What happened to the 'acid casualties'?
This is part two of Ed Prideaux’s exploration of the legendary ‘acid casualties’ of the 60s counter-culture, like Brian Wilson of the Beach Boys and Syd Barrett of Pink Floyd. Part one is here. And our survey on challenging psychedelic experiences is still open here.
I’ll repeat what I said in the last piece: it’s clearly about more than drugs with these fellas - or at least most of them - and the ‘acid casualty’ meme has, to all intents and purposes, formed a kind of ‘scare story’. Indeed, call them ‘acid casualties’, and you’ll have also have to call them ‘DOM/STP, cannabis, Mandrax (or Quaaludes) and amphetamine casualties’ - not to mention casualties of sleep deprivation and exhaustive touring schedules, or the psychospiritual wear-and-tear of a machine-like music business.
More than the world ‘out there’, however, we often see drug-related mental breakdowns reduced neatly to something within: a ‘predisposition’, or an internal bio-psychological vulnerability to stress. It could be the possession of certain key genes, or a brain with unusual regulation patterns, or it could be more a matter better-expressed in temperament: perhaps the same sensitivity that drives people to become musicians, among whom there are already higher rates of mental illness. Perhaps the ‘casualties’ would have developed their psychic problems anyway, the thought goes, not least given the appropriately young age at which they became ill. The impulsive and frenzied way in which some of them consumed hallucinogens likewise implies that the lines between self-medication, unhealthy impulsivity, and an unveiling mental problem are fairly blurred.
All these points are valid and frequently made. As pointed out recently by Rachel Petersen, though, this ‘predisposition’ is often written up as the be-all-end-all explainer to mental health issues that follow psychedelic trips, then rhetorically exonerated of any potential for serious danger - with ideologues and corporatists the beneficiaries.
In the psychedelic science world, the contributory role of psychedelics has been especially questioned by population studies, which indicate ‘no link between psychedelics and psychosis’ in large samples. The displacement of the ‘psychotomimesis’ model - that psychedelics are ‘mimicking’ psychosis in their acute effects - by that of ‘mind-manifestation’ has likewise weakened a possible link, though some researchers are still taking the original model seriously.
Yet the population studies cited above are scrubbed of people with ‘childhood depression’ as a form of control, many of whom may well be drawn to tripping today. It does not include those who have ended up in psychiatric care or homeless or died, either: not insignificant outcomes for those blighted by severe mental illness. As the authors concede, the population focus critically fails to offer insights on individual instances of psychedelic-induced issues. And that the study is so tentative - and others analysing epidemiological data sets have come to opposite conclusions - makes me worried about how often they’re cited in papers or the media to ‘prove’ that psychedelics ‘don’t cause’ mental problems.
Indeed, it’s questionable how far ‘predisposition’ can take us. As described in the DSM-5, most people who develop psychosis spectrum conditions have no family history. The 2006 ‘Swedish study’ found that 96% of individuals diagnosed with schizophrenia have no family members with the diagnosis. Plus, even in cited estimates of risks for siblings of people who have schizophrenia or bipolar disorder for developing psychosis, this is in the absence of psychedelic use. According to the work of Willoughy Britton, no patterns of family history have been found in relation to meditation-related mental health problems, which show considerable overlap with those reported in psychedelics: depersonalisation-derealisation, hallucinosis and HPPD-like phenomena, psychosis, anxiety elevations, and beyond. It is curious that Britton reportedly opposes the use of intensive screening in trials, more recommending bespoke and specific care and guidance according to sensitivities.
There are no genes specific to any one condition, and the influence of the environment - especially by epigenetic means - is substantial. According to a British Psychological Society report on psychosis, the genes researchers associate with diagnoses are more fundamentally linked to “a wide range of characteristics, for example the tendency to be emotional, or problems with concentration” or to have a “sensitive temperament”. It’s possible that some traits are helpful in other contexts, and profoundly unhelpful in others.
One heritable trait relevant here is absorption, or the degree to which people are temperamentally drawn to immersion in sensory experiences, which may also play a role in psychotic experiences: yet absorption is also suggested to heighten psychedelic experiences, and may be represented in greater numbers among those drawn to tripping, and may even be heightened by immersive trips. Absorption also plays a probably mixed role in experiences of HPPD, both intensifying its absolute symptom levels but depending on wider issues like emotional valence and the quality of the triggering trip. People’s degree of introspectiveness varies temperamentally: this could underlie cognitive breakthroughs, insights, and a positive integration process, but it could create the types of thinking seen in psychosis.
The role of the trip itself
Indeed, ensuring the safety of the trip itself and its aftermath probably provides the greatest low hanging fruit for harm reduction. We know that psychedelic trips can cause extreme emotional stress and trauma, and we also know that trauma is deeply related to psychosis. The hyper-reflexivity and associative thinking produced in rich amounts by psychedelic trips lend towards psychotic breaks. That schizophrenia and bipolar disorder are now being appraised as possible applications for psychedelic therapy - and anecdotal reports abound on how it can end well, if just not disastrously - further weakens the easy equation of background ‘mental illness’ and drug-induced breakdown.
