Is 'integration' always the right term for coping with post-psychedelic difficulties?

Two stories from the underground

The idea of ‘integration’ has come to play a central role in psychedelic culture. In the manuals for most psychedelic trials, and in the official legislation for Oregon’s psilocybin services, there are sessions offered for ‘integration’ after a psychedelic experience. Even in recreational use, it is commonly understood that ‘integration’ is a key part of the psychedelic journey, along with 'preparation’ and the experience itself.

But what exactly does ‘integration’ mean, and is it always the appropriate term when someone is dealing with serious post-psychedelic difficulties?

A document on the Oregon Health Advisory website says:

Psychedelic integration means working with the psychedelic experience as a valid and useful experience that can help a person grow and heal. This is especially important for difficult experiences (“bad trips”) because depending on the content of the experience, these…often contain important material that is relevant for a person’s growth or healing.

Bathje et al, in a 2022 review of 24 different definitions of the term, came up with this synthesis:

Integration is a process in which a person revisits and actively engages in making sense of, working through, translating, and processing the content of their psychedelic experience. Through intentional effort and supportive practices, this process allows one to gradually capture and incorporate the emergent lessons and insights into their lives, thus moving toward greater balance and wholeness, both internally (mind, body, and spirit) and externally (lifestyle, social relations, and the natural world).

There are loaded assumptions built into the term ‘integration’ - that psychedelic drugs reveal wisdom and insights that need to be learned and incorporated for holistic healing. ‘Bad integration’ means you have failed to heed the lessons of the medicine, failed to ‘become whole’. But is this terminology always appropriate if serious adverse effects have emerged during or after a psychedelic experience?

Here are two stories that readers recently sent to me.

Mindy’s story

‘Five months after I began experimenting with LSD to improve my low grade depression, I had a world-shattering bad trip. For about a year after that, my nervous system was stuck in a highly agitated state during which I could barely sleep or eat. When I did manage to fall asleep, I woke up having a panic attack, absolutely drenched in night sweats. I had never experienced this state in my twenty-six years of being alive. In order to cope, I jogged compulsively, which is wild because I usually dislike moving. I could run for hours without feeling tired; my body was running on pure adrenaline for no reason. I barely managed to go to work and during lunch time, I went to the bathroom to cry. 

‘It has been six years since this ordeal. I have healed and rebuilt myself, better and stronger. I devoted a good portion of my life to making sense of what happened. I would like to share my conclusions and hopefully prevent others from suffering as much as I did.

‘As we grow up, we develop an understanding of our place in the world and how we can keep ourselves safe. The mental frameworks we develop are rarely 100% accurate but they give us a false sense of control and security. For example, many believe that they will be safe if they live life the “right” way, whether it is being good followers of their religion, having a good work ethic, being kind, being smart, etc. 

‘To put it simplistically, when our belief framework isn’t optimal, we end up with mental health issues due to overwhelming pressure and stress. We may feel unsafe because we believe we’re not attractive enough, popular enough, successful enough, wealthy enough. Many of us live in this state of insecurity. 

‘And some of us decide to try psychedelics to open the hoods of our minds, in hopes that just by opening it we’ll heal ourselves. This belief is not entirely wrong, as simply observing the patterns we’re stuck in due to conditioning and trauma can often dissolve them; however, sometimes it can break us. 

‘My first few LSD trips were wonderful. I learned what being mindful in the Now felt like. I shed some unnecessary self-consciousness that got in the way of me socializing. I began to love myself. Then I got a new job. A difficult job in tech that challenged me and made me feel deeply inadequate. In my misery, I turned to LSD excessively to help me feel better. 

‘Since beliefs are built on top of each other, like in a house of cards, if you trip too often and break down the belief system without giving enough time for it to reintegrate, this might happen: you accidentally end up pulling a card from the bottom of the belief system pyramid, causing the whole thing to come crashing down.

‘On the night of the bad trip, I pulled a card from the very bottom. I was ruminating, lamenting the fact that my new coworkers couldn’t see what a capable person I was. And then I realized that “I” didn’t exist. “I” was an idea of myself that no one else could ever see. When I realized that I didn’t exist, all of my coping beliefs came crumbling down. I became unprotected from the world, raw and bare. The next morning, symptoms started. 

‘Here is some advice for those who want to avoid this experience. INTEGRATE every trip. Don’t trip too frequently. Every trip breaks your belief system down. You have to build it back up (hopefully with healthy ideas and not conspiracy theories) before breaking it down again. 

‘And this is my advice for anyone who is currently suffering from an ego death experience: be patient. This may be the best thing that has happened for your spiritual growth. You’re going through a bootcamp that you didn’t sign up for and the only way out is through. Find a way to shamelessly comfort yourself, whether it’s cuddling up with a seven-season TV show or a video game. I found hypnotherapy to be the most helpful in rebuilding my mental framework. Acupuncture was helpful in helping my body relax from the fight or flight mode. I also took a small dose of antidepressants to bring down the emotional pain to a tolerable level.’

