"Punching-the-hippy" politics aside, the political leaders told us there was nothing beneficial ever about those drugs, and we typically believed them, even lumping scientists who wanted to study them in the same camp as the "UFO Cranks".

So the question is, is it western medicine that's the issue, or the lack of science based politics?

I get that in some people it can be a wonderful thing, nearly a miracle cure. I've done plenty of psychedelics myself, but I always find the insistence by proponents that any harm done is the fault of the user ("poor preparation", "not the right setting", "inexperienced guide", etc, etc) to be really disingenuous and unscientific. Like, there are legit some people that really won't respond well to this as therapy.

Now, conventional pharmaceuticals and therapy have the same issues, but the reality is psychedelic therapies have never been a clear favorite.

I'd taken psychedelics perhaps 50-60 times before I had one out-of-nowhere bad experience that caused more harm than all the good I'd gotten out of them in my life.

I'm not against psychedelics after this either, huge supporter, but people like to pretend traumatic experiences don't have a chance of occuring.

I don't think I can do that much, but what I can do is offer some theories and context.

(Note: I wrote at length about this experience, and my general experiences with both psychedelics + MDMA here: https://news.ycombinator.com/item?id=22991744)

I'll write the following under the assumption that you/the reader don't have experience with psychedelics. There are some things you can put into words for those unfamiliar, and a great many other things you cannot.

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Psychedelics are a fundamentally neutral substance. What I mean by that is, that they and the experience, are neither good nor bad. As hippy as it sounds, "they are what you make of them".

This quality, if you ask me, boils down to one property: Psychedelics are enhancers. If you feel beautiful and happy and lively, you feel REALLY beautiful, happy, and lively.

If you start to become frightened/anxious of something, or are in a frightening situation, you become REALLY frightened.

And this becomes further amplified by a second property of psychedelics:

Rather than the usual business of "Some external occurrence or sensation happened, and here is my one thought/reaction to it." IE "Wow, that statement was rude, what a jerk." Or "Man, that dark alleyway looks kind of scary, I think I'll not go that way."

Your subconscious and free-association become stronger respective of dose, to the point where they can become runaway.

No longer is the equation "1 external action = 1 internal processing response", but some small experience can set off a chain reaction of internal association tumbling down a bunch of different paths.

Dark alleyway -> Oh that's scary -> That's the sort of place monsters would be -> Monsters, oh those are terrifying -> Murder is terrifying -> I don't want to be murdered -> There's probably a monster in that dark alleyway -> Dark alleyway, that's so terrifying -> You know what's probably in there, a monster? -> A monster would murder me -> I don't want to die -> Die.. death...

It becomes a looping, inescapable schizophrenic sort of experience where you've also lost enough short-term memory to forget you've been going in loops like this for what feels like years.

And because things are so ENHANCED, the amount of screaming terror, dread, etc you can feel is beyond any thing you can comprehend. Time is slowed to a crawl, this can continue for eternity.

Now, if that all sounds awful -- just imagine this whole scenario, but filled with the most intense happiness and love you can imagine. That's what MOST experiences are like, generally.

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What happened that night is I started getting anxious and fell into a dark place in my mind and got stuck there for an eternity instead of a happy place, to put it shortly.

I also won't pretend I probably didn't have a lot of subconscious trauma from a really messed up childhood and likely other mental issues/insecurities.

The time element of a deep LSD trip can make it very challenging. Being stuck in your thoughts for 18 hours is not for the light hearted

There are a significant number of people who view the psychedelic substances they use as teachers, as sacred, as emissaries of gods or other supernatural beings, or as those beings themselves.

Though such views are often dismissed as superstition or magical thinking by many who consider themselves part of "advanced", "civilized" societies, and who view these substances more as neutral tools, such societies' confrontation with these substances is relatively young, and I suspect that as they gain more experience with them their views will change.

Use of these substances have already been the wellspring from which multiple religions have come, and the potential for them to spawn more major religious movements, and with them a much more deferential attitude towards and view of these substances, will only grow as their use increases.

Kind of like how more experience with nature moved those same societies to not want to destroy it? While it's reasonable to question underlying prejudice and (frankly) very little actual knowledge I do not think that's going to be solved with more experience. We just don't see that reflected in reality. Most of Western society is fossilised, hostile and fundamentally exploitative. Having those attitudes change would involve a complete overhaul of the underlying cultures, which just isn't likely.

So the entire culture doesn't have to be overhauled to have a massive influence. During and after the 60's there was a backlash against the counterculture -- a backlash that was ultimately very effective in some ways, and one which continues today, but I do believe a lot of people will start to once again see that another way is possible once psychedelic use becomes more widespread and mainstream. That potential is one of the few things that gives me a sliver of hope about humanity's future.

Thinking about this further - have bad trips been observed in clinical studies where the the LSD was created in a controlled, ideal lab setting?

Would be interesting to know if this was or wasn't the case; could indicate a bad trip is an unavoidable potential side-effect, or if it is a specific reaction to poorly created LSD.