Some evidence suggests that cannabis use raises the risk of developing schizophrenia. Yet no such work has been done to investigate the possible role of psychedelics could play, especially in the critical neurodevelopment of children and adolescents. Barrett and others on the list were young when sampling these drugs. Yet Doblin’s MAPS are actively laying plans to administer MDMA to traumatised children, who are at considerable heightened risk of psychosis.
Beyond psychosis and schizophrenia, my specialism lies in Hallucinogen Persisting Perception Disorder (HPPD) and depersonalisation-derealisation (DP/DR). How these relate to ‘predispositions’ and co-occurring conditions, the nature of people’s trips, demographic and biographic data, or the type of drug used, is unknown. That HPPD’s lingering visual disturbances have been tied to neuroplasticity, however, suggests what I’ve been describing: that psychedelic drugs and neuroplastogens can instead play a considerable additive role.
Namely, that it’s not just your brain ‘going in’, but the way that your brain is changed by the drug. And while psychedelics have not proven perfect ‘psychotomimetics’, a proper analysis of those with ‘persistent psychosis’ or equivalent diagnoses following psychedelic use has not been executed. As one team of researchers have suggested, it is possible that, in contrast to the primarily auditory nature of psychosis spectrum conditions, those induced by LSD may be more visual through some hitherto uncharted mechanism - perhaps related to neuroplasticity and hygienes following an experience - that creates a lasting ‘crossover’ effect.
A psychiatric researcher with whom I spoke off-record suggests that we need to know much more about the role that high and frequent doses and bad trips could play in causing lasting psychoses and other serious mental illnesses. In alignment with the warnings of Haley-Marie Dourron - a PhD student researching the link between psychedelics and psychosis who cites the case of Syd Barrett - he suggests that LSD in particular may prove a ‘true psychotomimetic’. Research by Dr. David A. Martin and colleagues found that chronic LSD administration for ninety days to rodents resulted in seemingly-irreversible psychological and behavioural disturbances. Crucially, this was not observed in the rodents administered psilocybin and DOI, though this result has not been explored further.
The world ‘out there’
With runaway ‘predispositionalist’ thinking, we’re also at risk of reducing mental illness to simple, internalised equations affecting individuals - and neglecting the impact of the world in which we all live.
Indeed, Kefford, Barrett and Kirwan were all especially worn down by a music business in many ways still unreformed. By 1971, when Barrett is alleged to have express paranoia about aliens, it wasn’t anyone who was an alien: but his managers and friends, many of whom were likely hangers-on or possibly spiking him.A report from 2018 found that musicians experience suicidal thoughts at four times the rate of the rest of the population. I would advise readers to watch a powerful video by a YouTuber-musician on the continued predation levelled by record companies - now exacerbated by the pressures of constant promotion on social media - as well as the general agonies of touring: now the primary source of income for musicians, many of whom struggle to make ends meet amid tiny streaming revenue and record sales.
No doubt the later social problems of our ‘casualties’ emerged from their psychic conditions: the homelessness, hard drug addiction, and isolation. But they didn’t have to become homeless or addicted to hard drugs. Craig Smith, Sky Saxon, Skip Spence and Jerry Berkers spent time on the streets, but Brian Wilson, Syd Barrett and Peter Green didn’t. Why? Wealth and family structure. It doesn’t help that we live in a society characterised by still rampant and possibly-worsening stigma towards psychosis and schizophrenia, where those suffering face criminal degrees of unemployment, imprisonment and poverty. Did the fact of everyone around them deeming them ‘mad’ and victims purely of drug taking really help? I very much doubt it.
The ‘acid casualty’ meme shapes thinking both implicitly and explicitly. Vincent Crane’s bandmate made explicit reference to Peter Green and Syd Barrett in his analysis of Crane’s development, as did Killing Joke’s Youth. It’s curious how the meme has been wrongly applied to several individuals, too. For instance, Arthur Lee of Love was for years dismissed as a ‘casualty’, while ignoring the more pertinent problems of cocaine dependency, poverty, and imprisonment under California’s draconian ‘three strikes law’, which hands heavy sentences to repeat offenders - and which would very likely have affected Lee with disproportion being that he was Black. Something similar applies to Bruce Palmer of the band Buffalo Springfield, well known for their 1966 hit song ‘For What It’s Worth’, who was deemed a possibly ‘milder version of Syd Barrett or Skip Spence’. Palmer doesn’t seem to have dropped out of music for a surplus of acid, but a disgust at the music industry and the way it corrupted his friends, his absence from any commitments to royalties, poverty, and later overindulgence in alcohol.
