A Psychiatrist on Finding Meaning in Psychedelic Experiences and Altered States

This article was originally published on goop.com on July 7, 2020.

San Francisco–based psychiatrist Emily Williams, MD, specializes in integration therapies for altered states, including psychedelic ones. She also does psychedelic-harm-reduction work at festivals. She has seen people through some difficult experiences. (As a reminder, if psychedelics are done without careful attention to dose, set, and setting, it’s possible for things to go wrong. Legal status depends on where you use them.)

Because she’s worked with MAPS—the Multidisciplinary Association on Psychedelic Studies—on psychedelic-assisted psychotherapy, Williams has also had a lot of people walk into her psychiatry practice a day, or days, or weeks after a psychedelic experience. And this can be an interesting opportunity. “Just after a psychedelic experience, due to the phenomenon of heightened neuroplasticity, your mind, thoughts, and behaviors are more receptive to change,” Williams says. It’s thought to be like spring cleaning for the brain, she explains: a chance to start not necessarily from scratch but from a place of openness, flexibility, and energy.

What helps people take advantage of this clean slate, Williams says, is integration. Traditionally, psychedelics (as well as other experiences, like Holotropic Breathwork) are coupled with practices that confirm, extend, and expand the insights intrinsic to altered states. In secular contexts, however, where psychedelics aren’t typically connected to spiritual weight, people often miss this piece of the process. And they may lose something meaningful—and potentially life-changing. That’s why, Williams says, we need to consider shamanic tradition: Psychedelics may have the potential to unlock personal growth, but you need the right setting, context, and integration to open the door.

So when people talk about a trip, yes, they might mean psilocybin mushrooms. Or maybe they’ve hit an altered state of consciousness dancing, meditating, or having a baby. But they could also mean the integration end, William says, which could include talk therapy, freehand drawing, and yoga.

With some effort, William believes that all kinds of epiphanies (accidental or not) can be put to better use.

A Q&A with Emily Williams, MD

Q

What is integration, and why is it an important part of the psychedelic experience?

A

There’s a common misconception that a psychedelic experience is only the sensations you have while the drug is active in the body—the psychedelic state—but in reality, that’s part of a larger arc of the psychedelic process. The full experience begins the moment you decide to partake in psychedelics and extends into the days, weeks, and even months after.

Here’s why that’s important: The psychedelic state itself can spark an opportunity for powerful growth, but it doesn’t automatically translate to changes in behavior in our daily life. To see lasting change, we need to have the support of what we call integration. Integration is the process of taking insights or teachings from altered states and incorporating them into our lives in ways that benefit us and our communities. It’s the way we translate symbolic material into concrete actions for personal betterment and healing.

“The psychedelic state itself can spark an opportunity for powerful growth, but it doesn’t automatically translate to changes in behavior in our daily life.”

All of modern psychedelic medicine is attached to a rich history of humans altering consciousness to heal themselves and their communities. In Indigenous cultures, ceremonial traditions are foundational to the way that people live their lives, so there is less need for personal practices to support psychedelic medicine work. Societies that have prohibited psychedelics don’t have a good cultural structure to support altered states or their integration. So psychedelic research cultures have developed tools and strategies—often based on those used in traditions where psychedelics are sacred medicines—to support altered states and the valuable lessons we may find in them.

Q

What kinds of experiences, beyond psychedelics, is integration for?

A

Yoga, meditation retreats, breathwork—even childbirth—can create experiences with altered states of consciousness. All of those activities can stir up things that need integration psychotherapy to help people come to terms with and more fully understand them.

Q

What’s an example of an integration practice you recommend?

A

There’s an integration tool common in Holotropic Breathwork called the mandala practice. It’s a free-form, nonguided art integration usually done right after a psychedelic experience. It’s done without any kind of instruction. You allow yourself a set amount of time—like forty-five minutes or an hour—to just draw whatever shapes come up, whatever symbols or colors come to you, and really see what fills up that page. And then in the days that follow, you take some time to notice the symbols that came up in that mandala and determine how they relate to the experience and to your life.

Q

How do you tailor integration to the nature of someone’s experience?

A

There are some things that almost always apply: In the early part of integration—the first few hours the day of through the day after—it’s important for people to be gentle with themselves. This means allowing the time and space to be with the insights and wisdom of the medicine. Don’t go right back to work. Get enough sleep. Eat nourishing foods. And don’t speak too much.

But then the themes of psychedelic experiences often fall under different categories: somatic, spiritual, emotional, relational, nature-based. In the integration phase, I spend time helping clients decode their experiences and identify which category or categories best match the themes. From there, we start to determine what types of practices might best support those specific lessons and themes.

Singing, writing in your journal, and writing poetry seem to be well suited for assisting emotional themes, while massage, cupping, and dance can be helpful for processing more somatic journeys. A journey with insights about how you fit into your community might be integrated by volunteering with a local organization or by writing emails to friends to stay connected.

