The phenomenology of the intoxication with psychoactive substances – from clinical data to self-experiments in the medical and literary world (II)

Introduction

Continuing the presentation of altered states of consciousness (ASC) induced by psychoactive substances (PAS) in the first part of this review⁽¹⁾, the current section is dedicated to the phenomenological aspects of drug intoxication, as they can be retrieved from famous writers’ works. Taking into account the cultural trend for using PAS in certain periods of history and, at the same time, the desire of the writers to enhance their creativity using any available means, it is of no surprise that well-known literary works include testimonies of ASC either as autobiographical reports, or as revealed by different characters portrayed within the novels’ storyline or included in various poems.

As already mentioned in the previous section of this article, it is important to explore different perspectives on the phenomenon of drug-induced ASC to understand better the effects of the interaction between the PAS and personal vulnerabilities in modeling the trajectory of an individual toward substance use disorder (SUD). Psychological, social, biological, and cultural factors are all involved in creating unique configurations of vulnerability and resilience profiles that moderate the effects of a psychoactive substance on the mental health of each individual. While biological factors are not readily available, as the search for biomarkers in SUDs is still ongoing, by using a phenomenological approach, the psychological reactions to the effects of psychoactive substances can be more easily investigated as doorways to addiction. Such an approach may be of use not just for a more extensive understanding of the drug-induced ASC and, as a consequence, for better relating, as clinicians, with patients diagnosed with substance use disorder, but also for psychotherapeutic purposes. It would be difficult to build up a therapeutic relationship with a patient who is confronted with a drug addiction if the therapist has a poor theoretical understanding of the experiences such a patient lived at the beginning and throughout the history of his/her PAS use.

Regarding the interaction between psychological and sociocultural factors when referring to SUDs, the assignment of the significance of drugs in different societies and cultures has been explored by scientists from various domains, from historians, sociologists and anthropologists to psychiatrists, pharmacologists and psychologists. For example, the differences between cultures in ascribing psychological and social functions to PAS use explain why those drugs that are included in the rituals or other traditions of a certain society present a lower risk of creating dysfunctions at the societal level in the respective milieu⁽²⁾. As signaled by Westermeyer (1987), migration, affluence, urbanization, and rapid cultural changes contribute significantly to the onset of drug-related problems, because a specific drug is spread to another culture, where it loses its cultural role and becomes a drug of abuse (eventually, by getting another way of administration)⁽²⁾. For example, Amanita muscaria and other entheogens (“en” = in; “theo” = gods; “gen” = create) have been used by priests or shamans in different cultures for religious ceremonies by exploiting their effects of inducing dissociative trances, and opium was used by traditional healers from the 9^th century BC up to the recommendations of the German psychiatrist Griesienger (the 19^th century) for the use of opium in the treatment of melancholia^(3,4). However, the diversion of these substances from their original purpose and the abuse of such substances outside their initially ascribed ritualistic or medical role transformed their use into a severe medical, economic, social, and psychological challenge⁽³⁾.

From a historical perspective, the phenomenon of loss of control over psychoactive substances use began to be systematically described in the literature in the 17^th century⁽³⁾. However, avoiding the conundrum of altered states of consciousness’ origins in modern times and the historical debates regarding the nurture versus nature in the genesis of the same pathology, the objective of this review is to present the most relevant data in the literature regarding drug-induced altered states of consciousness in the literary world, as reported experiences collected from famous writers. As a cautionary statement, the reader is advised to interpret these experiences by considering the cultural context in which they were lived and the fact that, unlike the ASC reported in the clinical populations and scientific self-experiments, the level of the consumers’ creativity and thus, the possibility of they adding more material to the real events, is significantly higher when literary works are examined.

Materials and method

This section of the literature review is based on the exploration of three electronic databases (Google Scholar, PubMed, and CINAHL), using the paradigm “self-experiment(s)” AND “psychoactive substances” OR “drugs” AND “writers”, from the inception of the respective databases to June 2024. The list of references for each retrieved paper was consulted, and all sources corresponding to the initial search criteria were explored. Grey literature was also explored because of the need to find references on the literary world, which were not expected to be retrieved in great numbers within the scientific databases. In the second stage, all relevant sources found for each writer were manually searched, and the most significant paragraphs corresponding to the research objective were extracted.