One can’t overlook the paranoia and isolation that attend illegal activity, either. The 13th Floor Elevators certainly raised their odds of mental breaks through their years of diurnal use, but facing the constant intrusions of the neo-fascist Texan police force made for a fairly terrible set and setting. Most of the members would spend at least one tripped-out night in prison; their aforementioned guitarist, Sutherland, himself not a ‘casualty’ like Erickson, would undoubtedly have been traumatised by a 10-hit trip in which he was abducted by police officers and threatened with murder. Something similar applies to Jerry Berkers, a guitarist who’s described as reliving his PTSD-flared visions of combat in Vietnam while tripping, and never recovered. As discussed in my footnote on the Rolling Stones’ Brian Jones, his paranoia wasn’t directionless, but centred on a fear of plainclothes police officers after several drug busts and near prison stints. As Lennon said, ‘acid is only real life in cinemascope’: their breakdowns aren’t just personal-chemical, but societal-political.
The standard paranoias of the ascribed mentally ill - being followed, having one’s phone tapped, fearing infiltration and suspecting outsiders - turned out, in their own ways, to have real rationale with the revelations of COINTEL-PRO, Operation Bluebird and MK-ULTRA. It seems absurd or tautological to say, but Vietnam, the background of the Cold War and nuclear armageddon, and the widespread domestic chaos of 1968-1969, especially when combined with cannabis and psychedelics, would have spelt a lot of ‘anxiety’ for people around at the time.
The terror of the draft struck many young men at the time. Some rock musicians, including Snoopy Pfisterer and Roky Erickson, even took the ingenious (and probably risky) route of feigning insanity in front of Vietnam draft boards by going on drug benders and turning up tripping. Erickson’s bender, which likely included his usual diet of LSD and cannabis, was also driven by datura, a powerful deliriant - and some maintain that this particular bender “kicked him over the edge”.
The pros and cons of medicine
Despite driving their recent legitimation, the so-called ‘medicalisation’ of psychedelic drugs has a mixed effect here. As discussed in the work of critical psychiatric thinkers like John Read, Joanna Moncrieff, Tehseen Noorani and Psymposia’s David Nickles, to ‘medicalise’ a ‘mental health problem’ is to nudge it to a rhetorically ‘neutral’ place of expertise and science (or scientism) beyond politics and the social sphere. The above discussion should hopefully have shown that this political independence is quite imaginary - and that the tabloid ‘acid casualty’ meme, despite the real contributions of drugs, has cooperated over decades with the move away from politics.
One core technique of medicalisation - which considerably affected our ‘casualties’ - is the subtle ‘othering’ that accompanies their designation as ‘schizophrenics’. You’ll recall that schizophrenia is not as discrete and tightly-defined a condition as one may have assumed, either in symptomatic and hereditary links to other conditions, or even the variations of ‘normal’ experience. This ‘categorical’ view of mental illness, centred on discrete ‘brain diseases’ and ‘diseases’ as things, may be in reported decline in institutional psychiatry, but it still seems to shape public perceptions. The meme of the ‘acid casualty’ is linked to the subtler narratives around ‘predisposition’ and ‘triggering schizophrenia’: the latter implicitly rendered as a more noxious condition that ‘normals’ never experience.
In 1973, just as our casualties’ were likely entering hospitals, the World Health Organisation even concluded in a report that ‘[p]atients diagnosed as schizophrenic are distributed in all clusters. No single “schizophrenic profile” was elicited’. Why did they keep the term, then?
“The word schizophrenia has come into such widespread use that it is necessary to have a practical definition of it in order to keep public discussion of schizophrenia within reasonable limits . . . for the benefit of non- professional contemporaries who enjoy talking about schizophrenia without knowing what it is.”
Indeed, it’s striking that, despite never being diagnosed with the condition, we see reported and taken for granted among the public, mental health charities and Barrett’s bandmates that he suffered from schizophrenia. Herein, the ‘sacred symbol’ of psychiatry does its rhetorical job: Barrett et al are distanced from the rest of us and the drugs we like to take, too.
Diagnosis and treatment help many, no doubt, but it didn’t necessarily help our ‘casualties’. Following his Orange Sunshine psychosis, Green’s electroshock treatment haunted him: “it’s a terrible memory”, he said in an interview, describing the sharp cold of the paralysing agent streamlined in his arm before the shocks. The ‘treatment’, which likewise can help some people, made his head “feel like brickwork” and shattered his cognition and ability to function for several years.