Its not the substance purity, but some people are a mess, and sometimes they don't realize/admit it. Some become mess with frequent use. Those definitely shouldn't play with stronger stuff, whatever that is for them.

It will. I'll stake my life-savings on it too.

>Thinking about this further - have bad trips been observed in clinical studies where the the LSD was created in a controlled, ideal lab setting?

Yes, actually, the results here are the ones usually criticized by psychonauts for causing bad trips due to "bad settings" or "poor preparation". There's a bit of truth to that, but the bad trips are always going to happen.

What would be nice is that you get the benefits of the drug without any of the "bad trip" experiences, in a controlled way.

Now, I wouldn't wish my own bad trips on anyone, but I've found I learned far, far more from them than I did my good trips, so in that sense they were actually beneficial.

Also, the term "bad trip" may be a misnomer. They might be more fittingly called "difficult trips" or "challenging trips". It is possible to draw meaning and even wisdom from such trips.

For some, maybe even most, but it would be irresponsible to assume that it would be the case for everyone, and this is exactly the sort of blaming the victim of the bad trip for "doing it wrong" that I was talking about. Somehow it's their fault for having a bad trip, or for looking at it wrong and failing to "correctly" integrate it into their worldview.

Humans are a diverse group. That line of thinking just doesn't work from a clinical perspective.

Yes, things could go wrong even if one takes every reasonable precaution, is in the best frame of mind, etc. That's why having helped from experienced people you can trust is a good idea, but even that offers no guarantees.

There are no guarantees in life for anything. You could break your neck climbing a ladder to change a lightbulb. People can and do suffer severe accidents (including severe brain damage) skiing, driving, or crossing the street.

Yes, you should be aware of the risks and look both ways when crossing the street, but you could still suffer some accident even then. For some the risky activity is worth it, for others not. For those who think it is, it's helpful to educate oneself and take reasonable precautions. No blame necessary or intended.

How about lack of science based medicine?

https://news.ycombinator.com/item?id=24383819

Western medicine, which I would rather call scientific medicine is not against psychedelics and natural remedies, but instead of telling you to eat the funny shaped mushroom, it will study what exactly is in that mushroom, extract the good stuff, remove the bad, maybe try to improve it. It will then test it, with accurate dosing and if everything goes well, produce a treatment that is similar to what the shaman did but better.

I'd say the only thing the shaman has over a registered doctor is that he can spend more time with you, and hopefully have a positive influence on your lifestyle. But it is not a shortcoming of scientific medicine, in fact, it recognizes it. It is more about doctors being too few and overworked.

These are alpha-blockers for treating migraines or hypertension. There are psychotropic drugs based on these as well, and a bunch of discredited nootropics.

Now, high BDNF on its own is not a good or bad thing. It is released both when injuries and when growth happens...

I would be very careful recommending a shaman, unless you happen to have evidence for how well traditional approach to treatment works compared to recent drugs or current mental health treatments, or a precise description of what those people do, as it's more than just "take this drug and go home". We could use such studies for sure, and not for cultural appropriation!

We lack sufficient data to recommend for or against. (Partly because countries virtually banned research because "drugs" are "bad". Others are trying to hold it exclusive for their culture, which is wrong too. I think they should stand to gain from it if it works.)

Shamans are more like tour guides. Walking you through your own experience.

It is good to remember though that these approaches exist, and to let them be practiced safely and openly. As well as researched without interrupting it.

A tour guide does specific things. We could know what makes for a good or bad one.

Is a person who fakes the practice as good as a native life long taught shaman? Which kind of shaman is best? Is tailoring the experience needed and in what way? Etc.

That said, maybe it's more important to look at how these have been dealt with in the past than the data we have in the present.

The spike can just as well be caused by bad environment we made for ourselves, ecologically and psychologically.

The problem is, we really do not know what we're doing when dealing with mental issues. Typical western approach is only slightly better than dosing people with random psychedelic substances of mostly unknown effects. The science done in field of psychotherapy is low to non-existent quality. Methodologies are in their infancy.

Of course something barely effective will fail.

While I don't doubt there is some human component to this, what I worry about are interactions with standard prescriptions and OTC medicines.

Those risks are always weighted against benefits.

I get the romanticized enthusiasm but let’s not crap on scientific process that easily. Sure there has been political pressures that stagnated psychedelic research, but for a while western medicine has been trying to work this out in a replicable and safely administrable manner. Shamans don’t operate under those limitations, hence the apparent “superiority”, with all associated, undocumented risks.

To get to the point of this paper, there are “western” substances that help with BDNF and cognitive decline too, eg. lithium, which is not as psychoactive and has a perfectly well documented risk profile (not saying risk free).

I’m intrigued by lions mane because it’s legal, of course.

The "stack" is insane as we do not understand what each of the components does separately or in any combination and the rationale for including one of them is based on discredited ideas.

[https://omitted.useless.links]

I mean, you called them both addictive, how is that not “like” each other?