Part V
Chapter 29: Psychedelics
Estimated reading time: 23 min
Medical/Legal Caution
Psychedelics are high-risk catalysts, not casual tools.
This chapter is harm-reduction education, not an invitation to self-administer, self-prescribe, or stop or change medication. Legal status varies by jurisdiction; in many places, psychiatric use of classic psychedelics and MDMA remains investigational or legally restricted outside locally approved research, clinical, or other regulated settings.1
Do not combine lithium with classic psychedelics. Published reports associate the combination with seizures and serious reactions. If lithium is involved, stop here and speak with the prescriber or a physician before considering any altered-state container.2
If psychosis or bipolar spectrum is in the picture, stop here until a qualified psychiatric or medical clinician has cleared the risk.
Some combinations, especially multiple serotonergic drugs or MAOI-containing preparations, can raise the risk of serotonin toxicity. Serotonin syndrome can be life-threatening. Have the exact combination reviewed by a prescriber or pharmacist before considering use.3
Before you treat any room as safe, audit the Medical Screening: Breathwork, Substances, and Return Capacity and Facilitator Vetting & Safety Checklist sections in the Checklists and Materials appendix.
If you cannot reliably return to regulation with breath, orienting, grounding, and the somatic practices described in Part V, this is a No-Go. Build capacity first.
Psychedelics—substances that can profoundly alter perception, emotion, and meaning—stand at a volatile threshold on the Spiral Path.
They may flood the psyche with archetypal imagery, loosen the grip of rigid narratives, offer vistas into the Entangled Firmament, or momentarily part the veil toward the quiet Void.
Yet the flash is not the fire.
Lasting change shows after the peak, in what deliberate integration practice tests, selects, and reinforces in ordinary life.
An experience alone is not transformation; it is a spark.
With enough containment, a spark becomes hearth-fire: warm, bounded, life-sustaining.
Without containment, sparks become wildfires: dissociation, inflation, retraumatization.
Psychedelics are a paradox: revealing and destabilizing. They are studied as possible treatments in controlled settings, yet can cause harm when screening, legality, or aftercare are thin.
Curiosity is human; discernment is sacred.
Direct experience is never required—and not always wise.
It can be enough to study these substances, understand their context, and gaze with reverence from the trail’s edge.
A Parallel Path of Capacity
Sober practice can open profound depth, given time and consistency.
Many monastics, mystics, and embodied teachers who shaped contemplative traditions did not rely on psychedelics. Their traditions developed disciplines of repetition and devotion.
Micro-Útiseta is one such discipline: a brief vigil in which you stay regulated and attend to your surroundings. Stillness, attention, and contact can shift perception without taking a psychedelic.
If you feel no pull toward these substances, or if your body and history say “no,” trust that. Your path is not lesser. In many ways, it may be simpler: no medication interactions or legal risks from taking psychedelics, no chemically induced peak to unpack afterward. Capacity can grow through practice that fits your needs, with support and time to recover.
A better question than “Have you used psychedelics?” is: “What are you practicing, and how is it changing you?”
Counterfeit Transcendence: Spark Without Hearth
The same trap that appears in addiction can appear here in more luminous clothing: Counterfeit Transcendence.
A psychedelic state may be profound. The danger begins when chemistry is asked to keep delivering the transcendence that daily life has not been rebuilt to hold.
The Form Body still has to metabolize what the Soul Body touched. The nervous system must learn how to live differently when the vision is gone.
This is why the Law of Integration matters more than the peak itself. The point is not to visit the infinite so the ordinary can remain spiritually dead. The point is to bring the infinite back until the ordinary becomes more truthful, more sacred, and more embodied. The same law can deepen truth or distortion; the substance does not choose the direction for you.
There is also a cost to sight. If a catalyst lets you see more of the web, you lose the right to pretend you do not know your impact inside it. True vision strips false innocence; it does not grant exemption. You do not get the vision of a god and the accountability of a tourist.
