Psychedelics and Pregnancy: A Look Into the Safety, Research and Legality

By Rebecca Kronman

Illustration by Amalia Rompoulias for Plant Parenthood

Psychedelics and pregnancy is a highly controversial and often unspoken topic. But beyond the stigma, what does the research, law and culture say?

As she had done many times before, Leticia Pizano sat in ceremony with her medicine sisters waiting to feel the effects of the four grams of magic mushrooms that she had ingested. An experienced journeyer, Pizano found it strange that 45 minutes later she began vomiting, an effect she was unaccustomed to so early in the trip.

“The medicine just showed me that I needed to get that out of my body because I was with baby,” she tells Psychedelics Today.

Still, the mushrooms took effect and led her on a trip she described as beautiful and empowering. The experience enabled her to form a deeper bond with her unborn child. “There’s just a different connection with her; almost non-human,” Pizano says of her daughter, now six months old and the youngest of her twelve children. Since her daughter’s birth, Pizano has brought her “medicine baby” to every ceremony she has attended.

For Pizano, participation in community-based ceremony was a motivating factor for her use of entheogens, and her use during pregnancy was consistent with cultural norms—she is a member of the Sac and Fox and Kickapoo tribal nations, where partaking in ceremony that includes plant medicine sacraments spans throughout the lifecycle. For most non-Indigenous people, such participation would be unusual and likely stigmatized, perhaps viewed as dangerous or irresponsible.

Yet, as psychedelics enter a more mainstream era, non-Indigenous birthing parents are relying on them as tools for wellness and even lifesaving measures to address treatment-resistant depression, anxiety, post traumatic stress disorder and addiction. Our current paradigms for substance use during pregnancy do not account for these new developments, and examining them with a thoughtful, critical lens may be required to accommodate the myriad ways our culture has shifted towards relying on these substances for well-being.

Photo of Leticia Pizano and her daughter. Permission granted by Pizano.

Information, Misinformation and Disinformation: Research and Public Health Information on Psychedelics and Pregnancy

Just as with other psychotropics like antidepressants or anti-anxiety medications, birthing parents and their healthcare providers need to evaluate existing information on psychedelics and pregnancy to make informed decisions about whether to continue using them during pregnancy. But seeking information on the web yields few results. And what little information does exist on the topic is often confusing, incomplete and misleadingly shaped by the War on Drugs.

The American College of Obstetricians and Gynecologists offers a blanket statement recommending the cessation of all marijuana use. Other psychedelics are similarly classified into a category of “substances that are commonly misused or abused”, a classification that bears the markings of bias and misinformation. According to the Global Drug Survey, we know that many psychedelic users ingest these substances in a safe, prepared and informed way, and according to longtime drug researcher David Nutt’s book, Drugs Without the Hot Air, psychedelics like mushrooms and LSD are not inherently addictive.

The March of Dimes, a research and advocacy group for mothers and babies, offers an unsourced page last edited in 2016 on their website that reads: “Street drugs are bad for you, and they’re bad for your baby.” The psychedelics included in this category are marijuana and ecstasy. This broad categorization fails to account for the therapeutic applications of these substances. It also excludes critical factors like set, setting and dosage, all of which make a significant difference in a psychedelic user’s experience.

Mother to Baby provides more nuanced and specific information on psychedelics, but contains obvious biases such as suggesting that “people who use LSD might also have unhealthy lifestyles.” They also include misleading, inaccurate and fear-based information including the suggestion that people may mistake magic mushrooms for poisonous mushrooms.

These blanket prohibitions are largely based on the absence of—rather than the presence of—information about how a substance will impact a growing fetus. The medical research canon contains very little information about the effects of these substances during pregnancy, and substantial obstacles exist for this research to take place at all.

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Due to ethical and safety concerns, “The research we do have on pregnancy in general—let alone pregnancy with psychedelics or plant medicine—is minimal because we don’t do research in pregnancy for the most part,” says Jessilyn Dolan, a registered nurse, herbalist, hemp farmer and member of the Board of Directors for the American Cannabis Nurse Association.

Aside from ethical considerations, says Dolan, another challenge is measuring the long-term health impacts to the child of just one substance due to the enormity of confounding factors. For example, is a person who consumes cannabis edibles during pregnancy also consuming caffeine, alcohol, or prescription medication? How might these substances along with the birthing parent’s diet and lifestyle impact the long term health outcomes for the child? And how might the child’s environment, including exposure to toxins, food insecurity, poverty or traumatic life events, play a role in their health as well?

“When we look at pregnancy, breastfeeding and chest feeding and then doing longitudinal studies around kids, we have so many factors working against us to make that research really legitimized and standardized,” says Dolan

Of the existing research on this topic, most is either outdated or based on small sample sizes. As legal restrictions on these substances shift, this may change. But information about the safety of ingesting substances during pregnancy is still scant, inconclusive and conflicting.

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A study from 1968 on nine children exposed to LSD-25 in utero—the only study that we could identify on the topic—found elevated levels of chromosomal damage compared to a control group. However, none of these babies exhibited any birth defects. This study, with its very small sample size, has never been replicated. It also did not look at long-term outcomes for these children, rendering the results limited in value.

