‘I Can’t Say I Came Face to Face with God, But It Was Profound’: A Psychiatrist Describes His Experience with Psychedelics

16 Mar 2024

I have been interested in psychedelic-assisted therapy for many years.

I completed a training program with the Multidisciplinary Association for Psychedelic Studies (MAPS) in England ten years ago, which was doing exciting research using MDMA-assisted therapy for the treatment of PTSD.

I came back to Australia and tried to set up a trial here at the university where I was a professor.

But at the last moment, the ethics committee blocked it. They suggested that MAPS was an organisation encouraging illegal activities. 

In retrospect, I think it was a decision based on stigma attached to psychedelic substances, which was prevalent at the time.

So I continued for several years advocating research in this area with PRISM, the local organisation for psychedelic research, before being fortunate enough to become involved in two trials using psilocybin.

The first was Australia’s first allowed psychedelic-assisted psychotherapy trial at St Vincent’s Hospital, in Melbourne, using psilocybin for end-of-life anxiety and depression.

And the second was a smaller trial using psilocybin-assisted psychotherapy for treatment-resistant depression at Swinburne University.

I was fully involved in both trials as a psychiatrist, spending eight-hour dosing days with the patients as well as in preliminary and follow-up sessions.

The patients in these trials all wanted to know at the beginning of their treatments whether I and my co-therapists had tried psilocybin ourselves.

They were understandably apprehensive about their upcoming experiences, and they were reassured when I told them that I had.

I have been a psychiatrist for 45 years, and my own experience was in the early years.

As a much younger psychiatrist, I trained overseas, where it was legal at the time for trainees to undergo their own psychedelic experiences under strict clinical supervision.

Now of course, in the current environment, there are both legal and ethical problems with psychotherapists doing this.  

At Monash University, there has been one clinical trial where therapists under clinical supervision have had a psychedelic experience themselves, and this is commendable.

But for most potential therapists, this legal opportunity is not available.

Currently, the only way they can do this is illegally in unregulated circumstances.

I know of cases where this has happened and things have gone wrong for the therapists themselves — both from a clinical and legal standpoint.

So carefully legitimising such a process, where appropriate clinical supervision and legal authorisation are provided for psychedelic therapists and prescribing psychiatrists, is the way to go in my opinion.

As far as what it is like to take a psychedelic drug, I must emphasise that, unless clinically and legally sanctioned, it is dangerous for anyone to try these drugs themselves, and I do not encourage it.

Under the influence, there are four stages — and not everyone will experience them all.

The first often involves significant perceptual changes in all the sensory modalities but particularly the visual and auditory.  

You may see colours, shapes and images in the mind’s eye, and music may have a particularly moving or provocative influence.

The second stage of the experience involves personal issues, memories or attachments, which may surface in a challenging or revealing way.

This can lead to greater insight, or alternatively to anxiety and confusion, which is why it is important that such experiences often need support from trained clinicians or sitters as they are often called.

You may see problematic relationships from a different angle, which can be very helpful.

You might have some creative insights in relation to your work, what you want to do, decision-making.

Some individuals may go deeper to a third stage of what we call the collective unconscious, common to all of us, where so-called archetypal or mythical images appear.

They may have something to do with universal themes, such as the Great Mother, love, God or gods, wisdom or birth and death.

The final, deepest, level is dissolution of the ego.

You have this sort of oceanic feeling and sense of unity as if you are part of everything; there is no separation between you and the other.

Here, there is no logical understanding but rather a powerful sense of oneness with everything around you, and this is usually associated with deep understanding and acceptance.

That is quite a profound experience — some would say a spiritual experience.

Some would say here you come across some sort of force that is bigger than you, which gives you an innate understanding of the way the world works.

I cannot say I came face to face with God, but my own experience in this regard was profound.

I came to terms with my own insignificance in this beautiful awe-inspiring world, and since then, I have worked hard to maintain an attitude of what I would describe as radical amazement through meditation and by spending as much time as I can in nature.

You do not worry about conflict, dichotomies; everything seems to be at one.

There is not that split way of seeing the world: should I do this; should I do that?

Instead, everything is at ease; you have an equipoise where you are just very relaxed about things intellectually, but you also understand how the world works.

But of course, it is temporary, and eventually you come back down to earth.

Psychedelics, taken in safe circumstances with an experienced and qualified guide, may give you a glimpse or an understanding of how you want to live your life and the choices you might want to make.

My own experience greatly influenced my life thereafter — both in regard to career interests and the love I developed for nature.

I had been an urban dweller up until then, but after I returned to Australia, I bought some degraded land in the country and began planting many, many trees.

I still own the land and now enjoy walking through, and maintaining, the beautiful forest I have created. It is one of the great joys of my life.

Putting aside medical and psychiatric contraindications, such as heart disease or a history of psychosis, from my clinical experience, there are several factors that may determine who might benefit from a psychedelic experience and who might not.

First, there is what I would call psychological flexibility: the ability to distance oneself from one’s own thoughts, memories, emotions and ideas — a concept similar to the practice of mindfulness.

This skill or ability is, in my opinion, advantageous to a psychedelic encounter.

Second, those with a pre-existing understanding or connection to philosophical, spiritual or religious ideas or beliefs may also cope better with non-ordinary states of consciousness than those who do not.

Third, individuals with a relaxed, optimistic, positive, accepting attitude seem to do better under the influence of psychedelics than tense, reactive individuals with high scores for neuroticism.

These drugs can offer value to some of us who may be struggling with depression, with lack of direction or connection, or with personal existential challenges.

People can stand back and look inside themselves and see things that they might not have already seen because they are caught up in thought patterns or behaviours that really restrain their consciousness.

If you have those set patterns of behaviour — psychological tracks if you like — you might be able to get out of those tracks and get a new look at things.

I also believe psychedelics are drugs of meaning and connection.

I have observed in patients that, where meaning is missing or lacking, and they do not have many connections, often they are despondent, frustrated and their lives are not flourishing.

We all need meaning in our lives, and psychedelic experiences can often powerfully initiate or reinforce such connections or associations and hence provide or reinforce meaning for the individual concerned.

Psychedelic-assisted therapy is a very new way of approaching mental distress or mental illness in that it changes people’s consciousness, and no other approach really does that.

So, I think it is important that the psychiatrists who are authorised as prescribers should have some good experience in this work; they should have treated three or four patients.

The therapist also needs to be able to understand what is going on for the person and to guide them or provide a sense of calm or direction if they become a little distressed or anxious.

Some people need a good deal of support when they are having a psychedelic experience.

And many who are not suited for such an experience may have bad trips, which can have lasting and very unpleasant consequences; we still do not know enough about who is suitable and who is not.

This is why we need more research. Even though I am authorised to prescribe psilocybin under very specific circumstances, I remain very cautious about whom I might treat.

I think a good therapist in psychedelic work is someone who has been through a psychedelic experience, maybe had a bit of a stressful time or was challenged and then brought themselves through that.

They came away with some understanding of what can happen, and that really is of assistance.

We do not expect people who are prescribing antidepressants to have tried antidepressants.

But this is a not-ordinary state of consciousness, and as the prescriber, you are putting people into that state.

By Dr Nigel Strauss
Originally published in AusDoc, 15 Mar 2024