Transcendence found in the state needs to return as more presence while washing dishes, holding a boundary, or looking into a partner’s eyes. Without that return, the Law of Integration may still be operating: repeated escape can integrate avoidance as a default route.
Somatic Capacity Comes First
Before courting non-ordinary states, we cultivate somatic intelligence: interoception, regulation, titration, pendulation. The nervous system is the crucible.
If the crucible cracks, intensity spills into chaos.
If the crucible is sound, intensity can anneal the psyche—hardening what must be firm, softening what must release.
A dysregulated baseline does not make these states more profound. It makes them harder to metabolize, easier to misread, and more likely to amplify what was already unstable.
Before You Enter
Before you enter, keep three things plain:
- Know the legal terrain and approach these substances with humility, especially where Indigenous lineages, ceremony, and reciprocity are involved. Ask who is being paid, who is being erased, and whether “reverence” is covering extraction.
- Prefer sources and containers that reduce ecological harm, verify what they are offering, and make stewardship visible instead of decorative.
- Let biology outrank romance: verify contraindications, medication interactions, dose uncertainty, and emergency readiness before treating any container as safe enough to enter. If medication, diagnosis, pregnancy, cardiovascular risk, seizure history, or suicidality is involved, bring your medication and health history to a qualified medical or psychiatric clinician for assessment before considering a container.
Psychedelic Settings and Support
- Clinical, medical, or approved research environments: should screen health history, document what is given, verify supply, name oversight, and have emergency response ready. When a provider claims clinical benefit, ask what licence, research oversight, or regulated protocol governs their work.
- Lineage-rooted Indigenous ceremony: may carry deep tradition and established guidance, but its organisers still need to account for medications and health history and arrange access to emergency care.
- Unlicensed / self-proclaimed facilitators: quality varies widely; warmth, ceremony, and spiritual language are not accountability. Support is not treatment. Treat participant screening and honoured stop-conditions as non-negotiable.
- Personal use: may mean being alone, with trusted peers, or with a sober sitter. It may reduce some power dynamics, but it does not guarantee formal screening, emergency response, or reliable aftercare. A barely known sitter can become a risk, and improvised peers cannot carry a destabilizing aftermath.
Medicine Is Not a Wand
A substance does not become medicine because it is ancient, visionary, natural, intense, or wrapped in reverent language. Medicine requires a field of responsibility. That includes screening, known doses, contraindications, records, informed consent, emergency response, follow-up, and recourse when harm occurs.
Without that web, medicine can become marketing. A facilitator may be careful, rooted, and steady; that can matter. But if the role carries no medical or licensed clinical responsibility, its honest name is support. When support is inflated into “I heal trauma,” “I treat depression,” “I reset your nervous system,” or “the medicine knows what you need,” the room has crossed into medical cosplay.
In a room stripped of clinical accountability and genuine lineage, the honest role is closer to bartender than healer. A responsible bartender knows the limits of the work: serve the intoxicant, watch the room, set limits, and refuse more when safety requires it. They do not pretend the drink diagnoses grief, cures trauma, or grants authority over another person’s soul.
The danger is not only the substance. The danger is the triangle of intoxication, suggestibility, and unearned authority.
Do not grant medical authority to anyone who is not carrying medical responsibility.
Stacked Altered States: Breathwork, Mushrooms, and Euphemism
Rooms that combine psychedelics with high-ventilation breathwork deserve special caution.
Breath is not neutral. High-ventilation methods use sustained rapid or forceful breathing, which can lower carbon dioxide. Even without substances, these methods can produce tingling, dizziness, muscle spasms, chest discomfort, panic-like sensations, or altered experience.4 People report intense emotion and dissociative effects with some methods. These are not predictable effects of breathwork as a whole.
