people in states of psychosis often behave in frightening ways out of their control, and do and say hurtful things to those around them. if someone hurts you or does something very frightening, fear and anger are natural emotions.
but it’s not morally wrong to experience psychosis. so how could it be right for me to feel fear and anger towards that person when they haven’t done anything wrong? it is a tough contradiction.
you can resolve the contradiction by just deciding to hate and fear anyone who shows signs of psychosis, treat them as if it is a morally bad trait, which many people do, see discourse about homeless people in NYC.
or you can just try to pretend that psychosis doesn’t exist, which a lot of people do, like when some public figure shows obvious psychotic symptoms but people act like it’s rational behavior.
or you can disavow the fear and anger, but if a person does actually frighten and hurt you, the resulting negative feelings often tend to be expressed in weird and unfair ways. i suspect this author’s employers and doctors probably do a lot of this.
personally I think the least bad solution is to acknowledge that anger towards a person can be justified even if they’ve done nothing morally wrong, just feel anger, and express it only in controlled ways. but this is philosophically confusing, easy to state, hard to really believe deep down.
all kinds of authoritarian regimes and movements certainly do this.
that said... you just have to have a conversation with someone experiencing psychosis. it's a totally altered state of consciousness, they are sensing and understanding the world in a radically different way. it's never just an otherwise normal person with a nonconformist belief.
in the last few years' surge of popularity, I found that your typical psychedelic advocate* would never admit this category of people exists. they were committed to the idea that everyone can, should, and must take these drugs.
this attitude is currently on a downturn, which is a good thing. people now admit that these drugs are not for everyone.
however, there's little solid understanding of exactly who should avoid psychedelics. it would be good to have a more solid scientific understanding of this. i imagine psychedelic advocates (which includes many scientists working on the topic) would be wary of such research, because it seems to similar to the history of government-sponsored propaganda "science" finding exaggerated harms of various illegal drugs.
however, scientific knowledge about who most likely will have adverse effects would be useful. that way people at low risk could use psychedelic drugs with the confidence that they are very likely safe. people at high risk can avoid them. this would be a great outcome.
The only problem here would be that if someone chooses not to use psychedelics, this might mark them as having certain traits that most people judge negatively. For example, history of severe trauma, family or personal history of psychotic disorders, and so on.
Given this, I think anyone who wants to normalize psychedelic drug use in their local community, ought to really fight to destigmatize such traits (and most communities won't accept this), or else more practically, promote an extreme commitment to privacy and personal choice.
*: I don't just mean people who do drugs, I mean people who think that doing drugs is mandatory to fix various spiritual/mental problems that prevent you from being a fully ethical being.
> people who think that doing drugs is mandatory to fix various spiritual/mental problems that prevent you from being a fully ethical being.
I don't doubt that these people exist, but this premise boggles the mind. Does that mean fully ethical beings didn't exist outside small geographic pockets where specific cacti and fungi grow before ~1960?
I think they would say (reasonably accurately, tends to be exaggerated though) that traditional cultures all around the world did have psychedelic practices of one kind or another. a lot of places on earth have some kind of psychedelic plant.
i generally consider myself an enemy of psychedelic advocates, because I think they want to make it effectively socially mandatory to do these drugs, which is really bad.
("sure, it's your choice what you put in your body, but a really enlightened person wouldn't be so frightened and closed-minded that they don't want to see what psychedelics can show them...")
of course ketamine for depression has this giant downside risk of adverse effects and psychosis, and we should talk about it more, not just sell it as a safe miracle drug.
however... safe, neutral, bland, boring well-tolerated SSRIs, also have a massive downside risk, in that they can trigger a manic episode, which in severe cases also involves psychosis.
so i find myself in the position of being glad there are different depression treatments for different people, including psychedelics and dissociatives, and hopefully we can find a way to make sure people get sorted to the treatments where they are least exposed to the tail risk side effects.