Similarly, an often cited and widely circulated study from 1994 compared 24 newborns exposed to cannabis to 20 who were not; results at 30 days showed that the cannabis-exposed babies actually scored higher on measures of alertness, were less irritable and had better reflexes. But this study, again with a small sample size and never replicated, did not take into consideration the many confounding factors that could have contributed to the results. For example, the study took place in Jamaica where cannabis use during pregnancy is a common practice and is not stigmatized. In addition, the heavier cannabis-using birthing parents were also more educated, more financially stable and had fewer other children to care for, all of which could have impacted outcomes for their babies.

More broadly, research on prenatal drug exposure is often mired in biases. In his book Drug Use for Grownups, Dr. Carl Hart details several problems associated with brain imaging research on people exposed prenatally to drugs. It is easier to get findings published, he says, when they are consistent with the widespread notion that drug use is bad for the developing fetus. In addition, Hart writes the findings are almost never replicated and researchers often ignore their own data in order to draw conclusions that reflect their own biases.

Photo of Amanda Fielding. Permission granted by the Beckley Foundation.

Still, experts in the field like Amanda Fielding, executive director of the Beckley Foundation, a UK-based NGO that funds psychedelic research and supports policy change, remain hopeful about the prospect for more research on the topic.

“Scientific exploration could be carried out using animal models, or using naturalistic surveys to get answers from people who are already using or have already used psychedelics during their pregnancy,” Fielding says.

Keeping a Close Watch on Pregnant Bodies

Weighing risks of physical harm to the fetus against physical or mental health outcomes for the birthing parent is one framework for decision-making of this kind. But these calculations are not the only ones a birthing parent will have to assess. Most people who have experienced pregnancy will be familiar with an increase in monitoring by friends, family and even strangers who may feel entitled to comment on body changes, touch the pregnant person’s body without permission, or offer unsolicited advice or opinions on what the pregnant person ingests. Using psychedelics openly may create social stigma and isolation; the anxiety and stress that those conditions create may pose an additional risk for pregnant people.

Pregnant people are also monitored more closely by state and healthcare agencies. The American Academy of Pediatrics and American College of Obstetricians and Gynecologists recommends screening a pregnant person for drugs when they enter prenatal care. Twenty five states and the District of Columbia require healthcare professionals to report even suspected drug use, and eight states require them to test for prenatal drug exposure if they suspect drug use. In 2014, Tennessee became the first state to pass a “fetal assault” law specifically allowing prosecution of pregnant women who use drugs, imposing penalties of up to 15 years in prison. The legislation was so controversial it was discontinued in 2016, but has been introduced several times since.

Monitoring for drug use, however, happens disproportionately along racial lines. While white and Black birthing parents have similar rates of any drug use during the prenatal period (though the substances used and patterns of use may differ slightly), an often-cited study from 1990 found that Black birthing parents were 10 times more likely than their white counterparts to be reported to health authorities for their drug use.

Some states are actively working to correct these disparities, with mixed results. A 2015 study of California hospitals that adopted a protocol to monitor all birthing parents for prenatal substance use found that it did not impact child protective services reporting disparities.

New York has taken a different approach. In a testimony to the New York City Council from 2020, David Hansell, Commissioner of the New York City Administration for Children’s Services, stated that the agency had actively discouraged health professionals from making reports to them about a child or parent who tests positive for a substance if there is no negative impact on their well-being and instead make a referral to a service agency. While this could theoretically help level out racial differences, the question remains whether the service agencies would be equipped and trained to adequately address the physical and mental health and other needs of a birthing parent using substances.

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Vermont has also taken steps to eliminate the reporting requirement for healthcare practitioners treating birthing parents using substances. If a birthing parent tests positive only for marijuana, they are exempt from hospitals’ and healthcare professionals’ reporting requirements to the Department of Children and Families (although if the marijuana use is thought to endanger a child, it must be reported). The marijuana-only exemption in Vermont is informed by the lack of sufficient evidence suggesting that marijuana use during pregnancy is harmful. But similarly, there is a lack of sufficient evidence demonstrating that other psychedelics are harmful.

For birthing parents who do test positive for substances, their risk of losing custody is also informed by structural racism within the child welfare system. According to Dr. Kelly Sykes, a psychedelic integration therapist and child forensic psychologist, disparities exist between legal systems that govern custody and child protection systems. Allegations of abuse, neglect and drug abuse requiring court intervention exist in both systems. However, only parents within the child protection system—which disproportionately impacts poor single parents of color—can have their parental rights terminated and be permanently banned from having contact with their child. Further, all aspects of their parental judgement are subject to scrutiny; they may be randomly tested for substances, regardless of whether substance abuse was a part of their child protection case.

Community Support: Making Decisions on Psychedelics During Pregnancy

In this landscape of inconclusive, biased and misleading information, how can birthing parents make informed decisions on this topic? And without information from peer-reviewed, evidence based research, what might drive someone to elect to use psychedelics all the same during their pregnancy?

For some birthing parents, the mental health benefits outweigh the potential risks.

“Psychedelics can reduce anxiety and depression, and can help people cope with dramatic changes in their lives,” said Fielding. “For those reasons, it’s certainly possible that psychedelics could be beneficial for expectant mothers struggling with prenatal depression or anxiety.”

Dolan, who has worked with pregnant people using cannabis to address treatment-resistant hyperemesis, a condition in pregnancy that creates severe and persistent nausea, frames the issue similarly. If anxiety and stress impede on the connection between parent and baby, research shows that “the relationship and connection is just as, if not more important than the little bit of pharmaceutical that’s going to pass through your breastmilk or pass through in utero to the child,” she says.