Add mushrooms, MDMA, cannabis, ketamine, or another psychoactive substance, and the practice combines two state-altering inputs. Their joint risk has not been measured well. That uncertainty calls for stricter screening, sober monitoring, and a clear stop plan.
Stacked altered states require stacked responsibility.
Calling mushrooms “magic herbs” does not make the risk softer. It makes the disclosure weaker.
If it intoxicates, say so. If it is illegal or legally restricted, say so. If it can destabilize, say so.
Those offering psychoactive substances must disclose what is known and uncertain about the dose and supply. Name contraindications, psychiatric risks, and medication interactions. Explain the emergency plan and the limits of the facilitator’s role.
Sacred language does not absolve ordinary duty. The more sacred the room claims to be, the more plainly it must speak.
Readiness and Reasons to Wait
A “no” or “not sure” on any of the five questions below marks a clear No-Go. Stop here. Five yeses are not permission to proceed.
Preparation matters, but some medical risks cannot be resolved by building capacity.
If the nervous system already carries too much load, altered-state work adds to that strain. Give it stabilization, not more volatility.
Somatic Baseline: When you feel overwhelmed or shut down, can you reliably regain orientation, connection, and steadiness using breath, orienting, and grounding?
Shadow Literacy: Are you already working with parts and shadow, and can you name your escape hatches: spiritual bypass, intensity-chasing, or the Rescuer role?
Support & Container: If you are considering lower-dose or less destabilizing use outside a formal container, have you named that risk plainly, arranged a sober, trusted sitter, and made a clear escalation plan? For deeper or more destabilizing work, are you relying on real aftercare and experienced, grounded help rather than improvised peers alone?
Intention Integrity: Is your motive sober care, learning, or stabilization, rather than novelty-seeking, social pressure, or escape from difficult emotion?
Biological Reality Check: Have contraindications and drug interactions been properly verified against your health history by someone medically qualified to assess them?
The Psychedelic Landscape: How It Can Feel
Psychedelic and dissociative drugs can alter mood, thought, perception, and a person’s sense of reality. Mechanisms open doors, but your experience inside them is lived through the body and psyche.5
Classic Psychedelics
Classic psychedelics such as psilocybin, LSD, and DMT/ayahuasca are commonly discussed through serotonin 5-HT2A receptor activity. Some brain-imaging research links them to changes in how the Default Mode Network (DMN) works. In lived experience, this can feel like the familiar narrative thread of “I” loosening.
Stories and roles may fall away, revealing a wider, quieter witness or a sense of dissolving into a vast, entangled field—echoes of the Entangled Firmament and glimpses toward the Void.
Colours may appear more saturated, time less linear, and personal history may surface as vivid scenes or archetypal visions.
With ayahuasca, MAOIs and purgative effects can create intense somatic waves: nausea, shaking, heat. Those waves ask for grounded, experienced support.
Empathogens
Empathogens such as MDMA can feel like a softening of inner armor as serotonin and oxytocin signalling shifts. Fear and defensiveness may recede, allowing warmth, trust, and affection to come forward.
You may experience a tender, almost childlike openness. Researchers are studying whether MDMA-assisted therapy can help people with severe PTSD approach difficult memories with compassion.6 That formal research context is not a reason to improvise care. Without containment, the same openness can lead to over-disclosure, looser boundaries, or idealizing others.
Outside controlled settings, MDMA also raises practical body risks. These include overheating, dehydration or overhydration, strain on the heart and circulation, adulterated supply, and sleep disruption. A tender crash afterward can be misread as revelation or truth about a relationship.
Dissociatives
Dissociatives such as ketamine act through NMDA receptor antagonism. The experience may feel like floating outside the usual self-story, as if watching your life from a slight distance.