There are countless heartbreaking stories of people who were prescribed these drugs not knowing what they were subscribing to. In many cases, the effects of those drugs are worse than the symptoms they are supposed to alleviate. With "I Don't Wanna Be Me" there's even a song by Type O Negative (from Peter Steele's own experience with Prozac) about the devastating effects SSRIs can have on a person's life.
These drugs are handed out like candy while the physicians prescribing them often point-blank deny any side effects or even attribute those to the illness they are meant to treat.
Psychedelics, on the other hand, have actually been proven to be effective for many syndromes SSRIs are commonly used for and by comparison are very safe when used with proper preparation, medical surveillance, and in the right setting.
The only reason psychedelics are still widely shunned is a Puritan attitude to human well-being: You're not supposed to feel better than the common neutral base level. Any drugs achieving that (alongside with other, more specific and intended medical effects) are maligned and ostracized.
this is more or less exactly what i was trying to say. for most people SSRIs are safe, they experience manageable side effects and little health risk. psychedelics and dissociatives seem like they must be really drastic and risky. but actually SSRIs are pretty risky too, there are all these terrible low-probability outcomes.
so it's good we have all options, but ideally we'd have a better way of judging who is safest with which treatment.
With SSRIs you have a one in three chance for any number of the following side effects; many of them permanent, even after discontinuing medication (if you actually manage to do so, since SSRI come with severe withdrawal symptoms):
- sexual dysfunction
- loss of emotion and creativity
- drowsiness
- insomnia (including real fun stuff like night terrors)
- fatigue
- nausea
- tremors
I'd hardly call that safe or manageable.
With even the most potent psychedelics such as LSD, on the other hand, there's merely a one in thousand chance for severe side effects.
I'd go as far as prohibiting the prescription of SSRIs for all but the most severe cases (such as a severe depression where the patient is actually suicidal). For everything else these drugs are commonly used for, e.g., mild depression, OCD, or IBS, there are other - in many cases better - options with far less devastating (if any) adverse effects.
Almost none of these would be permanent, and you certainly don't have a 1 in 3 chance of them being permanent. Where did you get that number?
> With even the most potent psychedelics such as LSD, on the other hand, there's merely a one in thousand chance for severe side effects.
This is fucking nuts. We're in a thread about how taking too much can clearly cause weeks of psychosis, and how easy it is to do that. There's nothing wrong with warning about the risks of SSRIs, but to claim you have a 1 in 3 chance of having permanent nausea while, in the same breath, claiming psychedelics are 100x safer, is beyond irresponsible.
> in the same breath, claiming psychedelics are 100x safer, is beyond irresponsible.
Stating mere facts isn't irresponsible and those are the facts:
When taking SSRIs you have a one in three chance to permanently and severely change your life for the worse.
When taking LSD you have a 1 in 1,000 chance of suffering a psychotic break.
What's irresponsible - and unethical - is twisting and misrepresenting these facts - to the extent of outright lying about the purported innocuousness of SSRI, as is wont in the psychiatric community.
> Sexual dysfunction caused by SSRIs in many cases persists for the rest of the patient's life
You said most symptoms were permanent, don't back down now. Sexual Dysfunction is a pretty broad term, how would you even link it to being affected by an SSRI?
Literally says NOTHING about being permanent, this is about symptoms experienced while on SSRIs. Did you read your own source?
> When taking LSD you have a 1 in 1,000 chance of suffering a psychotic break
Where are you getting this number? It lacks so much context. What dosage gives you a 1/1000 chances of a psychotic break? Are you aware people are just taking whatever amount of Ketamine they feel like?
You seem to be arguing that Ketamine is somehow 300+ times safer than SSRIs as if you can compare the two 1:1. That is now how medication works.
> You said most symptoms were permanent, don't back down now. Sexual Dysfunction is a pretty broad term, how would you even link it to being affected by an SSRI?
Buddy, you're doing something called Source Bombing. I've read through 3 of these links and they directly contradict what you argued. I'm not going to waste my free time reading through the rest if you aren't going to bother reading at least one of them yourself.
