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Psychedelic therapy in practice. Case studies of self-treatment, individual therapy, and group therapy

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Psychedelic therapy in practice
Case studies of self-treatment, individual therapy, and group therapy
Abbreviations
The following abbreviations are used in this book:
2C-B 4-bromo-2,5-dimethoxyphenethylamine
2C-x psychedelic phenethylamines (e.g., 2C-B)
2C-T-x psychedelic phenethylamines (e.g., 2C-T-7)
2-FDCK 2-fluorodeschloroketamine
5-HT1𝐴receptor a subtype of serotonin (5-HT) receptors
5-HT2𝐴receptor a subtype of serotonin (5-HT) receptors
5-MeO-DMT 5-methoxy-N,N-dimethyltryptamine
5-MeO-xxT psychedelic tryptamines (e.g., 5-MeO-DMT)
ACE adverse childhood experience
ADD attention deficit disorder
ADHD attention-deficit hyperactivity disorder
BDI Beck Depression Index
C-PTSD complex post-traumatic stress disorder
CNS central nervous system
COEX systems of condensed experience; a set of similar experiences clustered on the first one
DMT N,N-dimethyltryptamine
DOC 2,5-dimethoxy-4-chloroamphetamine
DOx substituted amphetamines (e.g., 2,5-Dimethoxy-4-methylamphetamine; DOM)
DSM-5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
DXM dextromethorphan
ECT electroconvulsive therapy
EEG electroencephalography, electroencephalogram
GABA 𝛾-aminobutyric acid
GDP gross domestic product
HSP highly sensitive person
ICD-10 International Classification of Diseases, 10th Revision
ICD-11 International Classification of Diseases, 11th Revision
IFS Internal Family Systems therapy
LSD lysergic acid diethylamide
MAOI monoamine oxidase inhibitor
MAPS Multidisciplinary Association for Psychedelic Studies
MDD major depressive disorder
MDMA 3,4-methylenedioxymethamphetamine
MXE methoxetamine
MÅDRS Montgomery–Åsberg Depression Rating Scale
NBOM substituted phenethylamines (e.g., 25E-NBOMe)
NGO non-governmental organization
PTSD post-traumatic stress disorder
RCT randomized controlled clinical trials
rTMS repetitive transcranial magnetic stimulation
SNRI serotonin–norepinephrine reuptake inhibitor
SSRI selective serotonin reuptake inhibitor
tDCS transcranial direct current stimulation
THC tetrahydrocannabinol
TRD treatment-resistant depression
TRE Trauma Release Exercises
UdV União do Vegetal
Copyright ©Mika Turkia 2024
psychedelictherapy.fi
Version 1.0; October 2024
ISBN 978-952-65545-2-5
Authors’ contributions
The author was responsible for all aspects of this 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 have been deleted.
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
Chapters 2, 4, and 11: Consents from the interviewees were obtained. Chapters 3, 5, 6, 7, 8, 9, 10, 12, 13,
and 14: Verbal consents from the interviewees were obtained. Due to the sensitive nature of the subject the
interviewees requested a waiver of documentation of informed consent (45 CFR § 46.117(c)(1)(i)).
Competing interests
The author declares that he has no competing interests.
The use of generative AI technologies
These technologies were not used, except for grammar checking and in sections 13.3.1 and 13.3.2.
Author details
Independent researcher, Helsinki, Finland. ORCID iD: 0000-0002-8575-9838
Colophon
This document was typeset with kaobook.
’I want people who have been in similar situations to hear my story.
I was looking for people who would say, ’I had this too!’
But I didn’t have anyone to talk to. I felt lonely and conflicted.
It would matter a lot to me if people began to share these stories.’
’Even when we do small work for twenty people,
we have the potential to impact millions of people.’
’From your heart, for all of us.’
Chapter 8.
Contents
Contents vii
1 Introduction 1
2 Underground small-group therapy of depression and complex trauma with psilocybin 2
2.1 Introduction ............................................. 2
2.2 Case description ........................................... 4
2.3 Discussion .............................................. 14
2.4 Conclusions ............................................. 17
2.5 References .............................................. 17
3 Self-treatment of depression and complex trauma with psilocybin and LSD 22
3.1 Introduction ............................................. 22
3.2 Case description ........................................... 25
3.3 Discussion .............................................. 32
3.4 Conclusions ............................................. 34
3.5 References .............................................. 35
4 Self-treatment of psychosis and complex trauma with LSD and DMT 39
4.1 Introduction ............................................. 39
4.2 Case description ........................................... 44
4.2.1 Regular dose LSD and psycholytic dose DMT sessions ................. 47
4.3 Discussion .............................................. 49
4.3.1 Some benefits and risks related to various models of psychedelic therapy . . . . . . 52
4.3.2 Case studies and evidence based medicine ........................ 56
4.4 Conclusions ............................................. 56
4.5 References .............................................. 57
5 Healing early neonatal death related family trauma with psilocybin 64
5.1 Introduction ............................................. 64
5.2 Case description ........................................... 66
5.3 Discussion .............................................. 69
5.4 Conclusions ............................................. 71
5.5 References .............................................. 72
6 MDMA in the resolution of alcohol and diazepam addiction 75
6.1 Introduction ............................................. 75
6.1.1 Benzodiazepines as a substitute for alcohol ........................ 76
6.1.2 The Minnesota abstinence model ............................. 76
6.1.3 The Internal Family Systems therapy model ....................... 77
6.1.4 Trauma Release Exercises .................................. 79
6.1.5 Psychedelics for alcohol use disorders ........................... 79
6.1.5.1 LSD ......................................... 80
6.1.5.2 Ayahuasca ..................................... 80
6.1.5.3 MDMA ...................................... 81
6.2 Case description ........................................... 83
6.3 An analysis of the IFS session .................................... 89
6.4 Discussion .............................................. 91
6.4.1 On the adoption of psychedelic therapy .......................... 92
6.5 Conclusions ............................................. 93
6.6 References .............................................. 94
7
Self-treatment of parental neglect-induced mixed anxiety and depressive disorder with psilocybin
100
7.1 Introduction ............................................. 100
7.2 Case description ........................................... 102
7.3 Discussion .............................................. 107
7.4 Conclusions ............................................. 109
7.5 References .............................................. 110
