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Self-treatment of parental neglect-induced mixed anxiety and depressive disorder
with psilocybin—A retrospective case study
Mika Turkia
mika.turkia@alumni.helsinki.fi, psychedelictherapy.fi, February 19, 2023
Abstract
This article presents the case of a young woman in her mid-twenties with a history of depression since childhood. She
lived with a mother who failed to take care of her. The patient cared for the emotional needs of the mother instead
of the mother caring for the daughter’s needs. Her father was mostly absent. Already around the age of thirteen,
the patient was severely depressed and was self-harming without anyone interfering with it. Eventually, her parents
divorced when she was fourteen. Since then, she and her younger brother lived practically on their own for several
years.
She was ’unable to either recognize or process’ her feelings, and assumed that she was supposed to ’serve others’. At
the age of twenty, she moved in with a severely traumatized boyfriend. Compared to his, her childhood appeared
’very happy’. She was ’disconnected from her feelings’ and ’could not understand what was wrong’. As she enrolled
in a higher education facility, comparisons with other students made her realize that her own upbringing differed
from theirs.
She was unable to verbalize her problem, and the student healthcare system did not recommend psychotherapy
for her. She was prescribed escitalopram, but it ’never worked’. Cannabis somewhat alleviated anxiety but led to
passivity. Eventually, she tried psilocybin mushrooms. In the course of two years, she carried out four sessions with
lower doses, and three sessions with conventional psychedelic doses of psilocybin. Subsequently, she considered her
depression resolved.
The mushrooms ’did not provide a swift solution’ but ’played a major role’ in the resolution of her depression. They
enabled her to see that the root of her depression was in her adverse childhood experiences. Later, ’setting boundaries’
and ’doing things as she wished’ provided ’significant relief’. After this, she was also granted psychotherapy, which
she utilized for ’psychedelic integration’.
This case, along with previous case studies on the same approach, demonstrates that unsupervised self-treatment is a
feasible, cost-effective, and relatively simple method, which could enable societies to overcome the cost and resource
crisis of mental health care.
Keywords: psychedelic therapy, psychedelics, major depression, domestic violence, psilocybin, cannabis
Introduction
Unsupervised self-treatment of mental disorders with psychedelics has previously been discussed by the same author.
Self-treatment of psychosis and C-PTSD with LSD and DMT was featured in an article (Turkia, 2022b). A preprint
featured self-treatment of depression and complex post-traumatic stress disorder (C-PTSD) with psilocybin and LSD
(Turkia, 2022a). This case presentation supports the findings of the previous studies.
With regard to other case studies on this subject, Lyons presented the case of one patient for whom electroconvulsive
therapy had provided no relief of their treatment-resistant depression. Subsequently, the patient successfully self-
medicated with low, non-hallucinogenic doses of psilocybin (Lyons, 2022). During a two-year period of psilocybin
use, the patient’s Hamilton Depression Rating Scale (HDRS) score decreased in a linear fashion (Hamilton, 1960),
and the patient reached remission from depression. Lyons suggested psilocybin as a safer and cheaper alternative to
electroconvulsive therapy.
In the present case, the patient had been medicated with escitalopram, with no result. Nayak et al. discussed a
recent trial (n=59) of two doses of psilocybin (25 mg) versus six weeks of escitalopram (20 mg) for major depressive
disorder (Nayak et al., 2022). They presented a Bayesian (versus frequentist) reanalysis of the data, noting that they
found ’extremely strong evidence for psilocybin’s noninferiority versus escitalopram’.
A meta-analysis by Masi noted that according to RCTs, antidepressants were minimally to moderately more effective
than placebo, principally based on very high placebo responses, and only fluoxetine showed more evidence of efficacy
(Masi, 2022). An additional, often overlooked aspect of SSRI vs. psilocybin comparisons is antidepressant withdrawal
and rebound phenomena (Henssler et al., 2019). A pharmacovigilance database analysis by Chiappini et al. noted
Preprint; doi: 10.13140/RG.2.2.21687.39848 or 10.31234/osf.io/qyce5; link: https://doi.org/mmfx
that a range of proper withdrawal symptoms could occur well after SSRI discontinuation, especially with paroxetine,
and awareness of the dependence and withdrawal potential needed to be taken into account (Chiappini et al., 2022).