Being in a safe, supportive community to help weigh those decisions and process experiences in a nonjudgmental way can be very helpful. For someone like Pizano, this community is built into her everyday life. She grew up attending peyote ceremonies for occasions like baby namings, funerals or healing, and the wisdom she relies on comes from a long lineage of oral tradition, passed down by elders.

“Star Gazing” by Amalia Rompoulias. Original illustration commissioned by Plant Parenthood, a monthly integration group for parents. Permission to print from Rebecca Kronman.

For those without such a cultural container, more options are emerging for pregnant people in need of support. A recent event on Clubhouse hosted by @mamadelamyco brought together doctors and consumers to speak about psychedelics and pregnancy. On Instagram, communities like @cannabisandparenthood and @bluntblowinmama explore this topic specifically with cannabis. Other groups like Plant Parenthood (which this writer founded) also bring together parents to speak about topics that are so stigmatized, they’re rarely spoken about with others.

“Obviously safety is still a primary concern when it comes to kids and psychedelics, let alone issues like pregnancy,” says Andrew Rose, who co-facilitates Plant Parenthood, “but the riskiest thing is not talking about it at all. You can’t have good healthy community education without open, non-judgmental communication.”

Without a clear path for more research on the horizon, and with a landscape of confusing information to draw from, birthing parents will likely struggle to find simple answers. Individuals will still need to factor in their own level of vulnerability, which varies greatly based on race and other socioeconomic and cultural factors. Perhaps the answers we seek do not exist within a search engine, but in a patchwork of wisdom from Western medical research, ancestral knowledge and most importantly, our own inner healing intelligence. 

About the Author

Rebecca Kronman, LCSW is a licensed therapist and founder of Plant Parenthood, a digital and in-person community of parents who use psychedelics. She is also an assisting trainer with Fluence, a company that trains healthcare practitioners in harm reduction informed psychedelic preparation and integration. At her private practice in Brooklyn, she works with clients using mindfulness, experiential techniques and ketamine assisted psychotherapy to address depression, anxiety and life transitions. She also helps clients prepare for psychedelic experiences, incorporate insights or cope with challenges post-experience. Selected trainings include Mindfulness Based Stress Reduction, Mindfulness for Clinicians, Psychedelics 101 & 102 and Beyond Experience Psychedelic Integration Workshop. Outside of work, she is a mother of two boys ages 5 and 7.

Meet Microdosing TikTok—And Why the Community Matters

Microdosing TikTok

By Olivia Alexander

Original Illustration by Martin Clarke

Microdosing TikTok is a vibrant community of everyday people researching and experimenting with microdosing for mental health, and finding support in the process.

What if I told you that the microdosing movement has taken TikTok by storm? Or that TikTok wasn’t just a place for dancing or kids, but a community connecting people in a unique way? Now a cultural force, TikTok has even been invaded by psychedelics, specifically the microdosing movement. And I was there to see it unfold.

When people said I should join TikTok, I politely told everyone the same things you probably think right now. It was for kids, it was for dancing, it was too conservative for people like me mainly because I am the founder of a cannabis company. And of course, who needs another social media app in our already connected world? But during quarantine I (like many) eventually caved, and I found myself trying to make sense of an app that truly felt like another world.

At first, every word I tried to say was censored and I found myself unable to even post about my own business or much of anything outside my dog. I learned the sophistication level of TikTok’s algorithm is part of its beauty and design, and because it’s a Chinese-based company it is skilled at censorship. And don’t get me wrong, censorship is prevalent on all social media apps, but TikTok is inarguably the most strict.

Author Olivia Alexander’s viral microdosing TikTok that put her on the ‘FYP’ for the first time and connected her to a vibrant community.

As a cannabis social media influencer, I’ve dealt with my fair share of getting ‘deleted’ (when an app deletes your profile) and eventually lost 1.5 million followers on Instagram in 2017. On TikTok, I couldn’t find anything to talk about that was both authentic to me and interesting to the audience. Then one day I tried something new, I told my mental health story about being bipolar and how microdosing completely transformed my life. Given the level of censorship, I didn’t say or show much, just a photo series of myself along my journey. You could see the changes, the impact, and the joy in my face. That’s when it happened—I got my first taste of the FYP.

That’s the ‘For You Page’ in TikTok lingo. The app explains the FYP as “a curated feed of videos from creators you might not follow, but TikTok’s algorithm thinks you will like based on your interests and past interactions.” Once I made it to the FYP, I had my first bonafied ‘hit’ and two things were obvious: The first was that microdosing had slipped through the cracks of TikTok’s censorship algorithms, and the second was that the audience craved more. 

It’s hard to describe what happens on TikTok when your video lands on the FYP. To be honest, in the past 15 years of being on social media, I have never seen or felt anything like it. The views, comments, and follows piled up—fast. I was in sheer disbelief that I had stumbled upon something that people wanted to know more about that also wasn’t censored by TikTok. In the months to come, I would be connected to a community I could never have imagined in my wildest dreams.

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Why Choose TikTok for Microdosing Info and Community?

