Mushrooms as Medicine

Moss is one of many Oregonians benefitting from psilocybin, the active ingredient in “magic mushrooms.” Psilocybin was criminalized by the United States in 1970, but in recent years, there’s been a growing interest in the healing potential of psilocybin-containing mushrooms, which grow naturally in the Pacific Northwest and around the world. 

“Mushrooms make it easier for me to hold my feelings and relay them,” says Moss. Their psychedelic experiences have allowed them to work through childhood trauma and develop a deeper understanding of themself. In the past four years, Moss has used mushrooms at least once a month, both in microdoses and in larger doses that produce strong psychedelic effects.

When I speak with Moss, they’re wearing a T-shirt illustrated with ghost bats, lightning bolts, and a series of anthropomorphic flowers. The shirt reads “Comfort in chaos.” The words CRY BABY are tattooed across their knuckles. As we talk, Moss is quick to laugh and crack jokes. Today, we’re discussing Moss’s experiences with mushrooms—and their experience hearing voices that others do not hear.

Oregon’s new psilocybin services program allows adults to legally take mushrooms under the guidance of a trained facilitator, but Moss won’t be participating. Voice-hearers like Moss—and myself—are prohibited from tripping at the state-sanctioned facilities, which opened earlier this year. To the uninformed, this prohibition may seem intuitive. People who hear voices shouldn’t take mushrooms, right? When I talk to Moss about their experiences with psilocybin, that stereotype becomes more complicated.

Moss says mushrooms help them navigate their own internal world. “That’s useful for having headmates,” Moss says, referring to the voices that only they can hear. During the mushroom experience, their voices actually help them process old trauma. “Having the extra help,” says Moss, “I don’t have to attack these big feelings by myself. . . . It makes it a lot less scary.”

The Oregon Psilocybin Services (OPS) program was created by the Oregon Health Authority following passage of a ballot initiative, Measure 109. The program is regulated by state law and Chapter 333 of the Oregon Administrative Rules. As part of the intake process, people hoping to undertake psilocybin sessions with a state-licensed facilitator must complete a Client Information Form. The form asks, “Have you ever been diagnosed with active psychosis or treated for active psychosis?” If the potential client answers yes, they are barred from participating in a psilocybin session.

Since the 2020 passage of Oregon’s decriminalization bill, Measure 110, personal possession of psilocybin mushrooms is decriminalized in the state. As a result, people like Moss are able to use mushrooms with minimal legal risk—as long as the use takes place outside of state-sanctioned facilities.

Moss experiences three main voices, each of which have a distinct personality. They have lived with Moss since at least age five. “I don’t remember much of my childhood,” says Moss, “but they’ve been around for as long as I can remember.” In the past few years, Moss’s relationship with the voices has improved considerably. “I’ve been getting to know them, having a better relationship, and including them in my life more now than ever.”

Moss doesn’t believe these voices are linked to trauma—a common theory for the origin of voice-hearing—but there is one being who is. The scary lady, as Moss calls her, is “less like a voice and more like a feeling.” Moss says it was “a moment of assault [in late adolescence] that led to her being present in my life.”

Moss’s relationship with the voices has at times been difficult. Moss is trans-nonbinary, and they were raised in a religiously conservative household. In high school, Moss stopped listening to their voices. “My parents were going through a really rough time, and I had to focus a lot on my younger siblings,” says Moss. “Instead of sending me to psychiatric hospitals, my parents sent me to Christian camps for deviant children and conversion camps for queer kids—it was a different kind of psychological torture.”

“I was trying to be a ‘good Christian girl,’” says Moss, but the voices kept pestering them. “They were questioning [me], which feels mean when you’re in a very defensive state.”

After high school, Moss left their home in Raton, New Mexico, to attend college. They began their first serious relationship, dating a trans man who helped Moss accept themself. “Queer people are not demons,” Moss realized. “I’m not going to hell for any of this.” This realization also impacted Moss’s relationship with their voices. “The three major ones got less angry,” Moss says.

Moss’s boyfriend helped them let go of some religious trauma, but they also pushed Moss toward a medicalized view of their experiences. Moss’s boyfriend told them, “While you're seeing your doctor, you should also mention the voices.” Moss was then prescribed psychiatric drugs, and one day they took a double dose. “I got an upset stomach, and my partner was convinced I was trying to kill myself. I was put in the hospital in Roswell, which was whack.” Moss doesn’t remember much of their time in the hospital; they say it felt like being in a video game, zonked out on psychiatric drugs.