8 Ayahuasca in the treatment of bipolar disorder with psychotic features 114
8.1 Introduction ............................................. 114
8.1.1 The low-dose maintenance treatment method of Mudge ................ 119
8.1.2 Aspects of the present case ................................. 123
8.2 Case description ........................................... 124
8.2.1 The abuser’s perspective .................................. 141
8.2.2 Bipolar disorder as a consequence of trauma ....................... 143
8.3 Discussion .............................................. 144
8.3.1 LSD in the resolution of bipolar disorder ......................... 147
8.3.2 The role of trauma in the etiology of psychosis ...................... 148
8.3.3 The brain as a filter ..................................... 150
8.3.4 The three types of intuition ................................. 151
8.3.5 Victimization/object-perspective versus agency/subject-perspective ......... 152
8.3.6 Societal aspects ....................................... 153
8.3.7 Neurobiological aspects ................................... 155
8.3.8 The practice of self-experimentation ............................ 156
8.4 Conclusions ............................................. 156
8.5 References .............................................. 157
9 The treatment of abandonment anxiety with MDMA and LSD 175
9.1 Introduction ............................................. 175
9.2 Case description ........................................... 177
9.2.1 Self-treatment session practices .............................. 180
9.2.2 ’Mystical’ and religious experiences ............................ 181
9.3 Discussion .............................................. 183
9.4 Conclusions ............................................. 184
9.5 References .............................................. 185
10 Psycholytic dosing of Amanita muscaria (red fly agaric) mushrooms 188
10.1 Introduction ............................................. 188
10.2 Case description ........................................... 193
10.3 Discussion .............................................. 199
10.4 Conclusions ............................................. 200
10.5 References .............................................. 201
11 Ketamine in severe depression 207
11.1 Introduction ............................................. 207
11.2 Case description ........................................... 215
11.3 Discussion .............................................. 224
11.3.1 The problem of overcompliance .............................. 225
11.4 Economic considerations ...................................... 226
11.4.1 The pilot program treatment costs ............................. 226
11.4.2 Comparison to the Oxford model ............................. 226
11.4.3 The economic burden versus treatment costs ....................... 227
11.5 Complements and alternatives ................................... 228
11.5.1 Clinical applicability of ketamine versus classical psychedelics ............. 228
11.5.2 Alternatives to ketamine .................................. 230
11.6 Conclusions ............................................. 233
11.7 References .............................................. 233
12
5-MeO-DMT in the complete resolution of the consequences of chronic, severe sexual abuse in
early childhood 245
12.1 Introduction ............................................. 245
12.2 The client’s background and perspective ............................. 246
12.3 The facilitator’s background .................................... 249
12.4 The facilitator’s perspective on the present case ......................... 251
12.4.1 The nature of entities .................................... 254
12.4.2 Christ Consciousness .................................... 256
12.5 Discussion .............................................. 256
12.6 Conclusions ............................................. 260
12.7 References .............................................. 260
13
The mechanism of action in a spontaneous resolution of chronic depression, anxiety, and burnout
266
13.1 Introduction ............................................. 266
13.2 Case description ........................................... 267
13.3 Discussion .............................................. 273
13.3.1 An interpretation based on the Internal Family Systems method . . . . . . . . . . . . 274
13.3.2 General perspectives .................................... 275
13.4 Conclusions ............................................. 276
13.5 References .............................................. 276
14 LSD and ketamine in schizoaffective paranoid psychosis involving childhood and war trauma 279
14.1 Introduction ............................................. 279
14.2 Case description ........................................... 280
14.3 Discussion .............................................. 289
14.4 Conclusions ............................................. 294
14.5 References .............................................. 294
Introduction 1
Psychedelics could be described as a ’technology of connection’: con-
necting to yourself, your body, other people, society, and nature. As a
somewhat complex phenomenon, psychedelics may be seen as positioned
at the intersection of art, religion, and various fields of science, including
medicine, psychology, anthropology, and many others. Psychedelics have
been approached as a tool for achieving some purpose or as a sacrament.
Their traditional use is thought to have originated hundreds of years
ago.
Indigenous cultures typically approach their psychedelic plant medicines
from a more religious point of view. Recently, in Western societies, an
increasing interest in using psychedelics for healing emotional trauma,
depression, and similar issues has emerged. Millions of people worldwide
use psychedelics to enhance problem-solving skills, foster creativity, or
gain new insights into their lives.
Currently, many misunderstandings about the nature of psychedelics
still prevail. Lack of knowledge prevents the world from benefiting from
the full potential of these medicines.
This compilation focuses on success stories—cases of courage, innovation,
and the application of knowledge and power in overcoming illness and
suffering. It features fourteen ethnographic case studies that describe
how people were able to alleviate or overcome serious issues including
alcoholism, severe anxiety and depression, suicidal behavior, and psy-
chotic disorders caused by ignorance, neglect, violence, war, and sexual
abuse.
The approach is retrospective, i.e., based on interviews conducted after
the healing process was over and the main outcome had been achieved.
Many of these successes may have been due to exceptional skill, the
right timing, and perhaps luck. They may not be reproducible, nor were
they random occurrences. In any case, this compilation is not a manual,
recommendation, or guideline; it is for informational purposes only. Yet,
it is also a tribute to the possibility of healing.