In a review concerning children and adolescents, Strawn et al. noted that persistent or late-emerging adverse effects
of SSRIs included suicidal thinking and behavior, sexual dysfunction, weight gain, headaches, and other symptoms
(Strawn et al., 2023). They also reviewed aspects of sertraline and escitalopram withdrawal.
Davis et al. presented a randomized clinical trial (n=24) of two doses of psilocybin with major depressive disorder
(Davis et al., 2021), noting that the trial demonstrated the efficacy of psilocybin-assisted therapy in producing
large, rapid, and sustained antidepressant effects among patients with major depressive disorder. Al-Naggar et al.
interviewed ten patients who had self-medicated with psilocybin, and concluded that psilocybin appeared to have
promising effects on patients with depression and anxiety even after a single dose (Al-Naggar et al., 2021).
The safety of psilocybin has been discussed in more detail in two other case reports concerning self-treatment of
depression and complex post-traumatic stress disorder (C-PTSD) with psilocybin and LSD (Turkia, 2022a), and
small-group therapy of treatment-resistant depression and complex post-traumatic stress disorder (C-PTSD) with
psilocybin (Turkia, 2022c). Additional aspects related to the feasibility, safety, and necessity of self-treatment have
been discussed in the context of a case study concerning the self-treatment of C-PTSD and psychosis (Turkia, 2022b).
Goodwin et al. presented a phase II double-blind trial (n=233) of single-dose psilocybin for treatment-resistant
depression, indicating that a single dose of 25 mg (n=79) reduced depression more than a one-milligram dose (n=79)
or a ten-milligram dose (n=75) (Goodwin et al., 2022). In many clinical trials, adverse events such as suicidal
thoughts or acute suicidality are counted, and interpreted as harmful effects of the substance. As comparisons of
the prevalence of suicidal thoughts or acute suicidality pre- and post-treatment are rarely, if ever, made, conclusions
can’t be drawn: suicidality may have increased, remained unchanged, or decreased. In the mentioned trial, over
a period of twelve weeks, in the high-dose group, suicidal ideation occurred in two cases (2.5%), intentional self-
injury in two cases (2.5%), and suicidal behavior in three cases (3.7%). In the context of psychedelic therapy, the
traditional understanding of the concept of ’adverse events’ may rarely, if ever, be useful or applicable. Negative
experiences are almost always due to the underlying trauma, i.e., due to reliving or re-experiencing emotions and
somatic sensations related to the original trauma. The healing process explicitly requires the patient to, briefly but
consciously, re-experience them.
In the present case, major depression was a result of traumatization caused by parental neglect. Bird et al. provided
a review of psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) for the treatment of trauma-related psy-
chopathology (Bird et al., 2021). They noted that trauma exposure had been linked to the development and severity
of various psychiatric conditions, including major depressive disorder (MDD), substance abuse disorders, and anxiety
disorders, and that MDD was possibly the most common condition following trauma. They stated that the ‘trust
enhancing’ qualities of MDMA were likely useful in strengthening the therapeutic alliance in the first instance to
allow for a ‘deeper’ subsequent acute psilocybin experience. Proof-of-concept studies were suggested.
With regard to psilocybin versus esketamine for depression, Psiuk et al. provided a systematic review, noting that
psilocybin was possibly superior to esketamine treatment (Psiuk et al., 2022).
The interviewee was found on an online discussion platform and was subsequently invited to participate in this case
study by the author. The author’s approach was ethnographic, with the intention of collecting cases of self-treatment
or small-group treatment of various mental disorders with different psychedelics. The details of this case were acquired
from a semi-structured retrospective online interview with a total duration of approximately 1.5 hours conducted in
December 2022. An one-hour follow-up interview was conducted in January 2023. Medical records were unavailable.
Case description
A girl in her mid-twenties described how, in her childhood, her parents were not violent or otherwise overtly abusive
but neglected her. She lived with a mother who failed to take care of her; instead, the patient cared for herself,
her little brother, and largely also for her mother. The patient was assumed to answer for the mother’s emotional
needs instead of the mother answering for the daughter’s needs. She briefly referred to her mother as ’narcissistic’
and mentioned that she was ’never really a mother to us’. She and her brother had to manage largely on their own,
although the mother took somewhat better care of the son.