The TikTok community, much like I was, is mentally ill, yet at the same time disillusioned by the mental health system; they’re also desperate for healing, while being courageous and hopeful. I was excited to tell my story—despite being a relative newcomer to psychedelics—I’m farther along on my microdose journey than most TikTokers, and I wanted to use this new, powerful platform to share what I’ve learned. Over the next few months I began to contribute pieces of short form content daily from ‘How I Got Off Pharmaceuticals’, to my viral recap of microdosing with LSD for 30 days, to my mother’s microdosing journey.

Was it that microdosing—the act of ingesting 1/10th to 1/20th of a psychedelic substance for enhanced mood rather than classic psychedelic effects—was so new or was it that the psychedelic movement had successfully evaded TikTok’s strict censorship policies?

If you saw the TikTok hashtag #microdosing, which had 60 million views until it was removed in mid-August, 2021, you probably witnessed the broad spectrum of people and their reasons for microdosing. TikTok is a place where people with authentic stories and interesting lives thrive; where you don’t need to be a celebrity to be an influencer, you can just be you. Mental health TikTokers regularly show off their meds, spill revelations from therapists, and share both their traumas and explorations in healing. Microdose TikTok heavily intersects with mental health, fitness, and wellness TikTok. Even with censorship of the microdosing hashtag, the community has continued to evolve and share microdosing content. In the world of ‘the Tok’, there’s an ever evolving lexicon created to skirt the app’s advancing censorship. So soon #microdos or #mycrodose will replace #microdosing like #ouid replaced #weed.

What you’ll find in certain communities of TikTok is that you are encouraged to be yourself, which is unlike other social media platforms where a more polished version of yourself is rewarded. The people who use and create content on TikTok—referred to as ‘creators’—are as unique as the algorithm itself. And unlike other social media apps, these creators can see a quick rise, thrusting them into the spotlight, allowing them to share their journey and experiences with thousands of people seemingly overnight.

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Meet the Microdosing Stars of TikTok

One of the most beautiful things I have found at the intersection of microdosing and TikTok are the vibrant people who tell their stories. The bravery it takes to share your life online is often overlooked by people who don’t do it or look down on social media. It’s a compelling array of stories and personal experiences that could be such a benefit to the psychedelic and scientific communities, especially at a time when microdosing research is so desperately needed.

There’s something about TikTok’s design that makes you feel instantly seen, heard, and validated, and connects you with others in an authentic way. It’s why I believe the work of psychedelic and microdosing creators is so effective and special. Being seen and heard is an important and valuable part of the healing and integration process that’s built right into the platform.

The first person I ever saw cruising the FYP was Veronica Ridge, a hair stylist who shares her story of microdosing for ADHD with candid and endearing videos that her husband Patrick Ridge, also a well-known content creator with 16 years of sobriety, often joins. Veronica’s content about microdosing was endearing and approachable; even though she was microdosing for different reasons, seeing her content made me feel less alone. I was excited to see someone else normalizing microdosing.

Next I discovered TikTok’s microdosing mom (TikTok loves moms), Coach Kathleen who has over 130K followers. Coach Kathleen, a long time coach who focuses primarily on CEOs and executives, told me she went to TikTok after seeing the speed in which users go viral. Since then, she has garnered tens of millions of views on the app. In one of her largest videos, she explains how psilocybin affects the brain’s ‘default mode network’ that has a whopping 8 million views.

Coach Kathleen’s viral TikTok on how psychedelics affect the Default Mode Network.

Coach Kathleen’s educational content and frequent ‘lives’ (specifically microdosing Q&A’s) are much needed support to the TikTok microdosing community. Live is another feature that drives authentic conversations and page growth for creators. It allows users to get to know creators on a much more intimate level. Creators who activate these features often see their communities blossom way beyond what they imagined their reach could be.

There are also athletes and coaches like CoachJeremy305, who has over 875K followers and who has  been a long time fixture on the FYP page sharing how microdosing has aided in his fitness and wellness journey. He often encourages his audience to avoid alcohol and frequently posts psychedelic legislation updates.

Another creator, HolisticHustle, who calls herself “a crunchy mom with depression” has over 60K followers, shares her microdosing and parenthood journey. She focuses a fair amount of her content at the intersections of microdosing, motherhood, and healing her own generational trauma.
Holistic Hustle’s microdosing mom content

While some will write off TikTok as another social media app, I truly believe that would be doing a disservice to everyone. Believe it or not, TikTok has become a cultural mecca and there is so much to learn about people and community on this app. With the culmination of the mental health crisis, opioid epidemic, and of course the COVID-19 pandemic, people needed a virtual space where they feel safe to share, and TikTok has been the answer for a lot of people.

“TikTok has influenced my microdosing journey in the most positive way. Just following you and watching your lives has helped me tons!” Zenia, a 37-year-old mom of three kids who had resigned from her job to run an online business in order to spend more time with her children, tells Psychedelics Today. “Hearing how open and real you are about your journey and experiences made me want to do my own research and create experiences through my own journey.”

“It took me a while and lots of research to start my journey because it was such a new concept to me, but I’m glad I did!” Zenia continues. “I have really felt at home knowing that there is a huge community out there going through what I’m going through.”

This content is serving so much more than likes and views to the creator. It’s carrying microdosing to people who desperately need to know there are other alternatives, and giving them a place to share their microdosing experiences within a community. On TikTok, we see ourselves in the popular creators and feel hopeful for a new therapeutic tool, like microdosing. Plus, TikTokers, like many, are terrified to even speak to their doctors about psychedelics, but are completely out of traditional pharmaceutical options. So by finding community on TikTok, they find hope, access, and most of all, people just like them being transformed in a way they dreamed of for themselves.

