The psychedelic renaissance has a blind spot. Beyond the stories of profound healing and transformation, there lie untold stories of harm, confusion, and isolation.
Having worked with psychedelic casualties for the past 13 years, I've become intimately familiar with both the nature of psychedelic harm and how surprisingly common it is. Yet in my conversations with practitioners, researchers, and even experienced psychonauts, I'm struck by how few people grasp the true scope of this issue. The reason for this disconnect is a troubling pattern I've observed: the vast majority of psychedelic casualties never seek help, remaining invisible to the broader community.
Their silence isn't random—it stems from powerful psychological, social, and systemic barriers that keep them isolated in their suffering. This article will not only explore the main reasons why those harmed by psychedelics stay hidden but also what we, as a community, can do to change that. We'll begin with Jenny's story, which illustrates many of these barriers in action.
Jenny’s Story
Jenny’s first ayahuasca retreat had “opened her eyes” and sparked a new and profound relationship with the natural world. So, in July 2021, when Jenny headed out of the city for her second ayahuasca retreat, she felt excited. The retreat was to consist of two ceremonies on consecutive nights.
However, on the first night, Jenny had a very difficult trip and was left feeling “off.” It wasn’t what she expected, and she realized she’d gone in convinced she knew what she was doing. In her own words, “It wasn’t my first rodeo.” She felt embarrassed that she’d had such a messy and difficult time and, in her wobbly and discombobulated state, didn’t feel like talking to anyone. By mid-afternoon the following day, just before the “sharing circle,” she told one of her friends that something had come up at home and she’d have to leave.
Jenny drove home feeling quite unstable, needing to pull over several times. On one of these occasions, she felt so anxious that she vomited by the roadside. She was experiencing strange symptoms where her perception would “glitch,” everything would feel unreal, and waves of vertigo would hit. After vomiting, she sat in her car and plucked up the courage to text one of the facilitators of the event, wanting to ask if her symptoms were normal. She felt very awkward sending the text - the facilitator was a friend of a friend, and it didn’t feel easy to “confront” him this way. She did not get a response.
The next day, she felt even worse. She considered going to see a doctor but worried about where that might lead. What would her GP think? She’d heard of people having tough experiences, going to the doctor, and ending up “munted” on anti-psychotic medication. She also didn’t want to “blow the cover” of the facilitator, who had made it clear that discretion was essential.
A few days later, her symptoms had disconcertingly set in. She eventually received a message from the facilitator, apologizing that he’d been offline and decompressing after the energy he’d spent running the retreat. His recommendation was that she book in for a private psychedelic session - maybe mushrooms? - as soon as possible to “complete her journey.” In the meantime, he suggested she seek out Kambo. Jenny intuitively felt that neither of these suggestions would help. She didn’t reply.
Her symptoms persisted, becoming her new dysfunctional normal: a sense that life wasn’t real, a persistent low-level, nauseating anxiety, and torturous insomnia. When she tried to sleep, at the point of nodding off, the world would spin, and it would feel like “the bottom fell out of the world,” jolting her awake.
Her friends called and texted, checking in, but she fobbed them off, saying she was just busy. Three weeks after her experience, following a disconcerting tour of what the internet had to say about her symptoms, she found her way to me.
9 Reasons Casualties Don’t Get Help
Jenny's experience illustrates some of barriers that lead psychedelic casualties not to seek help. Let’s now take a deeper look at the 9 primary reasons psychedelic casualties don’t get the help they need.
Reason 1: Shame and Self-Blame
Reason 2: Difficulty Identifying and Articulating Symptoms
Reason 3: Trip-Specific Factors
Reason 4: Fear of Judgement
Reason 5: Fear of Diagnosis and Medication
Reason 6: Fear Arising from Illegality and “Fringe” Activity
Reason 7: The Impact of Abuse or Mistreatment
Reason 8: Facilitators Losing Track of Casualties
Reason 9: When a Psychedelic Casualty Does Seek Help
Reason 1: Shame and Self-Blame
The first and perhaps most significant factor is shame. Psychedelics are often surrounded by narratives of transformation, healing, and profound insight - stories of life-changing breakthroughs and deep connection. These stories create powerful expectations. People entering psychedelic experiences, particularly for therapeutic or spiritual purposes, often anticipate that they, too, will have an “amazing” or “healing” experience.
When the reality is difficult, chaotic, or deeply distressing, it can feel like a personal failure. Instead of viewing the challenge as part of a larger process or the result of external factors, many conclude there’s something uniquely wrong with them - that they are broken or deficient in some way.