Results

A number of 32 reports were found, all related to different writers who experienced ASC under the influence of PAS. However, only the most relevant seven sources were extensively analyzed to retrieve significant quotations reflecting famous writers’ PAS-induced experiences. Where the literary works were found in their original language, these editions were preferred for investigation, but if they were not accessible, their Romanian versions were used, and reverse translation was applied.

Illustrations of drug self-experiments in the literary works

Thomas De Quincey

In his partially autobiographical novel Confessions of an English Opium-Eater, De Quincey describes the manifestations of laudanum consumption from a literary perspective⁽⁵⁾. The author, who identifies himself with his main character, takes refuge in the consumption of opium as a form of moral protest against society. This novel will influence personalities of the literary world, such as Poe and Baudelaire, who were inspired by his methods, images and impressions reported in his seminal work.

Here is the impression of the main character in De Quincey’s aforementioned novel about the first dose of opium: “(...) what a revolution of the senses! What a revival from the deepest depths of my ego! What an apocalypse of my inner world!”⁽⁵⁾. This character has the feeling that he has discovered the “secret of happiness”, the “panacea for all human misfortunes”⁽⁵⁾. Regarding the effects on thinking, opium has stimulating properties, and the flow of associations is freer (“creates a perfect mental order and harmony”, while it “instills in all the faculties, awake or latent, serenity and balance”)⁽⁵⁾. Also, De Quincey’s character notes a pleasant mood of “perfect serenity”. The recollection of painful memories is, within the opioid trance, devoid of discomfort: “details of the events were removed or merged into a vague abstraction, and the old passions were exalted, spiritualized and purified”; “oh, eloquent opium! (...) in the divine sleep of one night, you help the one guilty of murder to relive the memories of his childhood and wash his hands of blood”⁽⁵⁾.

External stimuli are processed against the background of amplified esthetic feelings; opium “activates (…) that special process thanks to which we create a superior intellectual pleasure from the raw material of musical sound”⁽⁵⁾.

De Quincey believes that, unlike alcohol, opium does not produce a loss of self-control⁽⁵⁾, which, of course, is not a scientifically sound observation. In fact, the disorganized behavior during ordinary drunkenness corresponds to opioid-induced apathy and abulia, which both lead to a loss of self-control, only that in the second case, it is a matter of “quiet drunkenness”⁽⁵⁾.

The opium use triggers reveries, with the novel’s character recounting how he could spend “a summer night, sitting at a window where I had a view of the sea (...) and stay there from sunset to sunrise, motionless, as if petrified and without knowing that there are distinct objects from the vast and varied view we are contemplating”⁽⁵⁾.

Charles Baudelaire

Hashish produces, as Baudelaire reports in Du vin et du hashish, a “bizarre and irresistible hilarity”⁽⁶⁾. The euphoric mood is associated with the fact that even “the most vulgar words or the simplest ideas acquire a bizarre and new physiognomy”⁽⁶⁾. It is a “calm and immovable bliss” where “all contradictions have become unity”, so that “man has become God”⁽⁶⁾.

The acceleration of thinking is noticed by the poet: “Sometimes, people who are not related to the spiritual words improvise endless tirades of puns, associations of improbable ideas”⁽⁶⁾. But this acceleration is transient because there follows a phase in which “the threads that connect the concepts are so vague that only accomplices, co-religionists, are able to understand it”⁽⁶⁾. In this second phase, a “generalized stupefaction in the whole being” sets in⁽⁶⁾. At the same time, the mood changes, and suspiciousness appears, while in the background, the senses are sharpened: “the eyes perceive the infinite” and “the ears perceive the most imperceptible sounds in the midst of the sharpest noises”⁽⁶⁾. Monstrous hallucinations appear, and the objects suffer different deformations and transformations until merging with the subject’s being: “You are sitting and smoking, you think you are sitting in your pipe, and you are what the pipe smokes; you are exhaled in the form of bluish vapors”⁽⁶⁾. Synesthesias are also described by Baudelaire: “sounds acquire a color” and “colors have a music”⁽⁶⁾. The altered perception of space and time is thus described by the poet: “The proportions of time and being are disturbed by the countless multitude and the intensity of sensations and ideas” so that “we live human lives in the space of an hour”⁽⁶⁾. The loss of will induced by hashish is captured by Baudelaire in this sentence: “I dare you to sharpen a pencil or cut a flake; it will be work beyond your strength”⁽⁶⁾.