It’s important for people to make sure that the ongoing integration practices they choose fit easily into the lifestyle they already have. For example, if someone had an experience that was full of physical sensations, a desire to move, or lots of muscle tension, you might think that starting a daily yoga practice would be a good idea. However, if they don’t already have experience with yoga, they might want to start with light stretches three times a week. The goal is to choose something achievable, so that it doesn’t end up feeling like a task or a burden—it’s better to start small and work up than to go full-force and burn out.

Q

What is a bad trip? How could having one be an opportunity for growth?

A

Psychedelic research pioneer Dr. Stan Grof often described psychedelics as nonspecific amplifiers of the psyche, or mind. Which means that they have the ability to expand whatever feeling or belief is present. This can be positive, boosting feelings of happiness and love, or negative, exacerbating fear and uncertainty. Psychedelics can also bring up painful traumas from the past that may have been repressed as a form of self-protection; it can be disorienting to be faced suddenly with content that was previously unconscious, which may contribute to the possible challenging aspects of what’s commonly known as a bad trip.

“One of the main principles of psychedelic harm reduction is the idea that difficult is not the same as bad.”

It’s actually more accurate and helpful to think of this kind of experience not as a bad trip but as a difficult psychedelic experience. One of the main principles of psychedelic harm reduction is the idea that difficult is not the same as bad. Challenging experiences of any sort are often the ones that offer valuable learning opportunities. A breakup is a good example of this—it can be painful and bring up sadness, loss, or fear of abandonment, but these are the times that we likely learn how strong and independent we actually are.

Q

In your psychedelic-harm-reduction work, you help people turn around what might be a scary experience. What do people typically need?

A

People will sometimes try psychedelics for the first time at a festival, party, or concert with little to no thought about preparation. Even simple things, like whether you’re hydrated, whether you’ve eaten, what you’re wearing, can have a significant impact on your experience with psychedelics. Your social environment—are you with close friends or with people you don’t know?—also has a powerful impact. Not having a safe container for the altered state may be destabilizing and disorienting, resulting in anxiety, panic, or even paranoia and a sense of needing to escape.

In my experience, people often just need a safe, quiet space to sit; some water to drink; and a compassionate listener or a hand to hold. We sit with them through their experience, giving them room to move through it rather than shutting it down. And we often direct them to use their breath, similar to how we would for anxiety or panic states in normal waking consciousness. We ask them to think of the breath as a remote control for the experience. By doing their best to slow the breath, they can breathe through the anxious, fearful feeling, rather than pushing it down or trying to avoid it.

Sometimes with recreational use, the material that comes up falls out of the framework of recreation. This can happen in medicinal use, too. It can feel scary. I ask the person I’m working with to trust the medicine is contacting their inner healer and to recognize that it’s bringing up something that needs healing.

“Sometimes with recreational use, the material that comes up
falls out of the framework of recreation.”

Often, people will come out of these experiences saying, “This was one of the most powerful things that I’ve ever experienced, and I want to make such-and-such changes in my life.” And that’s great a lot of the time. But this is a vulnerable experience, and sometimes it’s important to see new insights as symbols and get a little less literal. And if someone isn’t there to help them through it, it’s beneficial for people to have independent integration strategies to support that process and to reach out to a therapist or psychiatrist with a background in integration.

Integration services are especially important if a psychedelic experience is disruptive to someone’s natural balance. If they notice a persistent lack of sleep, symptoms of mania, thoughts of self-harm, or suicidal thoughts, it’s vital to seek psychiatric care. This also applies to altered states outside of psychedelic ones—meditation retreats and breathwork sessions included.

Q

How do you guide someone who’s dealing with uncomfortable lasting effects?

A

Difficult psychedelic experiences can be broken down into two main categories: those that occur during the effect of the medicine and those that occur after the medicine’s effects have worn off, in the hours, days, and even weeks to follow.

When working with difficult content post-experience, the first thing I do with clients—after assessing for safety—is to help them circle back to their intention, if they had one going into the experience. Oftentimes, it can be illuminating to look through the lens of the intention that was set prior to their work with psychedelics. For example, if your intention was to find a deeper connection with your community and then in the days following your experience you are left feeling depressed and isolated, it may be helpful to think of ways that you may be blocking or preventing yourself from showing up in community. Have you had prior friendships that didn’t leave space for you to show up? What was your place in your family dynamics? Asking these questions and working through the answers could help you learn a lot about how you can find your place in your community or group of close friends.

Emily Williams, MD, is a psychiatrist, a researcher, and an educator. She is an advocate for psychedelic medicine and has worked on multiple clinical trials investigating psychedelic-assisted psychotherapy, including both MDMA and psilocybin. She is a member of the clinical research team for the Multidisciplinary Association for Psychedelic Studies (MAPS) at the San Francisco Insight and Integration Center. Additionally, Williams has a private practice in San Francisco and is an attending psychiatrist at the University of California, San Francisco and Zuckerberg SF General Hospital in psychiatric emergency services. She holds multiple mentorship and teaching roles, including at the California Institute of Integral Studies in the Center for Psychedelic Therapies and Research and the School of Consciousness and Transformation. She also serves as a supervisor for the Zendo Project, which provides psychedelic harm reduction for events and festivals.

This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.