The chapters were originally made available as preprints on ResearchGate,
later also on PhilPeople and PsyArXiv. The chapters are published in their
original form. Some of the discussion and analysis may appear outdated
or incomplete. Nevertheless, the essence—the case descriptions—may be
timeless.
Initially, medical terminology was adopted as a frame of reference. In
retrospect, another kind of approach would have been better, but there
were no resources for a rewrite.
The author would like to thank everyone who participated in the pro-
cess—above all, the interviewees. Unreasonable effort, suffering, and
sacrifices were required to produce these studies; please give them the
respect they deserve.
[1]: Vargas et al. 2020 doi
[2]: Teixeira et al. 2022 doi
[3]: Amsterdam et al. 2011 doi
2
Underground small-group therapy of
treatment-resistant depression and complex
post-traumatic stress disorder (C-PTSD) with
psilocybin
2.1 Introduction . . . . . . . . . . 2
2.2 Case description . . . . . . . 4
2.3 Discussion . . . . . . . . . . . 14
2.4 Conclusions . . . . . . . . . . 17
2.5 References . . . . . . . . . . . 17
While a relatively large body of research exists on many aspects of
psychedelic therapy, articles describing a complete, successful treatment
process are rarely found. This article therefore presents a case of a woman
in her early forties with early complex trauma due to domestic violence,
sexual abuse and poverty in her childhood, resulting in approximately
three decades of treatment resistant depression. Antidepressive medica-
tions did not alleviate her depression but resulted in adverse effects and
an eventual discontinuation of the medications. Eventually the woman
resorted to ’mixed-method’ underground small-group sessions that uti-
lized breathing exercises, cold exposure, physical exercises, music, and
psilocybin mushrooms.
April 25, 2022
10.13140/RG.2.2.24250.06089
10.31234/osf.io/t6k9b
Shortdoi: mmfr
Keywords: domestic violence,
childhood sexual abuse,
treatment-resistant depression,
psilocybin, hypnotherapy
Psilocybin appeared to interrupt trauma-related dissociation, producing
an ’anti-dissociative’ effect, allowing the woman to re-experience, in a
controlled setting, dissociated physical sensations produced by earlier
overwhelming events. After a period of approximately 1.5 years, during
which time she had six psilocybin sessions, either individually, in the
small group, or with friends, she achieved a remission of her depression. A
follow-up interview 2.5 years later indicated permanence of the result.
Information was acquired from semi-structured retrospective interviews
with a total duration of approximately eight hours. This case study
may facilitate an improved understanding of the requirements for and
the process of alleviating or resolving treatment-resistant depression
with psychedelics. Recent clinical trials have utilized one or two doses
of psilocybin. This case illustrates the need for adopting a multi-dose
strategy over an extended period of time in order to achieve remission.
2.1 Introduction
Psychedelic therapies for mental disorders are currently being intensively
studied, with psilocybin perhaps having received the most attention.
A systematic review and meta-analysis of clinical trials investigating
psilocybin for depression and anxiety in the context of life-threatening
diseases published in 2020 described the results as promising, indicating
psilocybin’s possible efficacy in conditions that are either resistant to
conventional pharmacotherapy or for which pharmacologic treatment
is not yet approved [1]. The review mentioned that due to its safety,
psilocybin could be relevant for first-line treatment.
With regard to pharmacology and risks of psilocybin, it is non-addictive
and has low toxicity [2]. According to a governmental assessment in the
Netherlands, acute and chronic adverse effects of magic mushrooms are
relatively infrequent and generally mild, its public health and public
order effects are very limited, and that criminality related to the use, the
production and trafficking of magic mushrooms is almost non-existent
[3]. Lifetime prevalence of use in 12 EU countries was estimated to vary
between less than 1% and 8%.
2.1 Introduction 3
[4]: Kopra et al. 2022 doi
[5]: Passie et al. 2002 doi
[6]: Carhart-Harris 2018 doi
[7]: Griffiths et al. 2017 doi
[8]: Passie 2005
[8]: Passie 2005
[8]: Passie 2005
[9]: Trope et al. 2019 doi
[10]: Roseman et al. 2018 doi
[11]: Carhart-Harris et al. 2017 doi
[12]: Bogenschutz et al. 2015 doi
[13]: dos Santos et al. 2016 url doi
[12]: Bogenschutz et al. 2015 doi
[14]: Davis et al. 2021 doi
[15]: COMPASS Pathways 2021 url
In a recent study, 19 (0.2%) of 9,233 past year magic mushroom users
reported having sought emergency medical treatment (EMT) [4]. Eleven
(58%) had simultaneously consumed cannabis, alcohol, cocaine, MDMA,
ketamine or opioids. The rest of the incidents were mainly due to badly
chosen environment, a wrong mindset before the session, or taking
too much. The most common adverse reactions were anxiety/panic,
paranoia/suspiciousness, and hallucinations. The only predictor of EMT
incidents was younger age. Twelve of the incidents were resolved in less
than six hours, all but one in 24 hours, and the last one in a week. The
per-session risk estimate for EMT was 0.06% although 1.4% of 12,534 users
(of which 9,233 responded to the EMT question) reported a diagnosis of
psychosis and 2.6% a diagnosis of bipolar disorder.
A typical duration of the effect of psilocybin is 3-4 hours [5]. It has been
proposed that psychedelics mediate their treatment effects through the
relaxation of (pathological) high-level beliefs [6]. It has also been noted
that psilocybin-occasioned mystical experiences correlate with indicators
of treatment efficacy [7]. These experiences may include, for example,
experiences of sacredness of life, or experiences of oneness with nature
and other people (temporary dissolution of ’ego structures’, or self-
transcendence); these may be seen as relaxation of high-level beliefs.
