The phenomenology of the psychotic break and Huxley's trip: substance use and the onset of psychosis.

The relationship between substance use and psychosis is usually studied as a cause-and-effect question, but the subjective experiences of both are often overlooked. This paper compares the phenomenology of psychosis onset, based on Sass's four components (Unreality, Fragmentation, Mere Being, Apophany), with the experience of hallucinogenic intoxication as described by Huxley. The analysis finds significant parallels, including a breakdown of the sign-referent relationship and disconnection from the practical world. However, in psychosis this breakdown feels like alienation from self and world, while in hallucinogenic states it is experienced as mystical union and revelation. The authors suggest a shared factor—psychotic-like experience—and propose further research on other drugs like cannabis.

Study at a glance

Abstract

While considerable research attention has been devoted to the causal relationship between substance use and psychosis, the phenomenology of the association between the two has largely been ignored. This is a significant shortcoming, because it blinds researchers to the possibility that there may be elements of the subjective experience of substance use and psychosis that contribute to their apparent relationship in empirical studies. The current paper examines the phenomenology of the onset of psychosis and the phenomenology of substance intoxication through consideration of two texts: Sass's account of the phenomenology of psychosis onset and Huxley's account of the experience of hallucinogenic intoxication. Sass's account of psychosis onset includes four components: Unreality, Fragmentation, Mere Being, and Apophany. The analysis reveals significant parallels - and also some differences - between this account and the phenomenology of substance intoxication. We discuss the implications of this for the causal relationship between psychosis and substance use and suggest several ways of understanding the overlapping phenomenologies. This includes the suggestion of a shared factor, perhaps best described as psychotic-like experience, which seems to involve a breakdown of the sign-referent relationship and relationship with the common-sense, practical world. However, in the onset of psychosis, this breakdown is primarily experienced as a sense of alienation from self and world, whereas in the hallucinogenic state a sense of mystical union and revelation seems predominant. Further research may extend this analysis by looking at experiences with other drugs, particularly cannabis, and by examining the phenomenology of psychotic disorder beyond the first episode.