 “I discovered microdosing [on TikTok] in January of 2021. In the fall of 2020, after almost a year of unemployment and the utter failure of my romantic relationship (epic implosion), I decided it was time for me to go off of the anti-anxiety/anti-depression pill I’d been on for the past three years. By the end of the year I wanted to learn more about how I might holistically begin to heal myself and by chance, I saw a TikTok where you’d discussed your journey with mental health, pharmaceuticals and microdosing popped up and I thought the universe must have heard my heart because this was exactly what I was looking for,” Jen, a 38-year-old project manager from NY tells Psychedelics Today. “I went through all of the videos and consumed the information like a fire. I looked up the Microdosing Institute, reached out to, spoke to and described microdosing to my personal support circle of family and friends (and urged them to do their own research), found a support group online and based in my region and reached out on Instagram to find my own healer who could act as a guide. By February, I had all of the resources to begin my first journey and so I did at the end of March.”

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Microdosing and TikTok Are the Future: Will the Psychedelic Community Join?

Over my time on TikTok I have been able to come to a unique understanding of the sheer magnitude and scale of the future surrounding the psychedelic space as an industry and the mental health crisis it will be meeting. I sit up late at night and worry about the time it will take for real progress and access for the countless people who endlessly direct message me for help. I feel hopeful for the clinical trials on psychedelics, for FDA approval of these drugs as medicine, and for the legalization of psychedelics because Gen Z and Millenials are not the generations of the past.

We want to be part of the future where entheogens are regulated and accessible. We want to appreciate, know, respect, and understand Indigenous practices. We wish we could talk to our therapists, psychiatrists, and psychologists about alternative treatments. We will fight for a future where universal health care covers psychedelic therapy. But for now, we are struggling with mental health—and with the COVID-19 pandemic, there’s new people arriving to the struggle everyday. We’re dealing with despair, isolation, and the side effects of antidepressants for the first time in a broken and overloaded system, and we need help wherever we can get it.

In the unlikeliest of places I have seen and felt a snapshot of humanity that was simply unexpected. A place built so perfectly imperfect, like humans themselves, that even with censorship and sophisticated algorithms alike it could not be stopped or suppress the needs of the people. And it’s my greatest hope that progress, unity, science, Indigenous and modern culture can coexist for the greatest success for all. In the race for the golden ticket of the burgeoning psychedelic industry, TikTok has shown me what’s really at stake—our mental health and wellbeing. I hope more clinicians, researchers, leaders, and companies in the space take on the challenge of joining the rest of the community.

The cultural storm and human need for psychedelics can’t be stopped or slowed down because of the sheer speed of social media, and the psychedelic community can do the important work during this digital age on an app where the impact can be truly astounding.

This next chapter of the psychedelic renaissance will not be televised, it will be on TikTok and I hope the psychedelic community will pay attention.

About the Author

After years spent in the cannabis trenches, Kush Queen founder Olivia Alexander was determined to change the face of the cannabis topicals business for the better. By focusing on CBD-infused products and continually improving formulas designed to work with the feminine body, Kush Queen has become one of the most respected and sought-after cannabis wellness brands on the market. Their nearly instantaneously active Ignite Lubricant is a game-changer in the personal lubricant class, and their carefully formulated tinctures, bath bombs and other personal care products have earned Olivia the title “The Mariah Carey of Weed” by Elle magazine. She has over 1 billion impressions as a social media influencer, sharing her own mental health and alternative medicine journey on Instagram and Tiktok.

About the Illustrator

Martin Clarke is a British Designer and Illustrator from Nottingham, England. Specializing in branding, marketing and visual communication, Martin excels at creating bespoke brand identities and striking visual content across multiple platforms for web, social media, print and packaging. See more of his work here.

Understanding ‘Spiritual Emergency’ in the Context of Psychedelics

By Jasmine Virdi

Understanding what spiritual emergence and spiritual emergency are, how they differ from psychosis, and how to integrate them as a psychedelic traveler or practitioner.

This is part of our ongoing series on transpersonal psychology and how it can help us understand psychedelic experiences. Check out part 1, ‘What is Transpersonal Psychology?’ here.

In recent years there has been a resurgence of interest in the therapeutic potentials of psychedelic substances within both clinical and non-clinical settings, with many seeking out psychedelics and plant medicines for spiritual purposes and attempts at self-healing. Psychedelics have the ability to catalyze immense shifts in our understanding and perceptions of reality as well as the potential to bring forth that which is latent within the psyche. Although the sudden eruption of psychic content or change in ways of seeing the world is at the core of psychedelic healing, it can be a destabilizing process that occasionally triggers a type of unintended psychological distress known as “spiritual emergency.”

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What Is Spiritual Emergency?

The term “spiritual emergency” was introduced to the field of transpersonal psychology by psychiatrist Stanislav Grof and his late wife, psychotherapist Christina Grof, in the 1980s to refer to a kind of spiritual or transformative crisis in which an individual could move towards a greater state of integration and wholeness. In their groundbreaking book on the subject, Spiritual Emergency: When Personal Transformation Becomes a Crisis, the Grofs describe spiritual emergency as “both a crisis and an opportunity of rising to a new level of awareness.”

