Aixalà's review discussion (in Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness) of adverse effects of psychedelic drugs comes only after almost 200 pages of hagiography (as if of Saint Mushroom, Saint Molly, Saint Ketamine, etc.). Given the context of this book, the adverse effects discussion is surprisingly gruesome.
The other thing that's surprising is that the leading expert on the subject is none other than Sidney Cohen, M.D., who has been dead for 35 years. Cohen was the character who gave LSD to Auldus Huxley and Clare Booth Luce (among other elite socialites) in the 1950's. Later, he debated Timothy Leary and warned about the drug's extensive dangers.
Sidney Cohen has investigated the adverse effects of psychedelic therapy perhaps more than any other author. Working as a psychedelic therapist over the years, Cohen became quite interested in the adverse reactions, devising a model of description and classification that evolved over the years.
Cohen describes the adverse symptomatology following the use of LSD and classifies it in two main groups: 1) acute reactions and 2) prolonged reactions. However, he does not make such a distinction in all his publications, and some confusion remains regarding the types of adverse events he catalogs. We know (and it will be addressed in the corresponding chapter) that difficult experiences can arise during the acute effects of any psychedelic experience, regardless of the substance or the context. A thorough discussion regarding how to best deal with these acute episodes well surpasses the objectives of this book. Therefore, we will focus on the prolonged reactions that occur and linger after the experience, as they are the ones more closely related to integration. Within this category, Cohen distinguished four different groups of adverse effects: 1) prolonged psychotic decompensation (schizophrenia, intermittent reactions, or flashbacks); 2) depressive and anxious reactions (the most frequent complication, according to Cohen); 3) the activation of psychopathic or anti-social tendencies, anti-social behavior, and letting go of social responsibilities; and 4) paranoid reactions or the confirmation of delusions of greatness in relation to the transcendental aspects of the experience.
While the phenomenological description of the symptoms is extensive, the classification seems to change as his model evolves, with the different categories eventually including many overlapping elements. Cohen affirms that these episodes are infrequent, and most of them may be resolved in the course of a few days or weeks by means of psychiatric medication, but he also reports cases in which the adverse effects persisted for months or years. In this regard, Cohen's approach to the integration and comprehension of these phenomena follows the aforementioned diagnostic line, quite confusing and impractical when trying to prescribe courses of treatment.
Perhaps more interestingly, Cohen further discusses the causes of prolonged psychotic reactions in some subjects. These include: 1)the character structure of the subject; 2) the context; 3) the insecurity and vulnerability entailed by a psychedelic experience; 4) the set and the contagious nature of the group experiences; 5) panic inducing negative experiences; 6) difficulties in "landing" while approaching the end of the experience; 7) dosage; 8) frequent use; 9) previous state of mind and stress levels; and 10) insufficient preparation.