First known mention of psilocybin use occurs in a 1598 document describ-
ing the religious rituals of Aztecs in Mexico [8]. In Western countries,
therapeutic use of psilocybin begun in the 1960s [8]. In Europe, psilocybin
was used as an agent to help activate unconscious material, i.e. re-create
subconscious conflicts and memories in order to make them accessible
to psychotherapy. The therapeutic effect was considered to result from
long-term processing of this material, not from the pharmacological
effect of psilocybin.
In the 1960s, psilocybin was utilized in individual psychotherapy and
various types of group therapies [8,9]. In the 2000s, psilocybin therapy
has been studied for treatment-resistant depression [10,11], alcohol
dependency [12], as well as for nicotine dependency, cancer-related
anxiety, and obsessive compulsive disorder [13].
In 2015, ten-patient proof-of-concept study about psilocybin for alcohol
dependence indicated that abstinence increased significantly following
psilocybin administration (p<0.05) and the gains were largely maintained
in a nine-month follow-up [12]. In 2020, 24-patient study with one session
utilizing 20 mg of psilocybin and a second session utilizing 30 mg of
psilocybin, combined with eleven hours of supportive psychotherapy,
resulted in a remission of 13 participants (54%) in an one-month follow-up
[14]. In 2021, a 233-patient, randomized, controlled, double-blind phase
IIb trial about psilocybin for treatment-resistant depression indicated
that in a three-month follow-up, approximately a quarter of patients
in a high-dose psilocybin group achieved remission, in comparison to
approximately one tenth in low-dose and control groups (NCT03775200)
[15].
This case study illustrates the treatment of both alcohol dependence
and treatment-resistant depression, both of which originated from and
appeared as symptoms of complex post-traumatic stress disorder (C-
PTSD). The details of this case have been acquired from two semi-
structured retrospective interviews with a total duration of approximately
4 2 Underground small-group therapy of depression and complex trauma with psilocybin
[16]: Walker 2013 url
four hours conducted in November 2019. Two follow-up interviews with a
total duration of approximately four hours were arranged in March-April
2022. As the patient’s contacts with the healthcare system had been
sparse and somewhat superficial, as there was no indication of a need for
differential diagnosis, and as medical records from past decades were
not available online, they were not acquired for this study.
2.2 Case description
A middle-class woman in her early forties had been exposed to a threat
of domestic violence since very early childhood. In addition there had
been some sexual abuse. Her childhood had been dominated by an
unpredictable, violent father that she described as ’narcissistic’. Her
mother and older siblings had been targets of the father’s raging violence.
She was significantly younger than her siblings and had adopted a
strategy of attempting to please her father and avoid his attention by
being ’nice and invisible’ (sometimes called a ’fawn response’ [16]). The
older siblings displayed more opposition towards the father.
The violence had an intergenerational origin. Her father’s background
could be described as upper class. Regardless, she described her grand-
mother (her father’s mother) as ’cruel and sadistic’. Her father and his
siblings had been exposed to daily, ’blind’, ’raging’ violence that had
occasionally appeared as life-threatening. Her father had been the oldest
child. She described that the grandmother had acted extremely violently
towards the children even in the presence of friends and guests who had
ignored the violence. As an example, the grandmother had once kicked
the father’s sister hard and thrown her forcefully against a wall during a
party, without any of the guests interfering.
Her father developed a ’grandiose self’ in order to compensate for feelings
of inadequacy. He was a workaholic who prioritized his work above
everything else including the needs of his family and children. He adopted
the behavioral pattern of raging violence while his social environment
adopted the pattern of ignoring the obvious domestic violence. She
described that the father and the grandmother had been ’experts at
manipulating people’. She described a case in which her mother had
’maybe appeared too happy’ or had ’received too much attention from
guests’ at a party. The father had subsequently hit the mother in the face
in front of the guests. As the mother had been lying on the floor barely
conscious, one of the guests had told her to get up in order to avoid
’spoiling the party for no reason’.
Her father also repeated a relationship pattern of being extremely charm-
ing at first, yet later destroying his partner’s already deficient self-
confidence with verbal abuse, proceeding to physical violence later. She
said that her mother had been ’already crushed’ by the time she was
born. The mother had eventually attempted to find psychotherapy for
the father. Instead of agreeing to try to help the father, the therapist had
asked the mother to attend therapy sessions herself. In the course of
therapy the mother realized that the family’s behavioral patterns were
severely dysfunctional. The father subsequently threatened to kill the
therapist. Eventually a divorce followed. The father immediately started
a new relationship with another woman who was a generation younger.
2.2 Case description 5
In this new relationship the pattern of domestic violence had apparently
been repeated again.
She described having suffered from the lack of expressions of love.
Eventually, at the age of ten, she asked her mother why the mother never
held her or told her that she loved her. The mother replied that she
was unable to do that. She interpreted the reply to mean that she was
unlovable: loving her was impossible. This resulted in ’a deep feeling of
emptiness’ and a resignation of her efforts to be loved. These factors in
conjunction with the general atmosphere of fear and her feeling of shame
about herself ’resulted in consequences’ later in life: in a deep feeling of
never being enough, and in ’a desperate search for external validation by
any possible means’.
After the divorce the mother’s unemployment caused severe financial
insecurity. The father refused to support his children in any way. She suf-
fered from relative poverty and uncertainty, worrying about her mother
and the family situation. This childhood experience led to overcompen-
sation later in life: she had ’given everything’ to become successful and
financially stable.
In her mid-twenties she married, had two children and became a suc-
cessful middle-class entrepreneur. She described herself as having had
no self-confidence whatsoever but succeeding ’accidentally’. Success
in studies and work was her only way to feel valued, to overcome ’an
immense worthlessness’. Her occupation protected her from a total emo-
tional collapse by providing the necessary external validation and social
status. Despite feeling that her only way out was to end her life at some
point in the near future, she was never absent from work. She described
having developed ’excellent skills of acting happy in front of customers’.
Despite succeeding in preserving the facade of normalcy, this acting
further exhausted her.