The mother bought food and clothes for them, but since approximately the age of ten, she had to, for example, wash
her clothes by herself. Her father, in turn, was mostly absent from home and did not interfere with the upbringing of
their children. He worked in another country, and while he visited, he remained ’not present’. She mentioned being
’confused’ about her school never paying attention to the complete absence of her mother: she failed to even sign
official documents.
The girl was ’unable to either recognize or process’ her feelings. Individuation, individual thoughts, and feelings
appeared to have been ’forbidden’. She ’lacked a capability for independent thinking’. She assumed that she was
’supposed to live for other people’ and ’serve others’. She was tasked with listening to her mother’s sorrows and
worries, and with ’supporting’ her mother. She was occasionally praised for ’acting very adult-like’.
2
She was ’obviously and visibly severely depressed’ already around the age of ten, and was self-harming around the
age of thirteen. Neither of the parents interfered with this. Eventually, her parents divorced when she was fourteen.
Since then, she and her younger brother lived practically on their own for a couple of years. For one year, their father
was working abroad, and the mother ’disappeared’, leaving the children on their own. When she was sixteen, the
father returned from abroad, and the mother officially moved away. However, the father was forced to stay in other
locations for work during weeks and often also during weekends.
At the age of 20, she moved in with a boyfriend in another city. The distancing from her childhood environment
caused previously unrecognized feelings to surface. She described that she was ’disconnected from her feelings’ and
’could not understand what was wrong’. Initially, she began wondering ’why her mother had never cared for her’.
The boyfriend had been taken into custody at an early age due to severe domestic violence, and had lived in
a children’s home since. While they both had their own issues, compared to their childhood environments, the
relationship appeared quite functional and supportive. Compared to the boyfriend’s childhood experiences, the girl’s
childhood appeared to her as ’very happy’. She stated that at this point, she had ’no clue that anything was wrong
with her relationship with her parents, or in her family, but she did not feel very well emotionally’. She attributed this
lack of situational understanding to the fact that ’the family had always been like that’, and that she lacked points
of reference, that is, experience of other kinds of families. She described herself as ’withdrawn’. She encountered
cannabis and used it occasionally.
She contacted a municipal health center, which referred her to a psychologist, but there was the possibility of only one
appointment. The psychologist commented that she should ’investigate her childhood in more depth’. Regardless, at
this point, she continued to believe that her childhood had been quite conventional, and searched for the root of her
problems in herself, conceptualizing her depression as a ’psychiatric problem’ of an individual instead of a systemic
issue.
At the age of 21, she enrolled in a higher education facility. Due to this, further contact with the municipal health
center was not allowed. She remained severely depressed and anxious, and accessed the student healthcare system
but was unable to verbalize her problem. She was diagnosed with mixed anxiety and depressive disorder (ICD-10
F41.2). During a few appointments with a psychiatric nurse, ’nothing sensible’ was discussed. She commented that
the personnel ’failed to recognize the severity’ of her situation. Psychotherapy was not recommended for her.
She was prescribed escitalopram, but it ’never worked’ and failed to resolve her depression. She mentioned that the
medication ’only caused harm’ by numbing her emotions. In addition, she commented that the medication probably
caused a hypomanic episode, during which she harmed her relationship. Subsequently, she discontinued medication.
As her condition worsened, she also ’searched for bad solutions’, meaning that her cannabis use became more frequent.
It slightly alleviated her anxiety but led to passivity. However, some varieties also activated her during the most
disabling depression so that she could, for example, clean her apartment instead of laying in bed all day. As a whole,
she considered cannabis ’quite passivating’.
Cannabis also caused some psychedelic, ’mind-expanding’ effects, but these easily led to daily rumination over the
same issues without real progress, and eventually ’to not ruminating about anything’, i.e., to a passive state. Due
to her depression, she could no longer experience pleasure from anything. In retrospect, she considered that her
cannabis use had not made any difference to her state, neither positive nor negative. She considered its daily use
harmful but also said it should be decriminalized. Had she used alcohol in the same manner, the end result ’would
have been way worse’. Cannabis had been ’graceful’ to her, not causing any permanent harm.