Théophile Gautier

Another writer who lived the experience of opium and hashish was Théophile Gautier (1811-1872). He describes in La pipe d’opium the manifestations of his trance in the domain of visual perception: “A net of fire and torrents of magnetic emanations wrapped and swirled around me, rising totally inexplicably and always closing; sparkling threads reached every pore and implanted in my skin like hairs”⁽⁷⁾. He also writes about other visual manifestations: “I saw small white flakes crossing the blue space of the ceiling like small balls of wool carried by the wind”⁽⁷⁾. The auditory hallucinations were reported, also: “low and rough voices that whispered in my ear with a foreign accent: «They are spirits!»”⁽⁷⁾.

The imagination, augmented by the opium consumption, leads the writer to unknown places and times. The French poet and dramatist describes this drug-induced ASC as a “complete somnambulism”⁽⁷⁾.

In Le Hachisch, Th. Gautier related another personal experience of altered states of consciousness, this time under the action of a drug from the cannabis family. The visual hallucinations reported here are stronger: “I saw my friends around me as disfigured, half-human, half-plant” or “in the form of ibises or ostriches”⁽⁸⁾. In the second stage of intoxication, the visual hallucinations multiply, being described as follows: “a bright confused environment, in which floated billions of butterflies whose wings beat like fans; huge flowers with crystal calyxes, golden and silver lilies ascended and unfolded in around me”⁽⁸⁾. Synaesthesias appear: “I could hear the noise of colors (...), green, red, blue, yellow sounds”⁽⁸⁾. The sharpening of the senses (hyperesthesia) makes the author notice how “a fallen glass, a crack of the armchair, a whispered word vibrated in me like thunder; my own voice seemed so strong that I did not dare to speak for fear that the walls will collapse or that I will explode like a bomb”⁽⁸⁾. The perception of time undergoes important changes – thus, in 15 minutes, the writer acknowledges that he has experienced events that could have happened in 300 years. Depersonalization is presented further: “I was so absent from myself, so deprived of the Self, this odious witness that accompanies me everywhere, that I understood for the first time what the existence of elemental spirits, angels and disembodied souls can be”⁽⁸⁾.

The emotional exaltation is felt by the writer: “Never before had such bliss overtaken me”; “every minute waves of joy crossed me, entering and exiting through my pores”⁽⁸⁾. After a break, the hashish intoxication enters a new phase, with grotesque hallucinations: “All pantagruelian chimeras pass before my eyes”⁽⁸⁾. The writer tries to draw these visions and makes a series of sketches that he considers “the most extravagant in the world”⁽⁸⁾. One of these is called “a locomotive of the future” – “a living locomotive, with a swan’s neck and finished with a snake’s mouth from which clouds of smoke come out”⁽⁸⁾. One can observe, in addition to the elements resulting from the distorted processing of reality, the exacerbation of imagination, which combines and recombines images at an accelerated pace and without logical continuity.

Aldous Huxley

In The Doors of Perception⁽⁹⁾, A. Huxley recounts his psychedelic trip after taking 0.4 g of mescaline orally. This approach was motivated by the author’s idea that, in this way, “I could change my ordinary state of consciousness, and I would be able to find out, from the inside, what the visionaries, the mediums, the mystics know”⁽⁹⁾. Huxley shows the importance of individual factors in modeling the ecstatic experience, such as the capacity for representation, temperament, habits, and level of training.

Visual perception is modified due to mescaline ingestion, and surfaces change their contours; objects come to life and move rhythmically. Spatial relations are no longer important, the emphasis being on understanding: “The mind was primarily concerned not with distances and locations, but with existence and meaning”⁽⁹⁾. The writer lives this experience by valuing Istigkeit, the “meaning of being”, according to Meister Eckhart’s terminology⁽⁹⁾.

“Recall capacity and «logical thinking» are little or not at all reduced”, a phenomenon observed by individuals who have used this type of drug; the will and interest in the external world gradually decrease, the attention being entirely focused on inner experiences: “contemplation is incompatible with action and even with the desire to act”⁽⁹⁾. Depersonalization makes Huxley say that “I was non-I, perceiving and being the non-I of the surrounding things”; “I was not the same with the legs and hands that were «outside», but I could move easily”⁽⁹⁾.