This shame can be especially acute for those with pre-existing mental health challenges, reinforcing patterns of self-blame or fragile self-worth. Thoughts like “I must be especially messed up, I’m beyond help.” Comparative thoughts are also common, “Other people heal because they don’t have the trauma I have.” “Everyone else can heal, what is wrong with me?!”
The psychedelic subculture can also unintentionally amplify this shame. Discussions often focus on breakthroughs while downplaying risks. As discussed, responses like “You just need to surrender” or “The medicine is showing you what you need” may hold partial truth but can feel dismissive, implying the struggle is a personal failing rather than a legitimate difficulty.
More often than not, the result is silence. Feeling ashamed, many keep their experiences to themselves.
Reason 2: Difficulty Identifying and Articulating Symptoms
There is also the reality that psychedelic casualties often lack the capacity, either emotionally or cognitively, to articulate what has gone wrong. Psychedelic experiences can be profoundly disorienting. Someone suffering may sense, vaguely but powerfully, that their grasp on reality feels fragile or altered. Yet describing this to a facilitator - or anyone - can feel almost impossible: “What exactly am I trying to say?” This confusion, paired with fears of not being taken seriously, frequently leaves casualties retreating into silence.
Reason 3: Trip-Specific Factors
The content of a psychedelic experience itself can become a significant barrier to seeking help. Psychedelic journeys often give rise to powerful emotions, symbolic imagery, or new beliefs that linger afterward and shape how casualties make sense of their suffering. Paranoia experienced during a trip - such as distrust toward the facilitator - can persist, making it feel impossible to approach them for support. Similarly, themes of shame or self-blame that arose in the experience can solidify into lasting beliefs - "This is my fault. I deserve this" - that become barriers to getting support. These trip-specific factors trap casualties in a cycle where the very experience that caused harm reinforces their inability to seek help.
Reason 4: Fear of Judgement
The broader social stigma surrounding psychedelics compounds these challenges. Outside the subcultures where these practices are accepted, psychedelics are often viewed as risky, reckless, or fringe. Participants may fear being judged - not just by facilitators but by friends, family, or medical professionals. The implied question, “What were you thinking?!” can feel deeply shaming, reinforcing the isolation casualties often find themselves in.
Reason 5: Fear of Diagnosis and Medication
For many psychedelic casualties, seeking help from a medical professional can feel overwhelming and risky. Their symptoms - such as vivid or destabilizing experiences, disorganized thinking, paranoia, or hallucinations - can resemble psychosis, which raises fears of eventually being diagnosed with conditions like bipolar disorder or schizophrenia. These diagnoses can carry heavy consequences: stigma, a shift in how they see themselves, and a medicalized explanation that may not match how they understand their experience.
Adding to this fear is the possibility of being prescribed medication, such as antipsychotics or mood stabilizers, as the default treatment. For those who value their autonomy or feel uneasy about medication, this can be deeply unsettling. Many worry that medication will dull their emotions, suppress their ability to process what happened, or take away their sense of control - all of which feels like another obstacle to healing on their own terms.
Reason 6: Fear Arising from Illegality and "Fringe" Activity
In underground settings - such as ayahuasca circles, informal psychedelic retreats, or underground psychedelic-assisted therapy - there is an inherent tension between openness and discretion. The very nature of these spaces, operating outside the bounds of legality and regulation, creates a veil of secrecy that can make seeking help for harm particularly fraught. Participants are often asked to maintain strict confidentiality: to keep locations undisclosed, identities protected, and experiences unspoken outside of trusted circles. This culture of secrecy is intended to protect participants and facilitators from legal or social consequences, and at times, also aims to foster an environment of trust and safety. Yet, paradoxically, it can become a significant barrier when something goes wrong.
For someone experiencing harm, the act of returning to a facilitator or therapist to share their distress can feel very difficult. While it doesn’t necessarily break the implicit social contract of discretion, it can strain it. Participants may feel they are disrupting an unspoken agreement, or betraying a sort of group loyalty. This discomfort, coupled with the inherently awkward nature of raising concerns, can leave casualties hesitant to speak up.
Adding to this difficulty is the power dynamic between participants and facilitators. Approaching someone seen as a guide or authority to raise concerns requires confronting one’s own vulnerability while risking defensiveness, dismissal, or blame. Facilitators often hold significant sway over how participants interpret their experiences, leading to hesitation or self-doubt: ‘What if it’s just me?