At the age of 22, her relationship with the boyfriend ended, and she moved to live alone in her own apartment in
another city. Subsequently, her depression worsened, and eventually escalated into near-complete dysfunctionality.
At this point, she had realized that her issues were somehow causally related to her childhood experiences.
She contacted the student healthcare system again, and they informed her that they had nothing to offer her. She
was also refused sick leave from her studies. The personnel informed her that her childhood experiences were out of
the scope of their care, and again did not consider psychotherapy indicated for her. She was prescribed 50 mg of
sertraline, which she soon discontinued due to severe adverse effects, and continued with escitalopram. The clinic
granted her a few appointments with a psychologist, but the appointments were six months apart and led to nothing.
Her first boyfriend had experimented with psilocybin mushrooms and suggested that they could try them together.
He had been able to process some of his own experiences with the help of the mushrooms on his own, unsupervised.
This had initiated her interest in the mushrooms, but during the relationship, she never experimented with them. At
this point, living alone and being severely depressed, she remembered this option. She was ’searching for answers’
and assumed that mushrooms could provide them. She also understood that she was ’stuck’ with her issues and
would ’need to open’ something.
Having learned to be self-reliant, she decided to try psilocybin mushrooms on her own, unsupervised, like her first
boyfriend had done. During the year of living alone, she began ’practicing’ with the mushrooms. In order to keep
the possible anxiety under control, her approach was gradual. She was slightly fearful about the first trip, which
eventually proved to be an ’anticlimax’: she experienced next to no effects. Initially, due to the dampening effect
3
of escitalopram, her ’trips were not very deep’. Regardless, the session convinced her that she was ’not going to die
from taking them, and that being in the psychedelic state was manageable and okay’. The state felt ’safe and good’.
She carried out four unsupervised trips with doses of around one gram of dried psilocybin mushrooms. The most
important consequence of these sessions was that the mushrooms ’guided’ her to consider the role of her parents’
behavior as a possible cause of her emotional issues. They gave her a glimpse of how she would feel if she would not
be depressed: she could feel ’interested in life’ and ’feel good and normal’. Her depression was temporarily resolved
by each session.
Initially, the mushrooms ’enabled her to access her feelings’, although at that point, her view of her parents was
still ’incorrect’. She searched for the cause of her issues primarily within herself, not in her parents’ behavior. She
’remained unable to realize the severity’ of the condition in their home. Mushrooms allowed her to ’become unstuck
from her thought patterns and think outside of the box’.
Going forward, the sessions caused more of her childhood memories to surface, and caused her to more fully realize
the causality between her current state and the adverse childhood experiences. She fully realized that her parents
had not cared for her properly. At this point, she said, these realizations did not necessarily ’do good’ for her, as
her increased understanding of these facts merely increased her sadness and anxiety. Regardless, she mentioned
not having experienced so-called ’bad trips’. None of the trips had been ’solely agonizing’: there had always been
something positive.
For a year, she used cannabis almost daily. This period overlapped with her ’most severe’ period of depression. She
suspected that cannabis use had been ’a symptom of depression’ because it largely ceased at the time when her use
of psychedelics began and her depression ended. According to her, depression had caused her to use cannabis. Its
function was to numb emotions. When the emotions were processed, numbing them was no longer necessary. Also,
the mushrooms suggested that cannabis use was a problem, and that nothing should be used daily. She had no
experience of other drugs, nor experience of ’problematic substance use’.
Around the age of 23, she moved to another city and found a new relationship (it was ongoing at the time of the
interview). She arranged her first session with a ’regular’ psychedelic dose. As a consequence, for the first time, she
’realized which things in her life made her happy and what she wanted to include in her life’. In addition, ’saying
these things out loud for the first time in her life’ had been a very meaningful experience; she commented that this
’sounded stupid but had been a big thing’.
Due to the previous psilocybin sessions, she was able to verbalize her issues, and subsequently contacted a municipal
health center in her current city for additional help. She was officially assigned the same diagnosis (ICD-10 F41.2), but
she was also preliminarily diagnosed with recurrent depressive disorder, current episode severe, without psychotic
symptoms (ICD-10 F33.2). She was also granted a year of sick leave from her studies. Around this time, she
discontinued escitalopram.