The mood is euphoric, with laughter and tears being caused by minor stimuli.

However, the experience led Huxley to disappointment, as he stated that he saw no archetypes and no revelations. He only succeeded in seeing things with his eyes closed and in observing his inner universe. As for literary creation, in Huxley’s opinion, “the untalented visionary can perceive an inner reality no less beautiful, wonderful and full of meaning than that world of Blake; but the common man lacks the ability to express, in literary or plastic symbols, what he has seen”⁽⁹⁾.

Edgar Allan Poe

The famous American writer was an occasional user of opium – a controversial opinion in literary criticism – and several of his characters have the typical manifestations of an opiate user^(10,11). Thus, in the short story A Tale of the Ragged Mountains⁽¹⁰⁾, the character Augustus Bedloe is a morphine addict. His features are thus described by Poe: “He had an unusually strong and creative imagination, of course, enhanced even more by the morphine he was currently consuming, in large doses”⁽¹⁰⁾. The effects of morphine to accelerate thinking and imagination processes are highlighted. After taking a dose of morphine, the character describes how it, “having its usual effect, awakened my interest in the whole surrounding world (...)”⁽¹⁰⁾. Against this background of increased interest and perceptive acuity, very clear visual hallucinations appear, which makes the subject believe that he is living real experiences (“a dusky-visaged and half-naked man rushed past... with a shriek” and “an Eastern-looking city, such as we read of in the Arabian tales”), but also olfactory and auditive hallucinations (odors, murmurs)⁽¹⁰⁾.

In Ligeia, the main character describes himself as being “bound in long chains of opium”, and his actions and commands “had taken on the color of dream hallucinations”⁽¹²⁾. Decreased will, apathy, the feeling of derealization, visual hallucinations (“cloudy visions, steaming with opium, flew in front of me like shadows”), the exaltation of the imagination at the expense of logical thinking, the impression of stopping instead of time, all these are found in Poe’s portrait of his character⁽¹²⁾.

Carlos Castaneda

The well-known anthropologist and writer, who was considered one of the founders of the New Age current, followed – according to his own story, but the fact is highly controversial – a long ritual of initiation into the mysticism of Yaqui shamans from Mexico. The drugs used during the ritualistic use were Datura stramonium, Lophophira williamsii, and Psilocybe mexicana, all of which contain hallucinogenic substances⁽¹³⁾.  However, his critics state that Castaneda’s books are purely fictional because the facts described in his work do not correspond to the anthropological realities^(13,14). Castaneda proposes the term “unusual reality” instead of altered states of consciousness⁽¹⁵⁾. Here, in the author’s description, is how the mescaline trance manifests itself: “Instantly, I felt an icy cold in my mouth and nose. I took another smoke, and the cold also spread to my chest. When I took the last smoke, I felt that my whole body was numbed by a peculiar sensation of cold heat”⁽¹⁵⁾.

In addition to these phenomena, the author reports feeling “some difficulty in articulating words” and the impossibility of moving⁽¹⁵⁾. The one who guides Castaneda through the labyrinth of hallucinations is Juan Matus, an Indian shaman whose main role is to keep his disciple in touch with objective reality and not to let him fall prey to the inner world. The goal of this initiating journey is to gain control over hallucinations, the latter being conceptualized as “gateways” to a transcendent world. One of the steps the disciple must take is “knowing the guardian of the other world”; this appears to him as a “gigantic, monstrous animal (…). I thought it must have been nearly thirty meters tall. It seemed to be standing upright, but I could not make out how it was standing. Then I noticed that it had wings, two large and wide wings (...). His body was covered with tufts of black hair. He had a long muzzle and rattled. His eyes were bulbous and round like two enormous balls”⁽¹⁵⁾. Such terrifying zoomorphic hallucinations make the author “scream with all his might”⁽¹⁵⁾. This is where the action of Don Juan’s “guide” (shaman) becomes important, as he explains the meaning of what Castaneda presumably saw and urges him to remain lucid.