She led a ‘mainstream lifestyle’ and strived to be ‘a good taxpayer’. She
valued people by their education, level of income and other indicators
of social status, and acted dismissively towards people not up to her
standards. In retrospect, she felt having been very judgmental and
insensitive about the feelings of others, yet having been oversensitive
about herself. She had also been dismissive of anything ’unscientific’ or
’alternative’, exhibiting an uncritical attitude towards ’science’.
Consistent with her middle-class background, she unquestioningly be-
lieved that medical doctors would resolve her chronic depression. During
the next decade, in fifteen-minute appointments, various general prac-
titioners prescribed her several different selective serotonin reuptake
inhibitors (SSRIs). Possible reasons for her depression were never ad-
dressed, and prescriptions were often renewed without an appointment.
The SSRIs had no effect on her depression but caused adverse effects,
including a tinnitus persisting to this day. The inefficacy combined
with adverse effects led to disillusionment, frustration and an eventual
discontinuation of the medications.
She played the role of a housewife and took care of her children although
she was emotionally absent and tired. Like her father, she prioritized
work assignments over family time or the children’s needs. The essence
and focus of her life was the habit of drinking alcohol every weekend
6 2 Underground small-group therapy of depression and complex trauma with psilocybin
[17]: Laurel Parnell 2013 url
and sometimes during the week. She was unable to derive pleasure from
anything else including the family life. Alcohol was ’her thing, an escape
into a world of softness’. Despite drinking secretly, aiming at getting
drunk on every possible occasion, and being unable to even imagine
spending a weekend without drinking (’it was not even theoretically
possible’), she never considered her alcohol use to be a problem.
In her late twenties the situation escalated and she exhibited constant
suicidal ideation, planning on jumping in front of a subway train. At
the age of 29 she visited a psychiatrist for the first time. The psychiatrist
commented that due to her depression having recurred for decades she
would be on SSRIs for the rest of her life. At this point she initiated a
three-year psychodynamic psychotherapy, along with SSRI medication.
She described the therapist as ’very passive’: during the sessions she
was ’giving monologues for three years’. She said that the therapy had
no effect on her self-image of deep worthlessness. She said that since
the therapist never challenged anything, the therapy allowed her to
completely avoid any difficult subjects. Between the ages of 33 and 37
her mood varied, with occasional periods of no SSRI medication due
to pregnancies. After the birth of a second child, at the age of 34, she
received another SSRI prescription.
At the age of 38, the severe depression re-emerged, with SSRIs having no
effect on it. As she had the financial resources and was still functional
enough to find a psychotherapist, at the age of 39 she eventually attended
a second period of psychotherapy sessions which included eye movement
desensitization and reprocessing (EMDR) trauma therapy (the standard
type, not attachment-focused [17]). The therapist suggested that she
would not use SSRIs during the therapy, and she discontinued them.
Unfortunately she experienced little benefit from the psychotherapy
sessions.
Striving to be a ’good citizen’, she also opposed illegal drug use. In
the comprehensive school, psychedelics had been described as life-
threatening, the absolute worst thing to do, causing one to jump from
a roof thinking one was a bird, or to peel oneself like an orange. In her
youth she briefly tested cannabis but it did not alleviate her depression,
only making her feel worse.
Once, a severely depressed friend surprised her by commenting that
their only chance was to ’wait for the legalization of psychedelics’. She
had been unaware of such an option and despite her ’very negative
attitude’ towards drugs she was ’desperate for any solution’. An online
search revealed preliminary studies about psychedelics on depression;
this information ’completely contradicted’ the information provided by
the school system. As her suicidal ideation was constant and she felt
hopeless, the risks seemed low and possible benefits significant; she
commented that she would have accepted much higher risks.
She found a psychotherapist who agreed to discuss psychedelic thera-
pies on a general level. Later she found a person who had investigated
psychedelic therapies for five years. This person had observed conven-
tional treatment of psychoses and had become disillusioned by it for
family reasons. In his view, the treatment was not founded on a well-
defined ’theory of mind’, and antipsychotic medication appeared merely
as palliative care. As he did not understand what psychosis was like, he
2.2 Case description 7
[18]: Berlowitz et al. 2022 doi
[19]: Ledford 2014 doi
[20]: Kox et al. 2014 doi
resorted to the idea of ’model psychosis’ originating from the ’first wave’
of psychedelics in the 1960s. According to the model psychosis theory,
psychedelics were a method for experiencing psychosis-like states.
The person had become acquainted with various traditions and acquired
personal experience of plant-based classical psychedelics psilocybin,
ayahuasca, and mescaline. He had subsequently resolved his own de-
pression with these plants. His depression had been due to ’a lack of
self-understanding’: lack of life purpose, working ’too much, in a wrong
environment, with wrong people, for wrong reasons’. The resulting
bad feeling he had dismissed as ’weakness’. To overcome stress, he had
used alcohol. He had later overcome these issues, was physically fit,
had received military leadership training, and appeared able to handle
challenging situations.
The person interviewed possible group session attendees in advance
and gave detailed instructions for preparation. The required preparation
period was a few days. The instructions included avoidance of alcohol
and recreational drugs, nutritional advice, and the importance of setting
a precise intention for the session (see e.g. [18]). The intention and
commitment to proper preparation were considered essential for the
success of the session.
The group sessions were organized in a cottage in a forest with psilocybin
mushrooms collected nearby. On-site preparations included physical
exercises such as yoga/stretching, movement, heat exposure (sauna),
cold exposure (ice swimming), and breathing exercises. Some of the
exercises were adopted or adapted from Kundalini yoga and the Wim
Hof method of immune system enhancement [19,20]. The methods were
predominantly body-oriented. Methods for mental preparation included
elements from martial arts.
The group setting aimed at providing safety and predefined structure.