With regards to Ketamine.
> There you go (for instance): "Cohen suggests a low rate of prolonged psychotic reactions in LSD users (1.8 per 1000) [19]"
That is a description of one of the many studies included in this meta-analysis. This is from the same article.
> Taken together, the effective risk of psychedelic-induced psychosis or worsening of pre-existing psychotic symptoms in schizophrenia -as well as in the early stages of the psychosis spectrum- remains incompletely understood
Also
> Overall quality of studies was low and only few studies (n = 9) could be included in the meta-analysis, hence the presented findings should be interpreted with caution.
> Buddy, you're doing something called Source Bombing.
You're doing something called "Moving the goalposts" by first asking for sources and then complaining because those sources don't support the very narrow construal you seem to be applying to my argument.
Those sources are scientific studies, which by the very nature of the scientific processes of course are open-ended.
However, the prevalence of side effects with psychedelics is in the single-digit range, whereas with SSRIs you're almost certain to be experiencing some sort of - often severe - side effects for the rest of your life.
> i generally consider myself an enemy of psychedelic advocates, because I think they want to make it effectively socially mandatory to do these drugs, which is really bad.
> ("sure, it's your choice what you put in your body, but a really enlightened person wouldn't be so frightened and closed-minded that they don't want to see what psychedelics can show them...")
I'm sorry WHAT? I've been to many open airs and other events where MOST of the people around have been under the effect of psychedelic and in other drug-friendly places, and I have never hear manipulative shit like that ever. On the contrary, if I heard people talk about this drugs it was always "it worked for me but might be a bad experience for you", "be safe, don't take it if you're not sure" and "you can always have a great time here completely sober".
i think that "we all want to get high on drugs" situations, like festivals, are actually a lot better. it's about personal choice.
when i talk about psychedelic advocates, i mean the people who think that widespread use of psychedelic drugs would massively improve mental health, make people more productive and happier, etc.
Confusing a minority of fringe members with the reasonable group of "psychedelic advocates" as a whole just delegitimizes the whole movement. There will always be some who take reasonable ideas to absurd extremes.
As a point of comparison: "social drinking advocates" vs. those who like to get blackout drunk every night.
The idea that everyone should be pressured into taking psychedelics is an absurd extreme. Psychedelics can be a powerful catalyst to growing as a person, but they're not a magic potion that makes you grow emotionally, spiritually, and intellectually.
They're likely going to bring your unprocessed ideas and personal issues to the forefront which can be very productive if you want to face them. But those who carry around demons that they've repressed and absolutely don't want to face would probably have a terrible time on psychedelics.
it's pretty hard to establish causality for something like this, but you have:
1) very solid evidence of correlation at a population level
2) a lot of clinical experience from doctors that patients with psychotic disorder diagnoses who use cannabis tend to do worse. and, similar stories from family members of people with psychotic symptoms who aren't in treatment.
so unfortunately I think there is something real here, it's not just people having transient bad reactions to weed and going to the ER and getting a diagnosis.
However, on an individual level, I think people need to know about the psychosis risks. It undoubtedly can trigger schizophrenia and make it much worse once it exists.
I know more than a few people who have severe alcoholism problems in their families, and just chose to never drink alcohol. I think a similar choice may be wise for cannabis if there is a history of psychosis.
On a public health level there was a theory that people would substitute cannabis for alcohol. But unfortunately, this doesn't seem to be bearing out.
cannabis is pretty safe for the average person, even heavy users. it's not good for you, but i think most of the effects like this are explained by selection effects. unhappy people use it to self-medicate.
however, using cannabis comes with a very big tail risk. if you are susceptible to psychosis, cannabis can cause it or make it much more severe. this is undoubtedly causal.
people take all kinds of worse risks in life which everyone agrees should be acceptable, so I think cannabis should be legal. but I also think that if people clearly understood this risk, most would choose to avoid cannabis.