Analysis of Mindy’s story

In Mindy’s case, it seems she did find the term ‘integration’ useful, even for her ego-shattering bad trip. She talks about ‘making sense of what happened’, building back her belief system, and healing herself through self-care and alternative health methods, as well as anti-depressants. She describes ego death experiences as ‘bootcamps’ that you have to work through, so she has a sense that the LSD was teaching her a lesson, albeit an extremely hardcore one she was not prepared for. Compare this to Charles’ experience with MDMA ‘therapy’.

Charles’ story

Charles lives in the Hamptons near New York, where he is a yacht captain, an award-winning photographer and a yogi. In 2021, he turned sixty. He was happy and felt he had made a good life for himself, despite battling PTSD and treatment-resistant depression for decades following a traumatic childhood.

Within the Hamptons’ wealthy social milieu, he met Miles (not his real name), a holistic healer and breathworker who trained with Stanislav Grof. Miles and Charles became friends and Charles invited him onto his yacht several times. Miles told Charles about MDMA therapy and the work of MAPS, the Multidisciplinary Association of Psychedelic Science – Miles is a friend of Rick Doblin’s and enthused about the incredible results MAPS was getting with MDMA therapy for PTSD. He suggested Charles should try MDMA for his lifelong PTSD.

Charles tells me:

I heard about the miracle drug MDMA and even donated to MAPS. But unfortunately, I never heard that there could be catastrophic risks.  I took MDMA three times in 2018 with Miles.  All three were negative experiences but I recovered.  I feel stupid for trying it a fourth time but felt in 2021 that I was in the best possible position in my life to deal with the PTSD of childhood trauma that I’d been facing my whole life. 

The fourth MDMA experience went worst of all:

I woke up from my  non-ordinary state with extreme, ear-splitting tinnitus. Eventually, I could not swallow or eat and became so panicked, I had trouble breathing. I think my vagus nerve might have been damaged. After months of not sleeping or eating, I eventually became so desperate and disorientated that I tried to kill myself, all the whole contacting Miles and begging him for help.

I understand MDMA is an experimental treatment with no protocol for when things go bad, but what I couldn’t understand and still don’t, is why, when I reached out to this very experienced guide for help in the aftermath of my bad trip, day after day for three months, he basically blew me off instead of trying to find me the help that I so desperately needed. 

I was made physically sick from MDMA but mostly, all Miles wanted to talk to me about was my “somatic” response and what the “somatic meaning of tinnitus was” 
This “guide” eventually summed up what he really felt about my experience  on MDMA when he wrote to me that “the medicine will have its way”. He had no contingency plan for how to handle adverse circumstances.  I kept asking him to reach out to Rick Doblin, who he had had lunch on 6/22/21, to try to get me some help and he wouldn’t do it.

I ended up locked up in a psyche ward and forced under duress to take psych meds including Thorazine and in total 10 other drugs, none of which did anything to help me and which took a year and a half to detox off. I have lost everything - my health, my strong mind, my boat, my money, my happiness, my career, I’m a alcoholic who now has heart disease and has not practiced yoga or been on the water since late June 2021 but “the medicine will have its way”?  Really? My trauma is 1000 times worse now than before I tried MDMA.

Charles eventually made contact with MAPS himself, asking for help and offering to share his story in the hope of helping others. He didn’t hear back from that email. A year later in 2022, when he was sent a MAPS fund-raiser email, he wrote back:

I took MDMA with Miles in New York City and had a nervous breakdown from the side effects…. my life was destroyed by the experience. Yet nobody from MAPS reached out to help me and Miles didn’t lift a finger or offer any help with the reintegration. It’s disgraceful that you are pushing this stuff and yet offer no assistance for those who take it up in good faith and run into trouble. You have a lot to answer for.  

MAPS funding department did reply to that email. A person wrote back:

Hi Charles

I am so sorry to hear you had such an awful experience. No one should have to go through an experience like that alone. I can imagine that support would have been immensely helpful under those circumstances, and I am sad to hear you didn’t have that. 

I wanted to tell you about a few resources that might be useful to you in retrospect of that experience. Both are resources related to processing a difficult experience like this, in case you’d like someone to talk to about what happened. One is a website that lists therapist and counselors and the other is a hotline, both options for finding support for what happened to you.

1.       Psychedelic.support curates evidence-based educational courses on psychedelic science and a directory of licensed mental health providers. Their network of therapists, counselors, holistic doctors, MDs, and integration consultants offer online and in-person services for transformational preparation, psychedelic/plant medicine integration, psychological and physical health, and personal growth.

2.       Fireside Project is a recently launched psychedelic peer support hotline available for callers in the United States. You can visit their website at FiresideProject.org to learn more.

Become a monthly MAPS donor to help expand psychedelic science, medicine, and therapy: maps.org/donate

Charles tells me:

They pushed the drug and took the money but were not there when things didn’t follow their script.  I feel there is a lack of concern for a person who was injured taking the drug. These people have a lot to answer for.