Sessions begun in the evening and ended in the morning. The first
session was an individual session with the organizer. The second and
sixth sessions were group sessions with the same organizer. The second
session was with two people and the organizer. Her third session was
carried out with her friend acting as a sitter. The fourth and fifth sessions
were group sessions but not with the same organizer. The fourth session
was with a group of four people and two sitters. The fifth was with five
people and two sitters. One of the sitters had ’extensive’ experience of
psilocybin, the other some experience. They had not organized such
events before. Also these events were structured as ceremonies. The sixth
session was with the original organizer, a ’shaman’, and three attendees.
Financially, the sessions were either non-profit (immediate costs only,
such as food and transportation) or free.
In order to facilitate a feeling of empowerment the attendees were recom-
mended to sit up instead of lying down but this was not a requirement.
The sessions consisted mainly of silent medication. Difficult emotions
were handled with the breathing techniques learned in advance. These in-
cluded forceful breathing similar to holotropic breathwork and Kundalini
breath of fire, and more subdued techniques such as simply lengthening
the exhalation.
8 2 Underground small-group therapy of depression and complex trauma with psilocybin
[21]: Knight 2020 doi
[22]: Meckel Fischer 2015
[23]: Sessa et al. 2015 doi
During the sessions the attendees were instructed to ’allow the medicine
to work’, i.e avoid resisting what was emerging in the body or mind.
According to the organizer, psychedelic plants possessed an intrinsic
intelligence which directed the attendees’ processes according to their
individual needs. In order to direct the mood, direction and progress of
the group the organizer utilized music, drumming, scents from essential
oils, and introduction of physical practices or breaks. The organizer’s
role was to ’hold space’: a concept commonly used in the context of
psychedelic group and individual therapies, referring to an insulation
from the external world that would allow participants to let go of
reality and regress to earlier states of developmental arrest in service of
reparation and healing [21]. The organizer also consumed psilocybin but
utilized a half-dosing strategy, consuming half of what the participants
did. This strategy has been recommended by, among others, Meckel
Fischer, a Swiss psychotherapist who arranged a somewhat large-scale
underground psychedelic group therapy in Switzerland for several years
in the early 2000s [22,23]. Half-dosing, also called psycholytic dosing,
allows the sitter to better perceive and attune into the emotional states
and needs of the participants.
Her first impression was that the organizer was a ’hippie’ and the
preparatory rituals ’ridiculous’ and ’unscientific’, something beneath
her. In her desperation she focused solely on receiving the mushrooms.
Her first psilocybin session ’taught her what acceptance means’. The
session did not eliminate her depression but rather ’only scratched the
surface . .. it was not sufficient in any way’. Regardless, she felt that the
method was the way forward for her. Simultaneously she felt ’cheated’
due to having expected something more impressive than a tutorial on
acceptance. In retrospect, she considered learning that concept as being
the most important for her at the time. Later she also ’understood the
purpose’ of the preparatory rituals.
Despite her depression remaining unresolved she was soon after sur-
prised by an unintended effect: her almost daily drinking begun to feel
inappropriate in an unspecified manner. There was ’a deep feeling of
wrongness in my body’, without specific intellectual content. In the fol-
lowing months she still occasionally got drunk at parties but the feeling
of inappropriateness gradually intensified until she stopped drinking
altogether. She commented that this result was unrelated to willpower: ’I
drink as much as I feel like. Nowadays it just happens to be one glass of
wine every three months’. She said this effect had felt very strange and
been completely unexpected: she had never intended to quit drinking as
it had been ’the only nice thing in my life’.
The second session three months later concerned ’compassion and
nothing else, from the beginning until the end. It was like: throw anything
at me, the compassion never ends .. . it was nice’. The third session
concerned childhood sexual abuse: an issue whose importance she had
until then denied. In the earlier psychotherapy sessions her therapist had
attempted to convince her of the importance of these experiences but
she had rejected these attempts, claiming that the abuse had been ’mild
and inconsequential’. In the session she understood in detail how the
abuse had affected her life. She described the reliving of these events
as ’freezing’. Subsequently, she was shocked about how she could have
until then denied the importance and consequences of the abuse. On the
2.2 Case description 9
positive side, the session also featured an experience of oneness’ with
everything: a common subtype of ’mystical experiences in which the
boundaries of self appear to dissolve. These experiences may alleviate
the feeling of isolation typical for depression.
The fourth session concerned her relationships with her parents and her
childhood need for feeling lovable. She could not recall the details of this
subject. The session also included ’a tutorial’ about her daily feeling of
inconvenience inher social interactions. The essence of the inconvenience
was her insecurity about herself with respect to expectations of others.
She felt as if someone was telling her how to get rid of the inconvenience:
’You can dissolve it by changing your thoughts in this way’. She said the
inconvenient feeling had soon returned and the process of teaching how
to dissolve it repeated, over and over again. Regardless, after the session
she soon relapsed into the same feeling of inconvenience in her daily life.
A few months later, however, the tutorial session re-emerged in her mind,
and she begun practicing its application in her daily life. She eventually
learned how to be ’open to experiences and ’truly myself without the
constant worry’.
The fifth session was a ’nightmarish horror trip’, the purpose of which she
had not yet understood. After the previous four sessions she had thought
that she had already seen everything and could handle any emerging
material without much trouble by simply surrendering’. Despite her
confidence, in the fifth session her strategy completely failed, rendering
her defenseless, ’isolated in a dark desert’, bombarded by ’indescribably
horrible things’. She ended up thinking that she would never touch
psychedelics again. She assumed that the session intended to show her
that there was no hope for her, and that she would end up being even
more traumatized than before, in hopeless suffering for the rest of her
life. However, as the morning arrived, birds begun singing, the darkness
disappeared, and ’love in the form of green sprouts begun growing in
my heart’. She ended up not at all traumatized, thinking that the horrors
had been something that she had needed to visit, yet couldn’t say what
she had been ’supposed to work on’. This session had been the only one
in which she had needed help from a sitter. In practice, the situation had
been solved by her telling that she was unable to handle the situation. As
a response, the sitter had asked her to ’surrender’ regardless. This had
been sufficient for her to move on and continue the silent meditation. In
retrospect, she speculated whether the difficult nature of the session had
been due to lack of proper preparation: she had decided to attend the
session at the last minute, ignoring the multi-day preparatory period.
