diannes are there, willing to improvise their own treatment? Dr Stephen Bright, a lecturer at Edith Cowan University and co-founder of Psychedelic Research in Science & Medicine (PRISM), has first-hand experience of the increase in people “seeking out these treatments in an underground environment”. He personally receives more than 20 emails per week from people looking to access psychedelic therapy, or seeking advice on how to perform it on themselves.
“I try to be as empathetic as possible”, says Dr Bright, “[But] I've seen… people having really distressing experiences.” He says the distress is often the result of an “inappropriate environment, inappropriate intentions, or preexisting health conditions that have been exacerbated by the psychedelic drugs.” Psychedelics are notoriously unpredictable, he stresses. “Even if you set your intention, that might not be where you go on your journey because they [mushrooms] are hypersensitive to your pre-existing psychological state and the environment you're in. So it's really hard to predict what can happen”.
If people are going to treat their mental health in this way, Dr Bright says, then they need to ensure they are prepared by having “harm reduction mechanisms in place” such as proper education (through sites like Erowid) and peer support during the experience.
Dr Ben Sessa, a consultant psychologist and psychedelic researcher at the University of Bristol, has conducted psychedelic-assisted trials using psilocybin and works largely with patients suffering acute, treatment-resistant PTSD. He argues that the drug experience itself is actually the least important aspect of treatment—clinical trials are almost always embedded within a course of therapy: “Three preparation sessions without psilocybin, then there’s a psilocybin session, then there are three non-drug integration sessions.”
The material Dr Sessa works through with his patients during their drug-assisted sessions is often “really difficult and overwhelming”, he says, and requires weeks of integration to process. When “people [take] these drugs because they've heard about the clinical work, the problem is not the drugs. It’s missing out on the non-drug support sessions.”
Dr Sessa does believe psychedelics are “perfectly safe” when “taken in a safe and judicious manner”, but says anyone consuming them “without the adequate preparation, and then the adequate integration afterwards” risks “really knocking themselves sideways”. He says he sees a lot of patients who require “integration work” because they have “gone along to some retreat in Peru or wherever, and they’ve had this drug experience and they've … not been given any support afterwards.”
In other words, anyone taking psychedelic-assisted therapy into their own hands risks making their mental health issues worse. Although mushrooms have the lowest incidence of emergency room admission of any drug, including cannabis, Dr Sessa says failure to integrate an “anxiety-provoking experience” brought on by psychedelics can cause those feelings to persist long after the trip has ended.
For people with more complex mental health issues, the problems could be far worse. Melissa Warner, co-founder of The Australian Psychedelic Society and a board member of PRISM, explains that there is “currently no evidence to say that more complex mental health disorders can be helped” through the use of psychedelics. One study published in the journal of psychopharmacology found that there is even a “potential risk” of psychedelics “provoking the onset of prolonged psychosis, lasting days or even months”. This is seen in 1.8 cases per 1,000, the study points out. The website Trip Safe cautions more broadly: “It is not a good idea to take any psychedelics, including mushrooms, if you or any of your first or second-degree relatives have a current or past history of psychotic disorders”.
For most people, however, psychedelics are “magnifiers of the environment that you're in”, Warner says. “[So] if you’re in an environment that makes you feel anxious or alone, that might be magnified”. This is what makes them so useful in the therapeutic setting, as the therapeutic process becomes magnified or “catalysed”.
Warner is very aware of the blurry line between recreational and therapeutic usage. Psychedelics, she says, don’t provide “an escape” from your mental health issues. “I think there’s a risk [when] people perceive them to be a bit of a distraction or a bit of fun, and they then have a much more complicated situation on their hands.”
After a transformative first experience, Dianne says she felt “the excuses” and the “self-sabotaging” creeping back after a few weeks. Because of the positive effects of her first trip, she was keen to try again, though this time she admits it was more of an attempt to escape. “Because of things that were going on at home and in life in general, I did go into it with a 'just make me numb for a little bit' sort of mindset.”
It wasn’t a bad experience, Dianne says. It was “just meh”, and didn’t leave her with the profound feelings of healing she experienced the first time. Nonetheless, despondent about her chances of accessing psilocybin-assisted psychotherapy in a clinical setting, she plans to continue seeking out mushrooms when and where she can. “I will go my entire life being the way I am [otherwise]," she says, through tears. "And that scares me.”