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Where Psychedelics Meet Madness: Intersections, Lessons and a Call for Transformative Research Agendas
By Tam Martin Fowles - June 23, 20260

Emerging from the crisis that transformed my life in 1990 was the hardest thing I’ve ever done. The brutal re-entry into consensus reality involved a sacrifice I couldn’t articulate, and the loss echoed resoundingly through subsequent decades.

No part of me wished to return to the terror of what had been diagnosed as psychosis; to hurtle again through a pan-dimensional hellscape of torturous images, cacophonous voices urging evermore violent ways to end a life I’d come to believe was worthless, and pockets of pain that drove me further into the escape that madness offered when I pictured the children I couldn’t care for.

No part missed being hounded to take medications I knew would erase what little remained of who I really was or, when I refused, being told I didn’t want to be helped.

What I did yearn for, again without articulation, was the expansive clarity that had occasionally enveloped me, always surprisingly; the sudden exquisite insight into the miraculous; the sense of oneness with the Universe and glorious vision across radiant vistas of truth beyond truth beyond truth. And no pain. No doubt. No shame. No place for those. The longing for these rare, transcendent pockets of bliss stayed with me, despite my efforts—encouraged by all—to cast the memories of “all that” out of my conscious mind and live in the consensus world with my priceless reward: reunion with my children.



I recovered, enough, and lived a life that contained much richness. Relieved beyond measure to have found my way back to my children, I tried my hardest to be a good mother. But beneath surface level that nameless yearning continued, merging with shame and grief, and fear of further madness. Haunted by these oppressive emotions, I struggled to be fully present. Decades of often excellent therapy worked wonders, but it had its limits, and I accepted that.

I had always been afraid to take psychedelics. Long before madness took its hold, I refused the mushrooms and LSD my friends were keen to share. I knew my psyche was fragile, and didn’t want to mess with it. So when, late in 2021, I began to encounter people and literature that repeatedly brought psychedelic therapy to my attention, I thought “Yes, but I could never do that.” Still, a curiosity began to form, and conversations with people I trusted gradually consolidated the idea that perhaps an encounter with the magic mushrooms I’d eschewed in my youth, sandwiched between careful preparation and thorough integration with a specially qualified therapist, could help me not only to heal some of the parts other therapies hadn’t reached, but—could it be possible?—find a way back to something of the spiritual awareness I had known in 1990.

It took 18 months of regular sessions for me to be ready. My therapist (who was available for preparation and integration) was skilled, and I trusted her. The psilocybin trip had little in common with my earlier altered states, and it was not enjoyable. But I felt safe, with experienced companions, and significant healing took place within those few hours. (Tehseen Noorani and I describe this in some detail in our recent open access article for the journal Psychedelics, “Meeting Grandmother: Breakdown, Breakthrough, and the Fear of Madness in Psychedelic Research.”)

However, it has been the integration of that process, carefully supported by my therapist, that has made the most profound difference to my life. While nothing has approached the transcendent splendour I experienced in 1990, a gentler transcendence has become accessible; one that is manageable in Consensus World. There is a balance to be found between the mundane and the profound that I’m learning to refine.

The process of integration following Psychedelic Assisted Therapy (PAT) is considered vital. It is a way to return to, explore, re-stitch and elaborate the meaning of psychedelic experiences, in spaces of trust, connection, curiosity and openness. Practices of integration and the scholarship on them are multiplying, (see here, here, and here). But the provision of extended, thoughtful, and compassionate integration is also expensive, and so something that the pharmaceuticalisation of psychedelics is looking to minimise or automate. Meanwhile, the language of integration is not entirely absent in historical research into madness and psychosis, and we trace one such potentially fruitful moment of trying to mainstream the language in psychiatric practice in our article.

As I began to integrate my psilocybin journey, I realised how vital such a process should also be in integrating spontaneous altered states within psychiatry. If I had been supported by mental health services to integrate my altered-state experiences 36 years ago in the way I have through PAT in the past 18 months, I can’t imagine how much suffering could have been alleviated—how much meaning made and life lived differently.

However, in the worlds of both psychiatry and psychedelic research, healing such as I’ve experienced (at great financial cost to myself) is unavailable. In psychedelic research this extends beyond anyone who has ever had a psychosis diagnosis, to anyone with a family member who has. We are considered too great a risk.