Intentionally constructed as a play on words, the term “emergency” indicates crisis, all the while containing within it the term “emergence”, pertaining to the process by which something becomes known or visible, implying that both—crisis and opportunity—can arise. The Grofs thus differentiate between a spiritual emergency and the more gradual, less disruptive process of spiritual emergence.

Compared with spiritual emergency, the process of spiritual emergence, sometimes referred to as ‘spiritual awakening’, consists of a slower, gentler unfoldment of psychospiritual energies that does not negatively affect an individual’s ability to function within the various domains of their life. Thus, spiritual emergence is a natural process of attuning to a more expanded state of awareness in which individuals generally feel a deeper sense of connection to themselves, others, and the world around them.

Conversely, cases of spiritual emergency usually share many characteristics with psychosis, and as such are often misunderstood and misdiagnosed. However, spiritual emergencies differ from psychosis in that they are not suggestive of long-term mental illness, and provide individuals with an opportunity to use their woundedness to go deeper into themselves and find healing.

The fact that the concept of spiritual emergency is not known and widely accepted beyond the context of transpersonal psychology is partially bound up with an age-old argument that has long permeated Western science and culture. In culture at large, spiritual and mystical-type experiences have long been ridiculed and pathologized, being considered delusional and reflective of mental illness. Dominated by materialist approaches to consciousness and mental health, Western science generally lumps spiritual crises together with psychosis, attributing their origins to biological or neurological dysfunction and treating them on the physical level. However, in the context of transpersonal psychology, spiritual experiences are considered to be real and integral to the evolutionary development of the individual.

Inherent to the Grofs’ concept of spiritual emergency is their holotropic model that revolves around the central tenet that we have an innate tendency to move towards wholeness, possessing within us an “inner healing intelligence.” Similar to the way the body starts its own sophisticated process of healing when we injure ourselves physically, the psyche possesses its own healing intelligence that takes place unseen within us. Just like fevers fighting off infections, spiritual crises can be understood as the psyche’s way of signalling that imbalance needs to be overcome as it moves toward a state of greater integration.

Although experiences of spiritual emergency are highly individual, they all share in the fact that the typical functioning of the ego is impaired, and the logical mind is overridden by the world of intuition. Scary and potentially traumatizing, spiritual emergencies can be interspersed with moments of fervent ecstasy in which an individual believes that they have special abilities to communicate with God or cosmic consciousness, giving way to a temporary messianic complex.

Conversely, a person might become possessed by a potent feeling of paranoia, feeling that the universe is conspiring against them, or they may feel detached from material reality, only connected to this realm through a fine, ephemeral thread. Happenings and material objects might become imbued with symbolic, other-worldly meaning. For some it means spirit possession, compulsive behaviors which lead them to forget to eat and sleep, or a soul-crushing sense of depression that makes them choose to isolate themselves from others.

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Spiritual Emergency Triggered By Psychedelics

Although states of spiritual crisis can come about spontaneously, they can be triggered by emotional stress, physical exertion, disease, near-death experiences, childbirth, meditative practice, and exposure to psychedelics, among other things.

Psychedelics, in particular, have the ability to trigger spiritual emergencies in that they rapidly propel a journeyer from one state of consciousness to another in a mere matter of hours. If an individual is not adequately prepared, these sudden encounters with the numinous can be incredibly destabilizing and have challenging, unintended impacts.

Furthermore, psychedelics can activate parts of the psyche, throwing us off balance by rapidly bringing forth material from the unconscious that we need to integrate. The Grofs expand on this further in their book, Stormy Search for the Self: A Guide to Personal Growth through Transformational Crisis, writing, “Occasionally, the amount of unconscious material that emerges from deep levels of the psyche can be so enormous that the person involved can have difficulty functioning in everyday reality.”

According to Kyle Buller, Co-Founder and Director of Education here at Psychedelics Today, M.S. in Clinical Mental Health, and certified Spiritual Emergence Coach, psychedelics and engaging in spiritual and contemplative practices can make individuals more prone to spiritual emergencies. “Psychedelics and plant medicines open us up to new ways of seeing the world, and this new way of being or seeing can be destabilizing for some,” he says.

Additionally, Buller explains that those with existing traumas or underlying mental health disorders are more at risk for spiritual emergency-type experiences. “I come back to Grof’s notion that psychedelics are ‘non-specific amplifiers of mental or psychic processes,’” he explains. “If someone is already dealing with a lot and difficult content is brought to the surface and amplified, they might not be able to contain it without a proper set and setting or support.”

In the context of psychedelics, spiritual crises can occur when there is an expansion of consciousness that happens without adequate containment. For that reason, most spiritual emergencies triggered by psychedelics don’t occur in the context of clinical studies, but rather through recreational use, self-exploration, and even ceremonial use. Arguably, within plant medicine ceremonies, there are clear parameters that contain the experience as it is unfolding, however, upon leaving the container of the ceremony, most individuals go back to their normal, everyday lives, and this shift can be challenging.

Research fellow at the Centre for the History of the Emotions at Queen Mary University of London, Jules Evans, detailed his experience of a psychedelic-induced spiritual emergency in his self-published, Holiday From the Self: An Accidental Ayahuasca Adventure. In Evans’ case, he went to the Peruvian Amazon to participate in an ayahuasca retreat.