She carried out three additional psilocybin sessions with doses of approximately three to four grams of dried mush-
rooms. Predicting the exact response to a certain dose of mushrooms was difficult because it ’depended on the day’.
One of her ’best memories’ from these trips was an autumn day when, untypically for her, she walked outdoors during
the experience. The nature had been in full fall foliage, and the visual experience had been breathtaking.
During some of these trips, she spent time with her new boyfriend. This was because ’during a trip, an enormous
need for another person’s presence arose’. His presence kept her calm because she expected him to assist her in the
event of severe anxiety. Such anxiety never arose, however. The presence of another person provided a feeling of
safety, allowing the experience to stay pleasant. A more important function of his presence was that she wanted to
express to him some feelings that she had not been able to express to anyone before.
At the time of the interview, she was nearly 26 years old. Compared to a few years before, her life was ’completely
different’. Her severe depression had been resolved nearly two years before. ’Setting boundaries’ and ’doing things
as she wished’ had provided ’significant relief’. This setting of boundaries included cutting off all contact with her
mother. Her father remained ’unable to understand the issue or handle it’. It appeared that another positive factor
had been the physical distance from her childhood environment.
Her last psilocybin session had been 1.5 years before, and her last cannabis use was a year ago (during the year
before that, she had used cannabis once a month). Her studies were on hold: she was waiting for her motivation to
return. Instead, she was working full time. She was ’able to make decisions’ and ’do things that felt good’. She now
had her own horse, and was also raising other animals. During her childhood, taking care of animals had ’comforted’
her, and allowed her to spend time out of their home. Otherwise, she ’might not have left her room at all’.
For the last year, based on a medical certificate issued by the municipal health center, she was granted psychotherapy
given by a cognitive therapist who had additional education in trauma awareness. She considered the latter an
essential factor: a therapist lacking it ’could not have helped her’. Attending therapy had ’not been easy’ because
she still had ’difficulties discussing certain issues in a close relationship’. It was more difficult to discuss sensitive
issues with someone one saw frequently. Regardless, she felt that she had undoubtedly been in need of psychotherapy.
4
While she had processed her ACEs quite a lot on her own, she considered therapy suitable for resolving practical
issues caused by ACEs. Although she had processed some issues in her mind, not all observations had yet been put
into practice (this is often referred to as ’psychedelic integration’ (Aixala, 2022)). Also, ’not everything could be
solved on one’s own’. A therapeutic alliance helped to improve self-esteem, and a professional could provide ’the
perspective of a professional’. According to her, psychotherapy would likely have been too exhausting during the
most severe period of depression. However, she considered that it should have been organized a year or two earlier
by the student healthcare system. When asked to compare the effects of therapy and the mushrooms, she speculated
that the mushrooms had greatly accelerated her progress and allowed for independent processing of ACEs prior to
the initiation of therapy.
Considering the mushroom experiences of her first boyfriend, she commented that ’a child always wants to believe
in the goodness of one’s parents’. During their relationship, the boyfriend had not been able to give up this belief.
She commented that ’singular insights only rarely produce feasible long-term outcomes’ and pointed to the necessity
of ’acknowledging the faults’ of one’s parents.
The mushrooms had not been a ’swift solution’ but had played a major role in the resolution of her depression. The
treatment took approximately two years and included approximately four lower-dose sessions and three higher-dose
sessions with psilocybin. She described how psilocybin had enabled her to see that the root of her depression had been
her adverse childhood experiences. Comparisons of family backgrounds with her fellow students were also important
in realizing this.
It was ’difficult to put in words how the mushrooms had helped, but perhaps the essence was that during bad times,
they could show the beauty of life, and give one a direction’. She cited another person who said that whenever a
person needed guidance in their life, they could take mushrooms to show them the right way. She considered this
’a good rule of thumb’. Recently, she had no longer felt the need for such guidance, nor would she have had the
required free time for preparations. Earlier, however, the mushrooms had produced an ’enormous improvement’.