Like Moss, my experiences with the mental health system have been less than helpful. Moss and I are part of the Mountain Beaver House, a Southern Oregon peer respite set to be funded by the Oregon Health Authority, which would provide an alternative to psychiatric hospitalization for people in crisis. We also run an alternative peer support group in Medford called the Bear Creek Hearing Voices Network. Diagnosis is not required to attend a HVN group, and many in the community say their experiences with voices and visions don’t fit neatly into the biomedical model of “mental illness” often pushed by psychiatrists.

Moss says that the only diagnosis they’ve ever felt comfortable with is autism. They have struggled with motor skill issues since childhood, and a couple years ago they developed a daily practice of making collages. “Whether my motor skills are shitty or not, I can still cut paper and glue it back together,” says Moss. They say collaging allowed them to “use everyday things to help me remember stuff, as well as move through the things I was told I couldn’t do.”

In college, Moss was hospitalized four times and prescribed various psychiatric drugs. The drugs came with negative side effects like lockjaw and irritable bowel syndrome. Today, Moss doesn’t take psych meds and prefers to smoke marijuana—something their straight-edge college boyfriend wouldn’t allow. “I've always been very firm on how marijuana is a useful and not super harmful medicine,” says Moss.

Moss first smoked marijuana at age sixteen, and their first psychedelic experience was taking LSD in college. Before their first trip, Moss kept thinking about drug stereotypes they’d heard in school, like the idea that bad trips cause schizophrenia. “I was scared shitless it would make things worse,” says Moss. “And then it didn’t.”

 

Wanting to understand why someone like Moss would be banned from participating in Oregon Psilocybin Services, I contact Angie Allbee, who manages OPS through the Oregon Health Authority. During our Zoom interview, Angie explains to me that the state’s rules regarding OPS, including the prohibition against people who have experienced “active psychosis,” follow the recommendations of a governor-appointed Psilocybin Advisory Board and were guided by a series of public comment periods.

“We actually heard from a number of folks that felt very strongly about ‘active psychosis’ being a problem,” Angie tells me. “We didn’t hear as much feedback about advocating for people to be able to access services if they do have ‘active psychosis.’”

I ask Angie about the nature of “active psychosis” as well as “drug-induced psychosis,” which is another term that occurs in the state’s administrative rules. Angie tells me, “The diagnosis of active psychosis comes from a medical diagnosis… Our licensed [psilocybin] facilitators cannot diagnose clients, and they also can’t assess whether or not a diagnosis is accurate.”

This is where it gets confusing, because “active psychosis” is not a medical diagnosis. In the United States, the definitive source on psychiatric diagnoses is the Diagnostic and Statistical Manual of Mental Disorders. In the book’s current edition, the DSM-5, there are diagnoses like schizophrenia, brief psychotic disorder, and depression with psychotic features, but nothing called “active psychosis.” The term doesn’t appear in the book’s index, nor is it found anywhere on the website of the American Psychiatric Association, the professional organization that publishes the DSM-5.

Despite my own experiences with voices and visions, I don’t like the word “psychosis.” It’s a psychiatric term, and that system has never made sense to me. As a teenager, I believed that LSD was a spiritual gift to humanity, and that if enough people took it, we could save the world. My dad said I was “delusional,” and I was sent away to a wilderness program and therapeutic boarding school. Today, my dad and I can talk more openly about these issues, but it was a challenging time for both of us.

I turned sixteen and seventeen in these highly restrictive programs, and I was diagnosed with “hallucinogen dependence.” In the case notes that I obtained as an adult, one of the “presenting issues” requiring treatment was “Derek relates his spiritual growth and abilities to the use of LSD.”

The program staff demanded abstinence, and they would regularly tell us, “If you weren’t a drug addict, you wouldn’t have ended up here.” According to staff, my use of psychedelics was part of the disease of addiction. In a case session, one therapist wrote, “Derek[‘s] argument of acid helping him to achieve a collective consciousness with others is a form of instant gratification.” My insistence that there could be healing or spirituality involved in taking LSD were just symptoms of denial.

Nearly two decades later, the landscape has changed significantly. Now doctors recommend psychedelics to treat addiction. You can even get a career helping people trip. But if mental health professionals could be so misguided in the past, who’s to say they are more trustworthy now?