The sixth session utilized a larger dose, and there were three attendees.
Also, instead of the organizer being the only ’sitter’, in this session there
was also a ’shaman who she described as ’strange and ageless, with
a face of a 75-year old and a body of a 23-year old’. Initially she had
been suspicious about the man, not understanding why he was there.
As she was later sitting with her eyes closed, going through a difficult
moment, the man approached her, and she felt ’as if someone had turned
on the lights’. The man also played an instrument that she did not
recognize; the instrument produced vibrations which ’penetrated her
body’. Occasionally the man also sang which she had experienced as
comforting. The man ’brought in some kind of eternal peace, light and
love.. . I can’t explain how’.
10 2 Underground small-group therapy of depression and complex trauma with psilocybin
In general, the sixth session had been unexpected again, different from
any of the previous ones, with her experiencing severe physical pains.
She said that previously, she had ’not even felt her body . .. I had been
elsewhere, completely’. When going through the pains, she had not
felt that she should resist them. Instead, she had felt that she somehow
needed to experience them, ’push through them’. Eventually, as the pain
’had gone through’ her, ’some kind of light, love, I don’t know, emerged,
and I became whole’. She described the session as ’comparable to giving
birth’, ’a warrior’s trip’, ’an empowering experience’.
During the sixth session the attendees interacted with each other for
the first time. After a period of silent meditation there was a moment
without a predefined purpose or instructions. Some of the attendees
began communicating with each other. One commented having ’a lot
to apologize for’ (in life). The others then joined in the theme, saying
that they forgave the person. They then began forgiving each other for
their various past mistakes, experiencing that they could better accept
themselves as they were. When she experienced a difficult moment,
another attendee approached her and asked whether they could extract
the difficult issue out of her body. She then felt as if the other energetically
entered her body, took away the difficult sensation, and disposed of it.
Returning home after the empowering sixth session felt ’like running into
a brick wall’. She said this was because the mushrooms had sensitized
her into seeing what was wrong about her life. The intensified awareness
of her discontent about her relationship and work triggered an immense
anxiety, making her realize that she needed to implement changes in
these aspects of her life. However, she possessed a newfound feeling of
empowerment and peace, a certainty that she would be able to implement
the necessary changes.
After a period of approximately 1.5 years, during which she attended
the six group sessions, she achieved a remission of her depression. She
had performed a psilocybin session approximately once every three
months. She commented that one could not go through such demanding
experiences more often. After these sessions she was retrospectively
interviewed about her experiences. She was occasionally feeling some-
what anxious, ’physically nervous’ or ’on overdrive’ but her depression
was in remission with a low BDI score. She planned on attending a
meditation retreat and at least one more psilocybin session, as well as
finding a new career. She said that she could not have imagined that such
a change was possible, and that the mushrooms ’likely saved my life’. She
mentioned having been an extremely bitter and cynical person but these
had now been replaced with their opposite: love. She added that ’this
love thing might be somewhat incomprehensible until one experiences it
personally’.
With regard to mechanisms of action of psychedelics, she said that
psychedelics ’turned off defenses which were originally intended to
protect oneself but turned disadvantageous when applied chronically.
As these defenses were temporarily turned off one could reach one’s
’true self’ or ’core self’, bypassing the layers of societal conditioning
(e.g. survival strategies and fixed beliefs). In the psychedelic state one
could discern which layers were beneficial or necessary and which were
harmful. An essential condition for progress was the strengthening of
2.2 Case description 11
intuition. In the childhood and youth she had learned to dismiss intuition
or ’inner knowledge’ as ’irrational’; she was in the process of unlearning
these patterns.
To her, the essence of psychedelic experience was experiencing the purest
form of oneself. According to her, all of the contents of her experience
originated ’from the inside’ and nothing from the outside. In a safe
setting one received only as much from the mushrooms as one could
handle at the time, not more or less.
Integration of the psychedelic experiences into everyday life presented a
constant challenge. Often she could not recall the contents of the session
immediately after it but gradually begun to notice situations reminding
her of the concepts experienced in the sessions. For example after the
first session she begun to notice situations in which she was able to apply
the concepts of acceptance and compassion. Learning to apply these
concepts in daily life required tens or hundreds of repetitions in order to
gradually bend one’s mind in the right direction’.
Comparing psychedelics to alcohol, psychedelics produced ’an opposite
effect’, forcing one to face one’s issues instead of isolating one from them.
She had been using alcohol to numb herself and to isolate herself from her
feelings. Psychedelics directed one closer to one’s essence, true needs or
’core self’, whereas other drugs deluded a person further away from them.
She had truly believed that she had been ’listening to herself’ all the time;
yet after the psychedelic sessions she had realized that her true needs
were not what she had thought they had been (e.g. alcohol). She had also
believed that her needs had originated from herself; later she had realized
that most of them originated from cultural conditioning including the
mass media. She also pointed at the absurdity of her alcohol use having
been considered acceptable and ’normal’, whereas her psychedelics use
rendered her a criminal, despite her being ’a better mother now by all
standards’.
About the resolution of her severe treatment-resistant depression she
said that in theory, people might achieve the same result with decades
of spiritual practice and meditation but it was unlikely in general and
would have been impossible for her. She had tried meditation but did
not understand how it could help her and could not figure out why she
should do it, not understanding what it was about. Choosing a path of
meditation in her suicidal, exhausted state would have been impossible.