When I was younger I had a bout of insomnia and somebody procured me some wee. I did not know how strong it was and had a psychedelic trip instead. It was terrifying, I thought it was the end for me. Nobody seems to believe me that weed could give you psychedelic visuals.
i think if the main thing is “hearing voices” this kind of thing is probably a good strategy, but there are lots of other probably worse symptoms of psychosis.
You identify objective metrics, and confirm that they're objective and useful over the course of several days / weeks in a variety of different mental states. For example: "everyone thinks The Cloud™ will solve their problems, even though it never has" -> mass insanity. "Everyone thinks the sun will rise tomorrow, because it always has" -> extrapolation / inductive reasoning (probably fine).
this and other alternative schizophrenia treatments a very good thing when they work, which is relatively rare.
as we can see from the comments here already, many people choose to believe these alternative treatments always work and there is never any need for antipsychotics.
it completely makes sense that some people who suffer from the horrible side effects of antipsychotics would have some wishful thinking of this kind.
what i don’t get is why random people with no skin in the game, are often so emotionally invested in the idea that antipsychotics don’t work or are unnecessary. but it’s very common.
>> what i don’t get is why random people with no skin in the game, are often so emotionally invested in....
Insert any subject there. This is a really interesting topic. I can understand having an idea on a subject, but why cling so tightly to the flimsy ones or refuse to accept them as wrong when given evidence?
I would tend to presume that alternative treatments paired with lower doses of antipsychotics would be a goal, rather than none. There comes a point where control is the goal rather than quality of life. And the treatment of Thorazine in the media in particular has not been kind.
I would presume that as well. For myself, cognitive behavioral therapy greatly reduced my need for medication because I could recognize symptoms and preemptively deal with them before they spiral out of control.
I’ll still be taking antipsychotics for the rest of my life, but at least the side effects are manageable enough I can live with it.
in northeast urban areas, if someone uses y’all it means they are probably a left-wing/social justice oriented person. use is correlated with “folks”/“folx”. no idea why, maybe to replace gendered “you guys”. weird but true.
Yep, it also replaces "ladies and gentlemen" and is a more informal "people."
I've heard of the the mythical gender neutral guys but having spent my life in classes and a career field where being the only woman is the standard, the amount of times folks are like "good morning guys… and girl" or "good morning fellas… and lady" is just comical at this point. Clearly speakers aren't imaging a mixed group when they say it.
It's been the same for me in the midwest and northeast.
Maybe it's that they were intending to address a group, but then realised that what they said might cause offence so they corrected themselves.
I think it's not so much they imagined what they were saying before they said it, it's that they reached for the handy phrase for addressing a group without thinking, and then only afterwards realised it. At least that's what I would do.
I wonder what it would feel like if I joined a majority female class and was addressed as "good morning ladies, and man". I've never been in the situation unfortunately.
Another phrase would be good. I vote for youse all.
Except that northeast urban areas are famously rife with transplants from all over the country, including me, who uses "y'all" because y'all don't know what "yinz" means.
but it’s not morally wrong to experience psychosis. so how could it be right for me to feel fear and anger towards that person when they haven’t done anything wrong? it is a tough contradiction.
you can resolve the contradiction by just deciding to hate and fear anyone who shows signs of psychosis, treat them as if it is a morally bad trait, which many people do, see discourse about homeless people in NYC.
or you can just try to pretend that psychosis doesn’t exist, which a lot of people do, like when some public figure shows obvious psychotic symptoms but people act like it’s rational behavior.
or you can disavow the fear and anger, but if a person does actually frighten and hurt you, the resulting negative feelings often tend to be expressed in weird and unfair ways. i suspect this author’s employers and doctors probably do a lot of this.
personally I think the least bad solution is to acknowledge that anger towards a person can be justified even if they’ve done nothing morally wrong, just feel anger, and express it only in controlled ways. but this is philosophically confusing, easy to state, hard to really believe deep down.
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