After our interview, I email Angie Allbee to ask her about those people she said “felt very strongly” about prohibiting anyone with “active psychosis” from participating in the psilocybin program. “Oregon Psilocybin Services (OPS) began rulemaking in September of 2022,” Angie replies. “Initially, OPS draft administrative rules did not include a prohibition for clients with a diagnosis of "active psychosis." However, after receiving public testimony during the public comment period and public hearings on rules in November of 2022, the prohibition was added.”

The key piece of public testimony in November 2022 came from a self-described “collaborative of psilocybin subject matter experts and advocates working together to promote high standards of safety.”

The letter outlined a number of proposed modifications to the state’s administrative rules. “In order to protect the safety of clients,” the letter states, “the reasons for exclusion from services should be expanded to include… active psychosis.” It was signed by over two dozen individuals, including numerous medical doctors, naturopathic doctors, and mental health professionals. Many of the signatories are also employed at state-licensed psilocybin facilitation training centers.

The letter doesn’t cite any research to support its proposals, and scientific research on the subject is sparse. In July 2021, Oregon’s Psilocybin Advisory Board conducted a Scientific Literature Review that stated: “It is widely assumed that individuals with a history of psychotic disorder such as schizophrenia are at high risk of precipitation or exacerbation of psychosis, although this has not been studied or quantified. Individuals with history of psychotic disorder are excluded from clinical trials studying psilocybin.”

I know that psychedelics can have an uncertain effect on mental health. After my time in residential programs as a teen, I didn’t take psychedelics again until my mid-twenties. By then, a psychiatrist had declared I was “psychotic,” but therapy wasn’t helping. I was suicidal and my life felt meaningless. LSD helped me overcome my depression—but I also spent nights peering through the blinds on my window, worried my neighbors were plotting to kill me. I got sober again in 2018, but I still believe that people should have legal access to psychedelics for healing, spiritual practices, and recreational tripping. It disturbs me when medical professional say that people like Moss and me should be prevented from taking psychedelics for our own “safety,” as if we aren’t capable of making those decisions ourselves.

To understand how these conversations fit in the broader field of psychedelic science, I reach out to Dr. Tehseen Noorani, an interdisciplinary social scientist based at the University of Auckland. Tehseen and I first met in 2021 when he was organizing the “Psychedelics, Madness & Awakening” conference. Now, as we exchange voice messages across our vastly different time zones, Tehseen discusses the wider “politics of exclusion” within psychedelic sciences, which is “based on rumor or moral panic.”

Discussing the lack of randomized controlled studies (RCTS) for psychedelics and “psychosis,” Tehseen speaks about a “deep frustration with a kind of evidentiary chauvinism.”

He says it is a common belief that “unless the RCTS are conducted [by] administering psychedelics to people with histories of psychosis [or] madness, then we can’t say anything about these things.” In other words, the emphasis on formal scientific knowledge excludes the lived expertise of people like Moss and myself, as well as Indigenous communities like the Mazatec of Southern Mexico who have used psilocybin outside the purview of Western science for centuries.

I ask Tehseen how he understands the demand that people with “active psychosis” be barred from Oregon’s program. “It’s risk reduction in the setting up of new markets,” he says, suggesting a possible profit-driven motive for facilitators and training centers.

“That to me is an echo of a wider psychedelic medicalization strategy,” says Tehseen. He describes this strategy as a “Trojan horse thing—let’s just get it through and get these substances approved, and then it will lead to all these other kinds of changes.” Medicalization relies on medical arguments for increasing access to psychedelics, rather than focusing on decolonization, ending the War on Drugs, or other arguments for legalization.

When I speak with Angie Allbee, she sounds more optimistic. “This is the nation's first framework for psilocybin services,” she says. “We adopted rules with the information that we had at that time, and we’ll continue to open up [the rulemaking process] every year and consider feedback from everyone.”

Moss says the exclusion is ridiculous. “What is a clear definition of ‘active psychosis’? asks Moss. “And what about your defined psychosis makes a person unable to take mushrooms?”

Instead of a hard no, Moss thinks the state’s screening process should involve a one-on-one conversation between the facilitator and the potential client to determine whether the mushroom services will be beneficial. “The human condition has never been cookie cutter,” they say. “We know [that approach] doesn't work. How is it going to work now?"

Tags

Government, Spirituality, mental health, LGBTQ+, exclusion, psychedelics