She said that many people were facing the same situation and had ’no
capacity whatsoever to overcome even the smallest obstacles’. She did
not find the motivation for meditation because she did not understand
what she could have achieved with it. In contrast, with psilocybin she
got a glimpse of what could be, what was possible, which created the
motivation to continue.
After her first psilocybin sessions she had still attended a few psy-
chotherapy sessions, processing some of the emerging issues there. She
commented that all her useful insights had emerged in the psychedelic
sessions, and without them the conventional psychotherapy ’would not
have had much of an effect’. She would have been stuck in ’superficial
issues’ instead of delving into ’core issues’. An example of this was her
earlier denial of the importance of the sexual abuse in the psychotherapy
until the issue had come up in her third psychedelic session. In her view,
12 2 Underground small-group therapy of depression and complex trauma with psilocybin
psychedelic therapy was ’immensely more effective’ than psychotherapy,
with psilocybin mushrooms possessing ’an almost scary power’. She did
not consider the sessions risky. Instead, she commented that her earlier
periods of suicidal ideation had been risky. She was disappointed about
her therapist’s inability to understand her experiences. The therapist’s
comments had felt irrelevant: the therapist had ’understood nothing’ and
attempts to discuss her experiences with the therapist had felt futile.
As another example, she described having possessed ’an enormous
number of defenses and survival strategies’ including the ’full-time search
for external validation by any means possible’. Lack of constant validation
had produced a feeling of not even existing, which she described as
’hellish’. She was still fighting with the need to please everyone: it had
been ’a core feature of her personality’ from a very early age. However,
she was now able to observe this process, to see how her mind was
functioning, and to ’follow it with acceptance’. While she could not
immediately change her behavior in all occasions, she was regardless
working on the change, while observing her actions ’with a certain
wisdom and a peace of mind’.
On epistemology, she commented that she no longer had ’illusions of
knowing anything’. She had possessed ’a rather rigid way of viewing the
world’, thinking that she knew and understood a certain amount, and
the rest could be fully explained using scientific methods. By performing
a scientific study about any subject one could ’find the facts’. What had
existed for her was what had been scientifically studied and proven true’.
However, psychedelics had given her an embodied experience indicating
that ’no research exists about the most important subjects . .. current
science does not cover all that exists’. According to her, ’a large part of
what exists cannot be scientifically proven, and the unprovable part is
larger and more important than the provable part’.
A follow-up interview 2.5 years after the initial interview indicated that
the remission of her depression and other symptoms was permanent.
She had successfully pursued several lifestyle and employment related
changes. She had attended one additional group session and could have
attended more of them but had not felt the need. Instead, she had consid-
ered herself sufficiently ’experienced’ to pursue two psilocybin sessions
together with a friend. These later sessions appeared predominantly
as ’fine-tuning’ of the treatment results achieved in the previous six
sessions. Most recently, she was undergoing a divorce which she felt as
’triggering’.
She had begun to attend once-weekly hypnotherapy sessions approxi-
mately one year after the sixth session, almost two years before the second
interview. Because psilocybin sessions had taught her how to access
her ’core’, how to ’bypass the ego’, she could subsequently experience
benefits from hypnotherapy. Although the therapist had no experience of
psychedelics, the therapist ’intuitively’ worked in a way compatible with
the principles of psychedelic therapy. For her, the therapy had therefore
begun to feel useful as a way of ’integration’ of the material that had
emerged in the psilocybin sessions.
After the idea of experimenting with hypnosis had occurred to her
she had tested it with a video tutorial, noticed that she could easily
enter a hypnotic state, that it was similar to a psychedelic experience,
2.2 Case description 13
[24]: Schwartz et al. 2020
and that the information gained in it was ’real’ in the same way as in
the psychedelic sessions. She found the idea of entering the state of
’direct experiencing of past events’ without external substances more
practical than psychedelic sessions. In her view, the psychedelic sessions
had ’opened the path’, showed her how she could access these states,
allowing the hypnotherapy to work. She felt hypnotherapy was on a direct
continuum with psychedelics: they shared the same mechanism of action.
As she described it, the method used in the hypnotherapy sessions was
essentially intuitively rediscovered Internal Family Systems therapy [24].
In the hypnotherapy sessions, she strengthened the intuitions achieved in
psychedelic sessions’, with the main intuitions being ’peace and love’.
The hypnotherapist did not know about her use of psychedelics. She had
found it ’unnecessary’ to mention it. In general, they talked very little.
The therapist had mentioned that for the therapist, working with her
was ’clinically very interesting’, assumedly because the therapist was
usually working in the cognitive-analytic framework, psychodrama, or
EMDR, and working with hypnosis only was unusual and often advised
against. Optimally, she wished to have a therapist who could sit her at
psychedelics sessions and also provide integrative sessions.
Following the sixth session, she carried out three more psilocybin sessions,
with increasingly long periods between them. The seventh was a group
session with the original organizer. This time, she took a larger dose than
the others, and her session was still ongoing when the others started a
verbal sharing of their experiences. This gave her an unpleasant feeling
that lasted for several days. After this she was unwilling to attend group
sessions. She had not taken up the issue with the organizer, however.
The eighth session was an individual session with a sitter, with five
grams of mushrooms resulting in ’a more challenging experience of
deep loneliness’ again, which transformed into a ’mystical experience’
of ’ego dissolution’, similar to the one experienced in the third session,
’strengthening access to a feeling of deep peace’.
The ninth session was with a friend, with both taking psilocybin at
the same time. She had experienced feelings of deep love towards her
husband who she had been in the process of divorcing. Issues in her
marriage had preceded her first psilocybin session but the sessions had
enabled her to better recognize her own needs. The feelings of love in
the session had confused her and she mentioned having ’ignored’ the
contents afterwards. Eventually, a divorce followed.
Another feature of the ninth session had been that when