Reason 7: The Impact of Abuse or Mistreatment
When facilitators or underground therapists commit abuse, the barriers to seeking help multiply dramatically. The person who should have been a source of safety becomes the source of harm, creating a devastating betrayal of trust. Casualties must navigate not only the destabilizing effects of their psychedelic experience but also the trauma of exploitation during a vulnerable state. Fear of not being believed, community backlash, or being blamed for what happened can make speaking out feel impossible. This intersection of psychedelic harm and interpersonal violation creates a particularly isolating form of suffering.
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For all these reasons - social pressures, power dynamics, stigma, fear of medication and diagnosis, and the difficulty of articulating experiences - it is not hard to see why so many people, already feeling vulnerable, choose to stay silent rather than seek help.
Systemic and Practical Barriers to Support
The reasons we've explored so far are deeply personal and relational. But even when a casualty overcomes these hurdles, they often face a different set of obstacles rooted in systemic failure. These final two barriers are not about the individual's internal experience, but about the practical absence of robust follow-up systems and specialized care.
Reason 8: Losing Track of Casualties
In underground settings, facilitators may genuinely want to follow up with participants after a session, particularly if there are concerns about their well-being. However, without the formal systems of clinical or research contexts - such as medical records, scheduled follow-ups, or coordinated support networks - this can be incredibly difficult. Even well-intentioned facilitators find that participants drop off the radar due to shame, confusion, or a desire to isolate. Unlike clinical settings, where missed follow-ups trigger outreach, underground practitioners lack the tools or authority to persist. The result is that casualties often disappear into silence, their suffering unnoticed and unsupported.
Reason 9: When a Psychedelic Casualty Does Seek Help
Even when a psychedelic casualty overcomes the barriers to seeking support, there's no guarantee they will receive the help they need. This work is difficult and highly specialized. Supporting someone during a psychedelic experience is not the same as helping someone who has been harmed by one - they require different skill sets, a distinction often overlooked. Casualties may find themselves with a guide, doctor or therapist who, despite good intentions, lacks the necessary tools or knowledge to address their situation. After a few sessions, many realize the support isn't helping and quietly drift away, feeling even more isolated. One common piece of advice underground facilitators give is to "take another trip" - a suggestion that is generally misguided. The result is a tragic irony: even when casualties overcome the many barriers to seeking help, gaps in understanding and expertise around psychedelic harm can leave them as unsupported as before.
Confirmation Bias
When we step back and examine these barriers collectively, a troubling pattern emerges. The very factors that keep casualties silent - shame, fear, stigma, and lack of support - create a profound confirmation bias within psychedelic communities. Those who have positive experiences share their stories enthusiastically, while those harmed retreat into silence. Facilitators receive glowing feedback from successful cases but rarely hear from casualties who've disappeared. The public narrative becomes dominated by breakthrough stories, while breakdowns remain hidden. This isn't just an information gap; it's a systematic distortion that makes psychedelic use appear far safer than it actually is, perpetuating the conditions that leave casualties isolated and unsupported.
Building a Culture of Support
Creating genuine safety in psychedelic spaces requires more than good intentions - it demands a fundamental shift in how we acknowledge and respond to harm. Just as society has slowly learned to create safer spaces for survivors of abuse to come forward, we need parallel structures for psychedelic casualties. This means establishing confidential pathways for sharing difficult experiences without fear of judgment, whether in clinical trials, therapeutic settings, or underground communities. It means training facilitators to recognize that "just take another trip" or "reframe your experience" can deepen someone's isolation rather than help them heal. Most importantly, it means normalizing the reality that psychedelic experiences can cause lasting harm, and that those who suffer deserve the same compassion and support as those who find healing.
Moving Forward: What We Can Do
We all have a role in changing this dynamic. The first step is acknowledging that these casualties exist and understanding the complex reasons for their silence. Here's how we can contribute to meaningful change:
For Facilitators:
Normalize conversations about difficult experiences and risks before and after a session
Develop clear, persistent follow-up procedures that don't rely on participants reaching out
Recognize that post-trip integration support requires a different skill set than in-session guidance
For Participants:
Trust your intuition - if advice like "take another trip" feels wrong, it probably is
Know that your difficult experience is not a personal failure
Seek support from professionals specifically trained in psychedelic harm
For the Community:
Allow and even amplify stories of harm and challenge, not just breakthrough stories
Create safe and anonymous spaces for sharing difficult experiences
Listen without judgment when someone shares their struggle
By taking these concrete steps, we can begin dismantling the barriers that keep casualties invisible. The next time someone shares a difficult psychedelic experience, ask yourself: Am I being a safe harbor or another reason to retreat into silence? Our collective response to this question will determine whether the psychedelic renaissance truly serves healing - or continues to leave its casualties behind.
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