While they ’had not solved all the issues’, they had ’allowed her mind to step across the threshold’. The sessions
always produced new issues to process, and she currently did not feel the need for, or have any interest in processing
additional issues.
Discussion
In comparison to the two other case studies about psilocybin by the author, in the present case, depression was
resolved more easily. The young woman resided in a relatively supportive environment since the beginning of her
psychedelic use. She had no experience with psychedelics other than psilocybin. She saw no reason to use psychedelics
again. Cannabis use had also ceased a year before. Only a few unsupervised sessions were necessary to resolve her
depression.
In the case of a middle-aged woman attending small-group therapy for treatment-resistant depression, the patient
was almost two decades older, had a more severe history of traumatization, and had been suicidal (Turkia, 2022c).
While her environment was relatively supportive, the resolution of her symptoms required group support and a higher
number of high-dose psilocybin sessions, which were also quite demanding for her.
In the case of a young man who self-treated his depression with psilocybin and LSD, the patient had a more severe
history of trauma and resided in a constantly retraumatizing environment (Turkia, 2022a). Based on this case, it
was suggested that psychedelics could be conceptualized as a tool for people who have been chronically anxious and
depressed since early childhood to understand ordinary states of mind (e.g., calmness, hopefulness, relaxation, and
joy). The young woman in the present case referred to the same concept, saying that psilocybin allowed her to feel
’normal’: happy, hopeful, and interested in life.
In the two previous cases, traumatization resulted from aggression and boundary violations. In contrast, in the
present case, traumatization resulted from deprivation of basic needs. While the resulting symptoms may not fulfill
the official criteria for C-PTSD, the required treatment approach is very similar.
In comparison with the case presented by Lyons, the present case appeared quite similar (Lyons, 2022). In both
cases, the depression gradually eased over the course of two years. The case featured very frequent non-psychedelic
doses. In contrast, in the present case, the dosing was higher and the number of sessions was lower. Similar results
were achieved regardless of the dosing strategy. No adverse events were noted in either case, supporting the concept
of unsupervised psilocybin use as relatively safe, similar to unsupervised use of alcohol.
The role of psychedelics was to identify (reveal) the underlying causes of symptoms, allowing for real-world interven-
tions to correct or resolve these issues. These actions included the setting of personal boundaries and the clarification
of responsibilities between parents and children. The case thus indicated the role of psychedelics as a temporary,
transitional tool. The actual resolution of symptoms depends on one’s ability to impose the necessary changes in the
real world.
5
The case also demonstrates a breakdown in societal communality: the children lived practically alone for years
without anyone noticing or interfering. It may also illustrate the breakdown of public mental health care: for years,
it offered her ’nothing’. Emotional traumas were considered ’out of scope’ of psychiatric care. On the societal level,
it appeared that reliance on the initially (in the 1980s) somewhat functional public health care system led to an
over-reliance on it and a breakup of communal support structures. A later, gradual deterioration of public mental
health care since the 1990s led to a situation in which neither a functional mental health care system nor supportive
communal structures existed. However, most people had been conditioned to believe in and rely on ’professionals’
(Illich, 2011). When such professionals were either unavailable or unable to solve patients’ issues, most patients
appeared unable to act on their own and were instead rendered helpless. As a solution, Illich suggested a partial
’deprofessionalization of medicine’ of which the present case may be considered an example.
Illich noted that medicine ’does for health what education does for learning: it converts a good that people might au-
tonomously cultivate into a scarce commodity only accessible through an institution that monopolizes its distribution’
(Shullenberger, 2022). In other words, it may have promoted ’learned helplessness’, which is considered a common
feature of depression. Lysaker et al. noted that recovery from mental illness involved recapturing a sense of agency
(Lysaker and Leonhardt, 2012). In this sense, weakening the sense of personal agency may promote depression.
With the exception of the trauma-informed psychotherapy received years later, the described mental health care
system appeared hollow. When adequate health services are not provided, it would appear reasonable to allow
patients to resort to self-treatment with efficacious methods such as the one presented in this case study. Regardless
of the chosen point of view, whether it is related to health, employment, or financial aspects, early self-treatment of
mental health issues is in everyone’s best interests.