But what about the known, well-documented risks that are breezily accepted in current mainstream services? We can be both skeptical of the usefulness of diagnostic terms like schizophrenia and psychosis, and still bear witness to the gaping disparities in people’s lives that the statistics reveal. In a recent paper on the exclusion of people with psychotic disorders from psychedelics research, Khaleel Rajwani describes how,

“The negative mental health outcomes of individuals diagnosed with schizophrenia and psychosis spectrum disorders represents a significant and ongoing public health crisis. Despite advances in psychiatric practice and mental health care in other domains, people with schizophrenia continue to face disproportionately poor outcomes, in terms of both morbidity and mortality. Individuals diagnosed with schizophrenia have a life expectancy of 20 years less than the general population, largely due to a combination of suicide (13 times more likely), high rates of cardiovascular disease, and other preventable physical health conditions; this gap has worsened in recent decades. The rate of sustained clinical or social improvement for people diagnosed with schizophrenia has remained stagnant for decades. Moreover, individuals with schizophrenia frequently experience social exclusion, unemployment, and homelessness, all of which exacerbate the challenges of managing the illness. This alarming crisis highlights the urgent need for more effective interventions and therapeutic models that benefit those living with schizophrenia and psychosis spectrum disorders.”

I am not suggesting that PAT would be appropriate or beneficial for everyone who has had a psychosis diagnosis; clearly many factors need to be taken into careful consideration. But I do call for a reconsideration of the blanket exclusion criteria that are currently in place.

In another paper, written in 2022, Phoebe Friesen outlines the clear and disturbing differences in attitudes to psychedelics and psychosis in current research, in stark contrast to those of the mid-20th century where both were deeply entangled. As Friesen has written, the rehabilitation of psychedelic science since the 1990s has been tethered to the scientific avant-garde, and the possibility of developing novel therapeutics that harness powerful non-ordinary states:

“While psychedelic research often includes scales that seek to capture experiences of mysticism, meaningfulness, and ego dissolution, research related to psychosis focuses on the measurement of pathological symptoms and functioning. Research into psychosis primarily seeks universal and reductionist causal explanations and interventions, while psychedelic research embraces the importance of set and setting in shaping unique experiences. Responses to psychedelic crisis involve warmth, compassion, and support, while responses to psychotic experiences often involve restraint, seclusion, and weapons.”

When I had my “psychotic” experience, and for years afterwards, I longed for someone to ask me the kind of questions included in the Ego-Dissolution Inventory (EDI), a popular scale in psychedelic research, mentioned by Friesen. This scale offers a wide variety of statements, such as “I felt at one with the universe,” “I felt a sense of union with others,” and “All notion of self and identity dissolved away.”

I would have scored highly on all of the above, and I feel sure that being given the opportunity to revisit and evaluate my impressions in this way would have been invaluable in terms of integration and recovery. In seeing these statements on a scale, I might have realised I was not alone in having visited realities outside of the consensus, and the acknowledgement that such things could occur, and were of interest to others, could have resulted in my feeling validated and more grounded. But there was no interest in my experiences other than as something to be medicated away and put behind me.

Before I knew anything about PAT, I wrote a poem, directed at the psychiatrist who dismissed my other-than-medication needs in 1990 and others who are doing the same to people struggling with similar experiences to mine three decades later. Called “Ask Us: To a Long-Ago Psychiatrist and Some Current Ones Too” it includes the lines:

…I wish it had occurred to you, instead of calling lunacy,
To ask what I experienced; embrace the opportunity
To gaze across the border and begin to hear the language
Of the fascinating territory that lay beyond my anguish…

The “fascinating territory” of my spontaneous altered states was many times more profound and meaningful than that of my subsequent psychedelic experience—or indeed any other at any time in my life—and considerably more suited to the EDI scale. What I was unknowingly asking for in the poem was exactly the kind of compassionately curious support I later encountered in PAT.

Since my sojourn into PAT, I have enjoyed learning more about the complex subject of psychedelic research and therapy modalities, and gradually uniting with others who are interested in the intersection of psychedelics and psychosis. The MadPsychedelics Collaboratory is a nascent collective of researchers and individuals with lived experience who are excited to build a pipeline for people with lived experience to lead the research at the intersections of psychedelics and madness/psychosis. This will help us in asking the most pertinent questions, and to analyse our data without (unreflected) fear or stigma towards pathologized non-ordinary states of consciousness.

We are hopeful that this will ensure that the rising tide of emerging psychedelic research helps transform psychosis (and other mental health) services for the better. At the same time—and as the pharmaceuticalization of psychedelics turns to psychosis as just yet another target for treatment—we are excited that the long histories of madness liberation movements might in turn sharpen how we do research and therapy with psychedelics.

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The author would like to acknowledge the contributions of Tehseen Noorani.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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