Analysis of Charles story:

Charles was very unlucky and developed a serious and rare adverse event after taking MDMA - tinnitus. This can sometimes happen after people take various drugs and is usually temporary, but in Charles’ case it combined with insomnia and extreme anxiety, and has lasted over a year. He reached out for help from Miles but unfortunately, Miles seemed to take a sort of MAPS / Stan Grof / holistic healing framework to this adverse event, and treat it as a ‘lesson’ that ‘the medicine’ was trying to teach Charles. This seems like the wrong response in this case. Eleven weeks after the last MDMA session, Miles put Charles in touch with a psychiatrist, who prescribed Charles an anti-psychotic. Unfortunately he had a bad reaction to this as well, and tried to kill himself. He was sectioned in a psychiatric emergency ward where he was given a cocktail of different drugs that did not help him. He is now out of the emergency ward but not in a good state, and deeply regrets trying MDMA for his PTSD, which he feels is worse now than it was before the treatment. When he contacted MAPS to ask for support, they put him in touch with Fireside Project, a support line run by volunteers without medical training. MDMA and all psychedelics are still experimental, unapproved and illegal treatments, which means we still have very limited knowledge about adverse effects and how to treat them. Even if MAPS gets FDA approval in 2024, there is still much we will only learn when large numbers of people try the drug treatment.

Conclusion:

It was recently suggested to me by Tomislav Majic, a psychiatrist at Charité Universitätsmediz in Berlin, that ‘integration’ is not always necessarily the appropriate term when people develop new and serious health problems during or after a psychedelic experience. I think Tomislav is right. ‘Integration’ suggests ‘learning the wisdom’ from psychedelic experiences, but what are the lessons to be learned from something like tinnitus, or derealization, or HPPD? A holistic integration framework to these post-psychedelic problems could end up over-spiritualizing them or seeing them as part of the soul’s journey to self-actualization, rather than serious adverse events requiring medical treatment.

Rick Strassman, the veteran psychedelic researcher, agrees. He tells me:

I see "integration" as what one does after a mostly positive experience. "Resolution" would apply more to adverse effects; that is, how does one resolve adverse effects, or how do adverse effects resolve? The medicines do not contain inherent wisdom. They only work on who we are, what the drugs work on, what's already more or less conscious in our minds.

This is an important lesson the psychedelic industry needs to learn, because there have been several tragic incidents in the last few years where a person had a medical emergency after taking psychedelics, but the psychonauts around them tried to treat it with holistic care as a ‘challenging experience’ rather a serious adverse event requiring emergency medical treatment, and the person ended up dying.

That’s what happened to Baylee Gatlin, who died of dehydration at the Lightning in a Bottle festival in 2017. She was taken to Zendo Project, MAPS’ psychedelic harm reduction festival service, where the volunteers and staff tragically mistook her symptoms as a ‘challenging experience’ requiring holistic care, rather than a serious medical emergency. As a result of this - and later errors by the on-site festival medical team - Gatlin died. A jury found MAPS partly responsible for her wrongful death and ordered it to pay $1 million in damages.

In 2018, Brandon Begley died of over-consumption of water after taking ayahuasca and kambo at Soul Quest, the ayahuasca church in Orlando, Florida. Begley became unresponsive, and church staff tragically mistook his physiological symptoms for a spiritual process, and laid him onto the grass to ‘ground him’, before finally calling an ambulance several hours after he first showed symptoms of distress. There’s an ongoing law case into Brandon’s death brought by his family.

Last year, Jarred Antonovich died at a New Age festival in Australia after being given ayahuasca and kambo in a ceremony. He was observed looking unwell at 10am - his neck was swollen and he was having trouble breathing - yet other participants were (according to evidence given at the inquest) told to ignore his laboured breathing and keep their eyes on the ‘shaman’ leading the ceremony. Eventually, two ‘guardians’ came to give him assistance, but Jarred apparently "was adamant he did not want to go to hospital”, saying 'I feel like this is a spiritual test I need to pass'."An ambulance was only called at 11.30pm, and when the ambulance crew arrived, they were reportedly told to "move away from Jarred because they were interfering with his aura".  Antonovich eventually died, and according to court testimony the festival organizer said it was a ‘beautiful occasion’.

These are the extreme, tragic cases, but there are many other cases where people develop new psychological or physiological problems after taking psychedelic drugs that they did not have before they took the drugs. In this instance, is it appropriate to talk about ‘integrating the lessons of the medicine’?

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• For more on this topic, come to our free psychedelic safety seminar on January 16, online, featuring Rick Strassman and Abigail Calder, in which Rick will discuss why he doesn’t like the term ‘challenging psychedelic experience’.

  

  After the paywall, some more links and news items for our paying subscribers, including a remarkable article on the malpractice law-suits likely to come from Oregon’s psilocybin legislation.