Throughout the 1970s, Green described being on seventeen different medications, which further stunted his thinking and made him feel like a “zombie”. So bad was his psychiatric treatment, in fact, that Green had to be rescued from the sedated stasis of hospital life later on by his family, and eventually regained his music career after weaning off tranquilisers at the encouragement of his biographer, Martin Cemlis. The bandmate of Skip Spence, who was likewise diagnosed with schizophrenia, describes how six months of Thorazine “took [Skip] out”. After being misdiagnosed with paranoid schizophrenia, Brian Wilson was subject to a controlling and predatory psychiatrist later in the 1980s named Eugene Landy, who overmedicated him with tranquilisers. Roky Erickson, Arnaldo Baptista, and Jerry Goffin seem all to have experienced coercive psychiatric treatment, toom with Erickson and his family later taking a Szaszian approach and rejecting both medication and an assignment as mentally ill; Killing Joke’s Youth considered himself lucky to have been let out of hospital fairly swiftly.
As discussed in the work of critical psychiatric thinkers like John Read, Joanna Moncrieff, Richart Bentall, Lucy Johnstone and Will Hall, between 50 and 70% of schizophrenic patients experience at least one serious side-effect from antipsychotic medication. This includes “Parkinsonism… akathisia [an inability to remain still]… tardive dyskinesia [sudden irregular movements]” and other side effects like “weight gain, excessive sleep, insomnia, sexual dysfunction, dry mouth, constipation, urinary problems, and dizziness.” While around one-third of patients with psychosis spectrum conditions do not benefit from antipsychotics, the topic of their overall effectiveness is not something in which I wish to invest too much time. Rather, what is more significant is that medications have not grown much safer since the time of the ‘acid casualties’ fifty years ago, and that psychiatric innovation has been in freefall for decades. Paul Hutton and his colleagues cite research suggesting that the ‘atypical’ antipsychotics introduced in the 1970s - so-called by pharmaceutical firms for their apparently-enhanced safety profiles over drugs like Thorazine - are not necessarily safer or more effective.
Psychiatry and social deviance
The illusion of a neutral ‘medicine’ is clear from psychiatry’s alliance with political forces of the time. Not least with Erickson’s internment in a criminal psychiatric facility (for the possession of a single joint, I will add), examples and contexts are legion. A comparison study of people with schizophrenia and LSD psychotics in a mental hospital evaluated the two groups on scales that measured ‘Personal Relations’ and ‘Sexual Adjustment’, among other things: to score highest meant having a ‘stable heterosexual relation and marriage', ‘habitually mixed with others, always [been] a leader', and ‘always showed a healthy interest in the opposite sex—with a "steady" during adolescence'.
A piece from 1969 describes how many hippies held negative attitudes towards mental health professionals, feeling that the latter couldn’t understand their trips and ways-of-thinking.The following case reports of hippies diagnosed with schizophrenia may explain why:
“The patient… returned home where his family found his "hippie" appearance, his passive withdrawn manner, and his bizarre speech in sharp contrast to his previous personality
“He avoided meaningful interaction in a stereotyped manner. He would sit passively and occasionally raise his hands, saying such things as, "Don't hassle me," or "It's a groove." His affect was flat and bland. Word associations were not loose but revolved around a philosophical belief in eastern religions, LSD experiences, and himself as the passive agent for whom things were cosmically determined. Strong denial and protective mechanisms were apparent in his thinking [...]
“The working clinical diagnosis was chronic undifferentiated schizophrenia, and the patient was hospitalized for four months while being seen in individual and group psychotherapy. He was placed on large doses of chlorpromazine (900 mg a day) which had some calming effect but did not alter his basic manner of thinking. The passive style, preoccupation with eastern religious fatalism, and avoidance of social interaction persisted.”
One patient, understandably miffed at being hospitalised by his parents for looking and thinking differently, was observed to be “avoiding any meaningful interaction… [and] sit passively while examining questions in minute detail, posing further questions so that the point was usually lost. After two weeks of hospitalization he escaped from the hospital. Phenothiazines had not been used, but an attempt was made to engage him in individual psychotherapy.”
This isn’t especially new. Bleuler and Kraepelin first developed the schizophrenia diagnosis partly around the social deviances of nineteenth-century Europe - including perceived laziness, “extraordinary” colour choices, smoking in church - and Black people, including and especially activists, have been disproportionately diagnosed with the condition. I’d point readers to interesting literature on the ways in which personality disorders and other diagnoses reify an expectation for individuals to be chipper, outgoing, co-operative, and ultimately productive.
Psychiatry isn’t just biomedical, proponents often respond. Despite the ‘bio-psycho-social’ understanding’s frequent colonisation by the bio - creating de facto a so-called ‘bio-bio-bio’ model of genes, brains and drugs -, it’s curious that the psychedelic culture has been so prone to neglecting psychosocial factors. Unless such trends are resisted, with a psychedelic culture changed from the outside in and inside out by pharmaceutical understanding, we can expect to see any adverse effects denied or vastly oversimplified by companies going forward. The conversation around adverse effects is thankfully maturing, but still much further ground needs to be tread.
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