Although Evans gave it careful consideration and had a positive experience at the retreat, once he began travelling back to Iquitos, he found himself feeling disconnected, and moreover disorientated. As the days passed by, an eerie and intense feeling of doubt around his sense of reality washed over him. In an article recounting his experience he writes, “When I got texts from loved ones, I thought my subconscious was constructing them. I felt profoundly alone in this fake reality.”

Evans had previously spent time studying ecstatic experiences academically, and was partially familiar with the concept of spiritual emergency, helping him to not “freak out.” However, for most of us, that isn’t the case and when spiritual crises start to unfold, not knowing what is happening can plunge us into a deep state of fear and terror.

Another reason why those who experiment with psychedelics are more prone to spiritual crises is the lack of cultural support. Buller places emphasis on the need for adequate cultural containers, suggesting that the fact that psychedelics and plant medicines are not accepted by dominant culture poses another hurdle for integrating these experiences. 

“When a person has a profound experience, where do they turn or seek support? Does the cultural cosmology around them embrace these types of experiences and if not, how does that exacerbate one’s difficult experience?” Buller says.

In Western culture, we have lost the cultural frames and mythological maps that could usher us through intense experiences of psychospiritual opening, a process which we need to go through at times. Reflecting on this subject in a 2008 paper, medical anthropologist Sara Lewis, explored how Westerners are at increased risk for experiencing spiritual crises and psychological distress following ayahuasca ceremonies due to what she describes as a “lack of cultural support.”

Spiritual crises have been suggested to resemble instances of ‘shamanic illness’ as experienced by shamanic initiates in certain Indigenous cultures. Compared with those in Indigenous communities, however, Westerners lack community resources and guidance to contextualize experiences produced by psychedelic plant medicines, and often fear becoming mentally ill as a result.

Distinguishing Between Psychosis and Spiritual Emergency

The Grofs suggest in their book, Spiritual Emergency, that mainstream psychiatry and psychology make no distinction between mystical states and mental illness, tending to treat non-ordinary states with suppressive medication rather than recognizing their healing potentials.

For psychedelic practitioners and integration providers working with those experiencing psychological distress after a psychedelic experience, evaluating whether the individual is a danger to themselves and others, and determining personal or family history of mental health disorders can be incredibly helpful in understanding whether the phenomenon is a psychotic break or a spiritual crisis. An additional indicator is understanding how a given individual relates to their spirituality, ascertaining whether it brings them a sense of hope. Further, it is useful to rule out any form of neurologic or physical disorder that would impair normal mental functioning such as an infection, tumor, or uremia.

Another crucial factor is the client’s ability to understand the phenomenon as an unfolding psychological process that they can navigate internally as well as cooperatively with the mental health provider, being able to differentiate to a substantial degree between their internal experience and consensus reality.

In a 1986 paper on the subject, the Grofs caution, “It is important to emphasize that not every experience of unusual states of consciousness and intense perceptual, emotional, cognitive, and psychosomatic changes falls into the category of spiritual emergency.” Further highlighting that the concept of spiritual crisis is not intended to counter traditional psychiatry, but rather offer an alternative to those who are able to benefit from it.

Thus mental health practitioners looking to learn how to distinguish between spiritual emergency and psychosis must learn there is a fine line between the two which often makes it difficult to discern. While there is a tendency for traditional psychiatry to pathologize mystical states, the Grofs jointly warn of the dangers of “spiritualizing psychotic states”, placing emphasis on the need to use proper discernment around a given individual’s experience.

Speaking to the subject, Buller offers advice, “I would encourage a combination of open-mindedness and critical thinking. For many mental health professionals, this concept is going to push against most of our training, however, we need an open mind to explore this area and do our best to listen to the experiencer.”

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How to Deal with a Spiritual Crisis

In a culture where spiritual issues are not easily understood, spiritual crises can be incredibly isolating and shameful in that the person undergoing them feels that they cannot open up and share about their experience with others for fear of being labeled as “crazy.”

Reflecting on people’s reluctance to share about these types of challenges, Buller offers, “I think this highlights some distrust in the current system around these types of experiences.” He adds, “It also makes me wonder how many people may be struggling with difficult experiences and aren’t reaching out for help because of fearing what might happen if they disclose their experience to a mental health professional.”

For those undergoing a spiritual emergency, it can feel comforting to know that they are not alone in their struggle, and that many other people have been through similarly challenging experiences. It is also helpful to remember that the crisis is part of the healing process, and that it too will pass.

One resource is the Spiritual Emergence Network (SEN), founded by Christina Grof in 1980, or its global sister project, the International Spiritual Emergence Network (ISEN) which provides practical advice for navigating spiritual emergency as well as offering a specialized mental health referral and support service for those seeking help. Additionally, for those merely looking to learn more about the subject, Psychedelics Today offers a free webinar called, “Spiritual Emergence or Psychosis,” which explores some of the research around psychosis and spiritual emergence. 

When experiencing a spiritual emergency as a result of psychedelic use, it is important to factor in set, setting, and integration, just as one would factor those components into an intentional psychedelic trip in the first place. In terms of ‘setting,’ the person experiencing the spiritual crisis should seek out a non-judgemental space in which they feel safe and supported—whether that be with a mental health practitioner or in the hands of family and friends.