Ketamine and esketamine sit in a different legal and clinical category from classic psychedelics and MDMA. In some jurisdictions, ketamine is approved as an anesthetic, while esketamine has specific supervised psychiatric indications. Other uses, including many compounded or off-label ketamine offerings, require careful scrutiny and may not carry the same regulatory oversight.7
Ketamine’s distance is not automatically therapeutic distance. Its risks include sedation, dissociation, blood-pressure changes, respiratory depression, misuse, worsening psychiatric symptoms, and bladder or urinary symptoms. All belong in the conversation, especially outside monitored care.
The same distance can become seductive or destabilizing. It may draw someone toward disconnection when embodied life feels too costly, or toward fragmentation if grounding and integration do not follow.
Each of these landscapes can be awe-inspiring, disorienting, or both.
Some harms do not end when the acute state ends. Panic, insomnia, derealization, depersonalization, or intrusive imagery may require prompt professional support. So may lasting perceptual disturbance, manic activation, psychotic symptoms, suicidality, or a feeling of being unable to return. Do not let a facilitator reinterpret persistent destabilization as “integration” when the body is clearly asking for clinical help.
None are inherently “higher” than sober consciousness. They are different thresholds, each asking something different of the body on the way back. The question is not just what you see there, but how you travel and how you return.
Does the ordinary sense of self reveal the whole of who we are? Four thresholds offer a way to explore that question: psychedelic trip, orgasm, near-death experience, and death itself. Reports from the first three can illuminate changes in ordinary self-filtering. Death marks the limit of what such reports can establish.
These thresholds differ in ethics, access conditions, and evidentiary weight. They are not interchangeable authorities. Psychedelics offer one doorway into the question, not its answer.
Within the Altered State
Once an altered state is entered, the work shifts from deciding whether to go in to learning how to move inside it.
Three orienting skills matter most: Surrender, Anchoring, and Steering.
Surrender, Ego Dissolution, and Discernment
Surrender in this context means yielding to the flow of experience while maintaining a thin, golden thread of witnessing.
In surrender, you are not fighting the waves; you are allowing them to move through you while remembering, “I am the one feeling this, not the feeling itself.”
Two different losses can happen here, and they must not be confused.
Ego Dissolution: A temporary weakening or dissolution of ordinary self-boundaries and self-referential structure. Reports range from loosened identity to little or no felt separation between self and world. Witnessing may persist or become difficult to access. “No one is present” is one possible report, not the definition or a depth target. The experience can feel profound, frightening, welcome, or unwanted. It is neither proof of truth nor evidence of successful integration.8
Loss of Discernment: The witness may still be present while sovereignty collapses. Thoughts become absolute truth, and authority is handed to facilitators, group beliefs, or inner narratives. The phrase “this too shall pass” becomes inaccessible. This is where loops can harden, dependency can grow, and boundary violations can become “normal.”
Awe, terror, entity-contact, and revelation may carry signal. Felt certainty inside the state is something to test later, not authority to obey now.
In practice:
- When intensity rises, experiment with saying internally: “Yes, this too,” while also silently naming, “I am aware of fear / grief / awe moving through.” This dual awareness is surrender.
- If you find yourself thinking, “This entity controls me,” “This facilitator is God,” or “This moment defines my entire life forever,” you may be sliding into loss of discernment. That is your cue to slow down, breathe, and reach for anchors.
Anchoring: Breath, Touch, Floor
Inside altered states, abstract reminders can be hard to access. Simple, repeatable anchors matter.
Use these anchors while you can still orient, choose, and communicate with sober support.
- Breath: Notice the actual sensations of air entering and leaving—cool at the nostrils, warm at the exhale, chest or belly rising and falling. Count a slow inhale for 4, exhale for 6. If you can’t count, simply whisper “in / out.”
- Touch: Place a hand on your chest, belly, or thighs. Feel temperature, pressure, fabric texture. If appropriate and consensual in a group, grip a familiar object (stone, cloth) as a tactile anchor.
- Floor: Feel the contact of your feet or body with the ground, cushion, or bed.
Let the ground take some of the weight. Sometimes that first sense of contact is how the body remembers it does not have to hold the whole surge alone.