Omar Khayyam

The “quatrains” of the Sufi poet, scholar and philosopher Omar Khayyam are proof of how the ecstatic experiences induced by psychoactive substances (in this case, alcohol) have been integrated into the Oriental literary creation. Alcohol becomes a means of achieving knowledge, of reaching the state of coincidentia oppositorum, in which all the contradictions of existence are overcome⁽¹⁶⁾. Wine also has the role of freeing the poet from the “prison of wisdom” by offering him another type of knowledge based on intuition and affectivity (a type of “Dionysian knowledge”)⁽¹⁶⁾.

Under the action of alcohol, life is lived more intensely, and euphoria takes over the poet: “Drink wine! In it you will find Life – without death./You will regain your lost youth,/The divine time of the rose and the heart clean!”^(17,18).

In the state of drunkenness, man is freed from constraints: “I fall from the heavy chains of an imprisoned slave/And in a golden nimbus – I am reborn free”^(17,18).

Discussion

Psychoactive substances represent one of the easiest, although the most dangerous, means of achieving altered states of consciousness, as it does not require a special voluntary effort and prolonged training (as in hypnosis or meditation), does not resort to complicated equipment (as in biofeedback), nor necessitates the presence of specialized personnel. From the individual who takes refuge in psychoactive substances in the hope of avoiding conflicts, escaping from daily difficulties, or improving his/her socio-professional performance up to the art creator or writer for whom the drug is a working tool, passing through the therapeutic perspective of the PAS use, one can observe the extreme complexity of the motivations that fuel the tendency towards reaching ASC. To illustrate further this complexity, Aldous Huxley, in his book on hallucinogens The Doors of Perception (initially published in 1954), encourages artists and intellectuals to increase their creativity by using pharmacological agents (especially psychedelics), while Theophile Gautier, in Le Haschish (published in 1843), warns the individuals tempted to use psychoactive substances about the difficulty to comprehend an altered states of consciousness – “to tell in its entirety a hallucination given by hashish should be a thick volume”^(8,9).

This recourse to psychoactive substances in the context of literary creation is unsurprising since the universe that opens before the creator is full of new, surprising elements, allowing original associations due to the acceleration of cognitive processes (imagination, thinking, etc.). However, the difficulty in communicating the experiences lived during ASCs is significant even for writers and artists accustomed to introspection, and such experiences may rapidly become uncontrollable, associating risks of harming themselves and others. In this context, it should be mentioned the high rate of negative consequences for creators who have been attracted to PAS use, including death by overdose or by somatic diseases induced by these substances. For example, the famous case of Truman Capote, who died prematurely, at 59 years old, due to the complications of prolonged, heavy use of alcohol, combined with abuse of cocaine, sedatives, marijuana, and other substances⁽¹⁹⁾. Also, in the same line of arguments, there are included the death of the famous American playwright and screenwriter Tennessee Williams (Thomas Lanier Williams III), which was related to the ingestion of barbiturates after a long history of alcohol dependence, and the premature death of Jack Kerouac (Jean-Louis Lebris de Kérouac) at 47 years old, related to complications of liver cirrhosis induced by long-term excessive alcohol use^(20,21). According to a very interesting cross-sectional study conducted by Just et al. (2016), celebrities (writers included) are at risk for drug-related premature death, and out of the 220 celebrities identified between 1970 and 2015 as having died from drug ingestion, most of them succumbed due to psychoactive substances use between the ages of 25 and 40 (mean age: 38.6 years old)⁽²²⁾.

The cultural background, the life experience reflected by the memories, the motivation of the act, and many other factors, personal, biological, and social, influence the experiences of the drug user. Thus, it is not expected that a poet who consumes, for example, LSD will relate to the psychedelic experience in the same way as a mental health specialist, the former wanting to let himself be “caught” in the vortex of imagination in order to capitalize on his/her visions in a literary work, the latter trying to study the phenomenon of consciousness destructuring as objectively as possible. The differences between the related experiences are, therefore, related to both objective factors (e.g., the ability to create vivid imagery or recount the perceived stimuli) and subjective factors (e.g., the desire to embellish the reality of the PAS use experience). Also, significant differences in motivations can be observed when comparing clinical populations with self-experiments in the literary and scientific world, but the focus of this review was on the phenomenology of altered states of consciousness, not on the origins of psychoactive substances (ab)‌use. At a phenomenological level, clinicians need to understand the experiences of their patients, as these experiences may explain various behavioral, mood, volition, perception, and thinking alterations detected during the psychiatric examination that may persist even outside the PAS-induced ASC.