According to a statement given in 2001 by Herbert Schaepe, Secretary of the Board of the United Nations International
Narcotics Control Board (INCB), psilocybin-containing plants were not controlled under the 1971 United Nations
Convention on Psychotropic Substances (Schaepe, 2001a,b). Schaepe stated that ’preparations made from these
plants are not under international control and, therefore, not subject to any of the articles of the 1971 Convention’.
Therefore, as these substances are under domestic law, adopting the presented kind of self-treatment would be
straightforward.
Internationally, psilocybin mushrooms have been legal at least in Brazil and Jamaica and either decriminalized or
illegal but unenforced in some other countries. In the United States, Oregon passed statewide legislation decrimi-
nalizing magic mushrooms in 2020 (Schwarz-Plaschg, 2022). By the end of 2022, San Francisco and approximately
twelve other US cities had either decriminalized or assigned the lowest level of law enforcement priority to psilocybin
mushrooms. In the Czech Republic, drug possession for personal use in small amounts has been decriminalized
since 1990 (Belackova and Stefunkova, 2018). A similar model was adopted in Spain in 1992 (Quintas and Arana,
2017). Portugal, adopting an approach focused on public health rather than public-order priorities, decriminalized
the public and private use, acquisition, and possession of all drugs in 2000 (Rˆego et al., 2021). In the Netherlands,
psilocybin truffles have been legal (Coordination Centre for the Assessment and Monitoring of New Drugs, 2000;
Schwarz-Plaschg, 2022). In Austria, suspension of prosecution for personal use of small amounts is possible (Eu-
ropean Monitoring Centre for Drugs and Drug Addiction, 2014). In Finland, according to a precedent issued by
the Supreme Court of Finland in 2017, psilocybin has been considered comparable to cannabis (Supreme Court of
Finland, 2017).
As illustrated by the present case, the principles of the treatment were relatively simple and easy to follow. The
requirements for a successful resolution of the condition were: 1. physical and emotional distancing from the trau-
matizing environment to a safer environment, to prevent retraumatization and allow for a wider perspective on one’s
issues; 2. comparisons with the experiences of others who had lived in a non-traumatizing environment, to allow
for an understanding of causal relationships; an understanding of what was missing, so that corrective emotional
experiences can later be pursued; 3. psilocybin-facilitated experiences of positive states of mind (happiness, joy,
calmness); access to dissociated memories, to expand the space of known states of mind, allowing them to be pursued
later without psychedelics; expression of previously suppressed feelings, and their interpersonal validation; 4. time
to put the gained insights into practice, preferably in a relationship with another person who has experience with
similar issues.
Conclusions
The findings align with those of previous case studies, suggesting that psilocybin is feasible for unsupervised self-
treatment of major depressive disorder. A reasonable expectation for resolution of a relatively uncomplicated case
of major depression, such as the one presented in this study, is a treatment period of approximately two years with
psilocybin, and an additional period for real-world application of the insights gained with psilocybin. The end result
depends largely on external, environmental factors such as the quality of human interactions, and the supportiveness
and coherence of the local community. From a healthcare perspective, the self-treatment approach would likely enable
significant improvements in both treatment efficacy and cost effectiveness, as well as reduce the need for health care
personnel.
6
Abbreviations: The following abbreviations are used in this manuscript:
ACE adverse childhood experience
C-PTSD complex post-traumatic stress disorder
DMT N,N-dimethyltryptamine
LSD lysergic acid diethylamide
MDD major depressive disorder
MDMA 3,4-methylenedioxymethamphetamine
NGO non-governmental organization
Authors’ contributions: The author was responsible for all aspects of the manuscript.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-
for-profit sectors.
Availability of data and materials: Due to the protection of anonymity, the materials are not available.
Ethics approval and consent to participate: A consent to participate from the patient was obtained. Ethics pre-approval
does not apply to retrospective ethnographic studies.
Consent for publication: Due to the sensitive nature of the subject and because interviews were done anonymously
and remotely, a waiver of documentation of informed consent was considered applicable in this case (45 CFR §
46.117(c)(1)(i)).
Competing interests: The author declares that he has no competing interests.
Author details: Independent researcher, Helsinki, Finland. ORCID iD: 0000-0002-8575-9838
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