When fear or intensity rises, silently cue yourself: “Breath. Touch. Floor.”
These three are the return line.
Steering: When the Mind Starts Looping
Looping is common: a thought, image, or fear repeats on a tight feedback loop (“I broke my brain,” “It will always be like this”).
The more you argue with a loop, the tighter it binds.
When you notice looping:
- Name the Loop: “Mind is looping on ‘I’m stuck like this.’” Treat it as weather, not prophecy.
- Move the Body: Change posture—sit if you were lying down, stand and shake out your hands, or walk slowly around the room if safe. Gently stretch neck and shoulders.
- Change the Inputs: Soften or change the music; dim bright lights; ask a trusted sitter to speak a simple, grounding sentence (“You are here. This will pass. Breathe with me.”).
- Return to the anchors: Breath, Touch, Floor—over and over, even if the mind keeps shouting. You are training attention to follow sensation instead of story.
If looping escalates into terror or confusion, and you are with a sober sitter or facilitator, name it out loud: “I’m looping and scared.”
This simple act of bringing the loop into relationship is often the first thread back to yourself.
These inner skills help you stay oriented, but the surrounding container also matters. How capable and ethical are the people holding it? How clear are the agreements, and what help is available if something goes wrong?
The Larger Shadow: Power, Profit, and Vulnerability
Regulated medical access is still rare in many places, so many encounters unfold outside clinical structures.
Altered-state work carries biological and legal risk in every context. When a facilitator or group container is involved, power becomes part of the experience and part of the risk.
In these liminal fields, vulnerability, money, and longing meet. Spaces that promise healing can reenact harm when power goes unchecked, charisma stands in for integrity, or community pressure overrides individual consent.
Here is a direct mirror: would you trust this facilitator to take your full medication list and history seriously? Would they care for your vulnerable body and respect your right to stop? Expect the care you would want around a medical procedure with serious consequences. If either answer is no, do not treat the container as “medical” just because it borrows clinical language.
From the Dragon’s vantage point, the lesson is not “Never enter,” but “Enter only from sovereignty.”
Reasons to Leave
- Claims that the substance is “always safe” or denial of biological risks.
- Pressure to dose beyond your explicit consent.
- “Trust the medicine” used to override your boundary, medical concern, dose hesitation, or wish to stop.
- Sexualization of the space or touch without explicit, prior permission.
- Discouraging outside help or professional care.
- Claims of exclusive power or induced dependency (“Only I can heal you.”).
Any one is enough to end the encounter. Bring a sober sitter or trusted person into the exit if one is available.
Make the agreements travel with you: boundaries, explicit consent for touch, aftercare, and clear stop-conditions.
Research and Informal Settings
Research rooms can lend public confidence to practices that happen elsewhere, but research rooms are held differently. At their best, they screen health history, control dose and supply, keep sober medical response close, and return to integration over weeks. Most informal rooms do not. Supply may be unverified, screening thin, emergency plans vague, and sustained follow-up absent.
Outcomes reported in research do not transfer by default to unregulated spaces. Without screening, sober staff, and follow-up, an experience presented as therapeutic can leave someone destabilized.
Reporting Harm
Regulation does not guarantee safety, but it can leave a route for reporting harm. Many spiritual, ceremonial, and informal medicine communities have no comparable path beyond the container. Review within the same lineage, organization, friendship network, or flow of money remains internal accountability. It is not independent oversight. Ask who can receive a report, what power they have, and whether the facilitator can influence them. If no credible route exists, let that weigh against the depth and risk of the work.
Set, Setting, and Integration
Set and setting shape the experience; integration shapes what follows.
Set (Mindset): Your inner state—intentions, readiness, neurotype, and history.
In this mindset, let intention be orientation, not demand. Prefer process-questions (What is my body ready to notice?) over outcomes (Fix my trauma now). The deeper intention is discerning surrender: “I will meet what emerges without forcing it, then integrate only what survives sober testing.”