Most psychoactive substances produce disturbances at the perceptual level (from commonplace alcohol to the complex arsenal of synthetic drugs) and induce quantitative and qualitative changes in perception, consciousness, thinking, imagination, memory, and attention, as well as changes in will and mood. Depersonalization and derealization are phenomena that contribute to the feeling of unreality for individuals presenting SUDs, feelings of simultaneous existence in another universe, subject-object indistinction, etc. Consciousness, which has the main role of integrating psychic functions, is severely disturbed during most of the PAS use. Similarities have been observed between psychotic states and those produced by drugs such as amphetamines (in high doses) or psychedelics; psychotic states can be induced by drug consumption in the so-called “toxic psychoses” or “substance-induced psychotic disorders”⁽²³⁾.

Theoretical models were developed to integrate psychedelic experiences in an explanatory context of ASC (such as the paradigm constructed by transpersonal analysis). A creativity-focused analysis can explore the phenomenon of the destructuring of consciousness from the perspective of changing cognitive processes under the action of drugs, as well as from the perspective of probing the unconscious under these circumstances.

Regarding the limitations of the current article, some biases in the reviewed sources must be emphasized, such as the accusations brought against Castaneda regarding the voluntary distortion of the accounts of his experiences with mescaline for the purpose of proselytizing^(13,14). However, these disputes cannot doubt the fact that, under the action of a psychedelic, consciousness is profoundly modified, but they show that content produced during altered states of consciousness can be further processed intentionally if there is a clearly formulated objective. Another limitation is related to the restricted number of reviewed reports, but this is not a systematic review; therefore, it can be further developed into more structured research, with the inclusion of all the relevant data in the literature. Also, except for some self-experiments in the scientific world and clinical studies, where appropriate measures of recording the experiences in real-time and with objective spectators, there is no way to determine if the phenomenological reports were not altered due to amnesia, confabulations, and altered thinking processes or attentional focus lived by the PAS consumers.

Regarding further developments in this field, in the era of new and promising therapies for different psychiatric disorders based on the psychoactive substances, like psilocybin, (es)ketamine, or cannabinoids, the understanding of how these substances may impact the central nervous system functioning, consciousness included, is of extreme importance^(24-26). In this context, it is profoundly erroneous to assimilate medical products with the drugs of abuse because the first category of substances has been explored in preclinical and clinical studies, especially for decreasing the risk of adverse events, ASC included. However, the risk of abusing medical products by altering the daily dose, the way of administration, or the indication for their use is always possible, as the history of PAS has already shown. Still, in order to avoid stigmatization of patients who are undergoing treatment with such drugs for medical purposes, the difference between psychoactive substances used for recreational purposes and those conditioned as pharmacological products should be clearly formulated⁽²⁷⁾. The phenomenon of novel psychoactive substances (NPS) as a means to reach ASC, mentioned in the first section of this review, is an emerging phenomenon that still needs to be assessed thoroughly because of the temptation to abuse such drugs, ignoring their potentially lethal consequences^(28-33).

Conclusions

While self-experimenting with psychoactive substances to achieve altered states of consciousness has a long tradition in the literary and scientific world, the risks of abusing such substances in the clinical population, but also in the general population, remain fearsome. Although significant literary creations were reportedly due to the enhanced creativity by the PAS use, and scientific experiments enlarged our current perspective on the psychological effects of these substances, fostering the development of new treatments, the use of such substances has taken its toll on the health and lives of famous writers who used psychoactive substances as a tool to improve their imagination, not to mention the increasing prevalence of such addictions in the general population, with all their associated complications. Also, care should be taken when self-experiment reports are analyzed because of the risk of voluntary or involuntary falsification of such data. This is the main reason why a triple perspective (artistic, scientific, and clinical) on the altered states of consciousness was chosen to present the results of such experiences, thus allowing the reader to confront different phenomenological reports when roughly the same psychoactive substances were used.

Autori pentru corespondenţă: Octavian Vasiliu E-mail: octavvasiliu@yahoo.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.