Mushroom Roulette: Hallucinogens, Anxiety, and The Youthful Brain

Hello and thank you for addressing this inquiry to me.

I understand that you now find yourself in a place of greater confusion, insecurity, self-doubt, and worry than ever before in your life; I sympathize greatly with the distress you are experiencing, although it makes complete sense to me that you now feel as you do.

You did not specify your age, but I am guessing that you are in your late teens or early twenties. If so, I would expect that your confusion about yourself is only that much more pronounced, given that you are still in the process of really figuring out who you are for the first time in your life. So, as your brain is just getting to know you, you have have been bewildering the hell out of it with your behavior.

You may not have known this, but our human brains rely primarily upon the observations they make of our BEHAVIOR when calculating our most important feelings and thoughts about ourselves.

So. It sounds like you have quite a combo-platter going there for yourself; on the non-substance side is a pre-existing case of emetophobia (which, for those who are not aware of it, is an often debilitating fear of vomiting or being around someone else who is vomiting, or even just talking about it). Emetophobia rarely presents by itself, and so I will assume you do also experience some degree of other types of anxiety (even when sober), such as panic disorder, generalized anxiety disorder, or social anxiety disorder. On top of this, you are a young adult, facing a variety of perfectly normal but nonetheless challenging life tasks, such as individuating from your family, establishing your own adult persona, choosing a professional or creative or educational path to pursue, exploring your sexual identity, and perhaps discovering your spiritual self.

And all of that is for sure enough to keep you darn busy for a while, and can prove to be, on its own, a somewhat intense path, with lots of ups and downs, trials and errors, hits and misses.

But several other potentially destabilizing events have also been introduced into the cocktail that is your life. You have been using hallucinogens on a recurrent (and it sounds more like frequent..3 times in 2 months?) basis. You also use marijuana, alcohol, and nicotine to modulate your experience. With the addition of these substances, your already quite changeable daily life has become dominated by a set of extremely powerful thoughts, feelings, images, memories, and behaviors. By taking the reins off of your frontal lobe and cerebral cortex, you have turned your brain from a helpful servant into a cross between a cruel taskmaster, and a 110 pound toddler! As we have 70,000 thoughts a day, and as the majority of them are negative, you have practically let your brain loose to tell you anything it wants, no matter how true or outrageously false it is, and you are far more vulnerable to actually believing it! Yeah, it's nice when you have the thought about being connected to everyone, however the notion that being dead really wouldn't matter much, or that something is very wrong with you mentally or physically, are cognitive experiences that are NOT intended to be given free rein to run wild in your psyche, completely unchecked. When these kinds of odd or negative experiences occur to us while sober, we typically have the resources to shrug them off as "silly," however the dysmodulated brain has no such ability, and thus the tail starts wagging the dog. In short, you were initially playing the game, and now the game appears to be playing you. I infer this, in part, from your closing line, "I don't understand what happens with me or how I can fix it or if I ever can." In this way, the "cure" for your problems has done far more damage than the underlying "disease."

In your account, you describe several signs of behavioral and psychological dysfunction, the majority of which seem to flow, not from your basic life circumstances, or your moderate degree of underlying anxiety, but from the act of adding drugs and alcohol to the mix. You have subsequently experienced recurrent suicidal ideation and imagery, desperate attempts to avoid being alone, aggressive, threatening, and perhaps even violent behavior (toward your own mother) in an effort to prevent such feared abandonment. Your basic life functioning has been notably disrupted, with prolonged periods of social isolation, avoidance of friends and others, and a reluctance to even leave the "safety" of your bed (I use quotes around safety because it just doesn't sound like it feels all that safe for you there).

Perhaps what I most want to tell you is that I am very concerned about you. Your willingness to take repeated risks with your physical and mental health, and lack of adaptive self-care, suggest that your judgment has gotten a bit bent by your choices and their consequences.

Give all of the above, I URGE you to immediately speak with a TRUSTED and TRUSTWORTHY adult caregiver, family member, teacher, spiritual advisor (priest, rabbi, youth minister, what have you), or friend about these difficulties. The goal in taking this step is to garner understanding and support for what you have gone through, and for what you must do to heal. Whether or not you take that first step, I also URGE you to consult a medical or mental health care professional as soon as possible so that you can be thoroughly evaluated, provided guidance in how to begin understanding the drivers and effects of your recent behavior, and to assess for the presence of any other underlying or accompanying medical or mental health conditions that may be relevant. I say this because the most common age of onset for schizophrenia is in the late teens and early 20's, and it often begins to emerge in the context of depression, unusual sensory and cognitive experiences, and accompanied by alcohol and substance abuse. In this regard, drugs and alcohol abuse is common among those beginning to experience prodromal symptoms of psychosis, as a direct attempt to neutralize or muffle the emerging disorder. Unfortunately, masking of the underlying disorder may indeed occur, preventing early diagnosis or treatment. And, of course, the substances themselves, and the incredibly challenging internal and external consequences to which they give rise, can also hasten the onset of another mental disorder (in addition to addiction).

Did I write this to scare you? In part, my answer is yes. Did I need to distort any facts of science in order to do so? Not at all. I know I probably have only one shot with you, my young friend, so I am making the most of it.

As difficult as things may be for you today, or even at this very moment, the fluid, impermanent nature of life, and the resilience and plasticity of our amazingly high tech brains, are solid proof of your ability to get to higher ground, and to a happier, more peaceful, and productive life. You had the freedom and ability to get from where you were before to where you are now, and you likewise have the built-in mobility to navigate to a far better place (None of us can ever get back to where we WERE, as that would require time travel, but we do have the ability to move into an even better future.

To quote "The Shawshank Redemption," an amazing film about internal and external imprisonment, we humans are faced daily with the option to "get busy living or get busy dying." And we have to remake that important decision every day of our lives.

I hope that some of what I have written here is of use to you, and I strongly encourage you to write back and provide an update on how you are doing. That will be of great help to others traveling the same difficult path, and it will also assist me in understanding what may have worked for you and what did not.

In the meantime, please review the several posts I have written in response to other young people with strikingly similar difficulties. You will know by reading the title of each post how relevant it may be to you. I point you to those posts because many of them flesh out more fully the mechanisms underlying the way substances and anxiety can interact and exacerbate one another, and what treatment for such difficulties would look like. You are of course welcome to follow me on Twitter (@mindsetdoc) or IG (@mindsetdude), or by subscribing to my blog (mindsetdoc.com).

Sincerely,

Richard E. Schultz, Ph.D.