Neurotype matters: neurodivergent sensory/cognitive patterns can amplify overwhelm or alter processing. Plan adaptations (simplified sensory field, slower pacing, clearer cues, clear ways to decline or stop) and arrange support that understands neurodivergent processing for integration.
Setting (Environment): The physical and social context must be safe, comfortable, and prepared for emergencies. In facilitated settings, this means sober, ethical staff with clear stop-conditions and response protocols; in non-facilitated settings, the absence of that staffing must be treated as a major risk variable.
Integration (Embodiment): The intentional process after the catalyst’s effects fade: stabilizing the nervous system, discerning what deserves reinforcement, and translating tested insight into sustainable behavioural change.
Peak states are weather. Character is climate. What you reinforce afterward changes the climate.
Integration Practice Is the Work
Integration practice is the fire of the Crucible across the Five Energetic Bodies.
The work settles in Form (sleep, food, movement), moves through Eros (life-force and emotion), and clarifies in Soul (memory, meaning, values, and responsible choice). The Archetypal Body gives roles, myths, and shadows their shape; the Void Body tempers the whole with silence and spaciousness.
Without anchoring through these layers, the spark either burns uncontained—or never catches at all.
The Law of Integration:
What is reinforced becomes integrated.
What is integrated reinforces itself.
A psychedelic journey can feel like a direct, amplified encounter with reality. You may witness a beauty not yet known, or a terror long held down may finally surface. When that meeting breaks, the pain can be truthful too. What it revealed may remain, even when the form of the meeting cannot. A remembered tenderness or a sense of wonder can matter while its meaning remains open. The Dragon is forged there, in what you deliberately reinforce once it has passed.
Leave that return unsupported, and what you reinforce may be the distortion: terror worn as identity, beauty used as permission.
That distortion has familiar shapes. Spiritual Bypassing uses the beauty, or any transcendent insight, to step around shadow and the repair a relationship still needs. Fragmentation is what happens when the terror, or any intense material, arrives and there is no way to hold it. Ego Inflation mistakes a passing dissolution of the self, or a passing sense of unity, for an enlightenment that has already been achieved. The Oneness Shadow, a form of the Ethical Shadow, appears when “all is one” is allowed to outrank consent, boundaries, impact, consequence, or repair.
Phase 1: Somatic Stabilization
In the early aftermath, while sleep, arousal, mood, or sense-making remain unsettled, prioritize rest and regulation over analysis.
When you feel more settled, return to the Somatic Triad (Exhale → Orient → Sensation) before interpreting the experience or adding activating practices. Rest, food, water, and quiet time in nature can help the Form Body recover.
Avoid major life decisions, charged conversations, or pronouncements until ordinary orientation and steadiness return, unless safety requires action. Insights, visions, and emotions can arrive tangled together. Part of integration is learning to tell them apart; no verdict is needed while the ground is still moving.
Phase 2: Cautious Meaning-Making
Once ordinary orientation and enough nervous-system stability have returned, you can begin the gentle work of meaning-making. The key is to witness and explore, not to force a conclusion or a tidy narrative.
This phase often moves through Soul, but not only there. Archetypal may arrive as symbols, roles, and images; Eros as charge, feeling, and longing; the Void Body as silence, spaciousness, or what cannot yet be said. Use reflective journaling, voice notes, drawing, or other creative forms to give shape to the experience. Do not judge what comes out; simply capture the textures, images, feelings, and silences.
Choose people whose roles are plain and whose backgrounds you have checked. Therapists and clinicians can help with clinical material within what they are trained and licensed to do. Facilitators can support meaning-making, ritual containment, or integration only within the limits of their own training and role. Medication, diagnosis, suicidality, and psychiatric risk belong with medical or psychiatric care that can answer for what happens. The right person can stay with ambiguity, track impact, and help you tell genuine insight from egoic fantasy. They do not take authority over your meaning.