Beyond the environment, ‘set’ refers to our mindset and the way we frame the experience. Because there is a conceivable amount of stigma surrounding spirituality, cultivating one’s mindset means understanding that there is nothing ‘wrong’ with the person experiencing a spiritual emergency, and that the difficulty may very well be a crucial stepping stone on their personal path to healing.

Lastly, meaning-making in the context of psychedelic integration is of paramount importance as it allows individuals to take the crucial step of transforming negative experiences into something of value, which could take anywhere from a couple of months to the rest of their lives.

When working with someone experiencing a spiritual emergency, it is important to take a destigmatizing and non-pathologizing approach. Recognizing this, Stanley Krippner, psychologist and parapsychologist, wrote in a 2012 paper, “The naming process is one of the most important components of healing.” As such, mental health practitioners working with those experiencing psychological distress after a psychedelic experience need to be mindful in how they frame what is happening.

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Spiritual Emergency Beyond the Scope of Transpersonal Psychology

While the Grofs’ concept of spiritual emergency was undoubtedly ahead of its time, there is still room for growth and maturation, and some suggest it may be helpful to use different terminology around the concept.

David Lukoff, professor of psychology at Sofia University and licensed psychologist specializing in the treatment of religious and spiritual crises, was influenced by the Grofs’ concept of spiritual emergency early on in his career, and has partially used the concept to inform his work in co-authoring new diagnostic category of “Religious or Spiritual Problem” included in the Diagnostic and Statistical Manual (DSM) 4 and DSM-5.

Lukoff suggests that although the term spiritual emergency, which is well-known in transpersonal psychology, is not used or necessarily accepted in mainstream circles, spiritual and religious issues are now becoming understood through different terminology. 

“I think Stan and Christina nailed the concept, but as soon as you use the term ‘emergency’ in the healthcare field, it implies the worst case scenario in which a person might need hospitalization,” Lukoff tells Psychedelics Today. “The more neutral term ‘problem’ is now used within psychiatry as a result of the DSM category that I helped author, and the term ‘struggle’ is now used within psychology.”

Further, Lukoff emphasizes that he has seen a major shift, even though it is still a minority, in psychology and psychiatry programs on the coverage of religion and spirituality. “I know that the transpersonal world doesn’t always pick up on this, but there is a real renaissance within the healthcare field in which more attention is being heeded to religious and spiritual strengths as well as problems and struggles,” he says.

“There are definitely times when spiritual issues can become crises or conflicts, however, it is also true that for the majority of people their religion and their spirituality are sources of strength, more often associated with positive coping,” shares Lukoff.

In his early 20s, Lukoff experienced his own LSD-induced spiritual crisis in which he believed that he was a reincarnation of Buddha and Jesus, manifested in his present form to unite the peoples of the world. In part, Lukoff attributes his career trajectory as a clinical psychologist and professor of psychology to the psychosis-like transformational crisis he experienced early on.

Reflecting on his own psychedelic-induced spiritual crisis, Lukoff offers the view that careful preparation goes a long way in being able to mitigate the potential negative effects of psychedelics. Even so, it is important not to trivialize or reduce psychedelic-induced spiritual crises to conjectures about “bad trips.” Spiritual crises need not merely be the product of challenging psychedelic experiences as they can be similarly triggered by potent positive experiences.

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Spiritual Crisis and The Future of Psychedelic Healing

Psychedelic healing is not linear. It is not as simple as popping a pill and being miraculously cured. Rather, it is a messy process which sometimes involves psychospiritual distress that is integral to the healing process. As medical and mainstream interest in psychedelic substances continues to expand, and more and more people have these kinds of experiences, it is imperative that psychedelic practitioners develop literacy around the concept of spiritual crisis, as well as develop frameworks to help individuals contextualize their challenging experiences.

With increased awareness and use of psychedelics, are practitioners ready to deal with some of the transpersonal experiences that clients will bring to them? Buller emphasizes the need for diverse and nuanced perspectives as we move forward into the psychedelic renaissance.

“While I appreciate the trauma focus and narrative in psychedelic research, I worry that we might end up reducing everything down to psychological terminology, discrediting a person’s experience,” he shares. “What happens when someone has an entity encounter in a psychedelic experience? Do we just reduce that experience down to a possible traumatic event in someone’s life or write it off as unreal because we have a mechanistic understanding of what that experience is?”

Moving towards the future, it is important to remain open-minded, and take holistic approaches that interweave multiple narrative frameworks, including that of transpersonal psychology, through which people can understand and make meaning of their experiences, including the potential for spiritual emergencies and their transformational—yet difficult—outcomes.

About the Author

Jasmine Virdi is a freelance writer in the psychedelic space. Since 2018, she has been working for the fiercely independent publishing company Synergetic Press, where her passions for ecology, ethnobotany, and psychoactive substances converge. Jasmine has written for Psychedelics Today, Chacruna Institute for Plant Medicines, Lucid News, Cosmic Sister, Psychable, and Microdosing Guru. She is currently pursuing an MSc in Spirituality, Consciousness, and Transpersonal Psychology at the Alef Trust with the future aim of working as a psychedelic practitioner. Jasmine’s goal as an advocate for psychoactive substances is to raise awareness of the socio-historical context in which these substances emerged in order to help integrate them into our modern-day lives in a safe, ethically-integral, and meaningful way.