Phase 3: Embodied Change
Over the following months, look for change in how you live and relate. Identify one small, sustainable action that embodies what has survived sober testing. It might be keeping a boundary you used to let slide or beginning a difficult but needed repair in a relationship. It might be making time for music or returning to unhurried company.
As you make these small changes, you begin to reshape repeated patterns across the Five Energetic Bodies. The appeasing pattern practices saying no; the isolating pattern practices asking for help. When such patterns appear as roles, myths, or images, the Archetypal Body gives them symbolic form; the chosen behaviour is carried by the whole person. This is slow, deliberate work, carried by one chosen action at a time.
The sober path is complete in its own right. Don’t chase the spark—become the Dragon through what you practice next.
As a U.S. regulatory example, the FDA frames psychedelic drug development around investigational products and clinical-trial design challenges, including subject safety, abuse potential, psychotherapy roles, and efficacy standards: FDA, FDA Issues First Draft Guidance on Clinical Trials with Psychedelic Drugs (2023).
In 2026, the FDA also announced regulatory actions supporting development of serotonin-2A agonists and related products. It emphasized that allowing a noribogaine study to proceed did not mean the drug had been approved or found safe or effective: FDA, FDA Accelerates Action on Treatments for Serious Mental Illness Following Executive Order (2026).
NIDA similarly describes ongoing research into possible medical uses while noting that many people use psychedelic and dissociative drugs outside medical settings: NIDA, Psychedelic and Dissociative Drugs.↩︎
For a published analysis of online reports associating classic psychedelic coadministration with lithium with seizures, see Sandeep M. Nayak et al., Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures, Pharmacopsychiatry (2021).↩︎
MedlinePlus describes serotonin syndrome as a potentially life-threatening drug reaction, often occurring when multiple medicines or drugs affecting serotonin are taken together: MedlinePlus, Serotonin syndrome.↩︎
MedlinePlus describes hyperventilation symptoms including dizziness, difficulty thinking clearly, chest discomfort, rapid heartbeat, numbness, tingling, and muscle spasms: MedlinePlus, Hyperventilation. For high-ventilation methods specifically, Guy W. Fincham et al. review their physiological and subjective effects, limited adverse-event reporting, and contraindication concerns: High Ventilation Breathwork Practices, Neuroscience & Biobehavioral Reviews (2023). Neither source establishes a quantified interaction with psychedelics.↩︎
NIDA notes that psychedelic and dissociative drugs can temporarily alter mood, thoughts, perception, and sense of reality, with effects varying by substance, dose, biology, set, and setting: NIDA, Psychedelic and Dissociative Drugs.↩︎
Jennifer M. Mitchell et al., “MDMA-Assisted Therapy for Severe PTSD: A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study”, Nature Medicine 27 (2021), 1025–1033. The trial evaluated MDMA with manualized therapy, preparatory sessions, and integration sessions.↩︎
NIDA distinguishes ketamine and esketamine’s FDA-approved uses from other psychedelic and dissociative substances still under study. It notes ketamine’s approval as an anesthetic and esketamine’s approval for depression-related treatment: NIDA, Psychedelic and Dissociative Drugs as Medicines.
The FDA’s compounded-ketamine alert makes the clinical boundary plainer. Ketamine is approved as an IV/IM anesthetic, not for any psychiatric disorder. Compounded ketamine products are not FDA-approved for any indication. Spravato (esketamine) is approved only for specified depression indications under a supervised REMS model: FDA, Compounding Risk Alerts (October 10, 2023 ketamine alert).↩︎
Matthew M. Nour et al. operationalize ego dissolution as a compromised sense of self and disruption of ego boundaries, while noting that its felt character varies with the person and setting: Ego-Dissolution and Psychedelics: Validation of the Ego-Dissolution Inventory, Frontiers in Human Neuroscience (2016).↩︎