I've had great experiences with LSD, experiences that may have even changed my trajectory in life.
That being said I would never recommend LSD to someone undergoing serious mental health issues. IMO not safe at all, you can really end up in a bad place.
A clinic, concert, or house party are all terrible settings for taking LSD. They are confined, crowded spaces. You want something wide open, in nature. Try the mountains, or the desert.
Well, just don't get lost. I've taken LSD hundreds of times and the worst was undoubtedly in nature (it was my fault, but I'm sure I'm not the first to make this mistake). I've done it plenty of times at house parties and it's been fine. My objection to a "clinical setting" is being alone with someone you don't know that well, and like you said, being confined and expected / forced to stay with that person.
> A clinic, concert, or house party are all terrible settings for taking LSD.
That's certainly the main reason for "bad trips". People just don't bother to read up on everything properly before the trip. So they do stupid things. And then it's the substance's fault.
My definition of clinical setting certainly includes nature, though I don't think that's required. The important part is professionals that first screen people (weed out people deemed to be high risk for bad episodes) and guides the process. A captain to steer the boat if you will.
I'm not talking about a sterile windowless room with bright lights and various people walking in and out telling you to do things. More like a therapy setup, similar to how they're experimenting with MDMA. Someone who knows what they are doing guiding things, helping you explore your mind.
LSD is probably not the best drug for this simply because it lasts for so long, but guided trips using psilocybin are definitely doable (and currently happen).
"I'm not talking about a sterile windowless room with bright lights and various people walking in and out telling you to do things. More like a therapy setup, similar to how they're experimenting with MDMA. Someone who knows what they are doing guiding things, helping you explore your mind."
Indeed. I highly recommend reading "The Secret Chief Revealed"[1], about Leo Zeff, a pioneering psychedelic therapist. His "clinic" was not a hospital with whitewashed walls, but more like a cozy apartment (it might have even been his apartment.. I don't have the book on hand myself right now). Here's an excerpt from the book that I wrote down. It doesn't talk about the setting much, but reveals some of his approach:
"Zeff did not like to refer to psychedelics as "drugs" rather "medicine". It could be used properly or improperly, just as morphine or antibiotics. Working as a Jungian therapist Zeff believed he was there to basically assist his clients in finding their own solutions, more of less waiting it out. With LSD the solutions came much quicker, often with a single trip. In therapeutic use of LSD Zeff had his clients agree to a basic set of rules: 1. they would not leave the house or place where the trip was taking place without his permission, 2. they agreed that there would be no physical harm or violence to them, him or anyplace they were, 3. reiterate the security agreement - they must agree that they will never reveal to anybody else where and with whom they had the experience without his prior approval, 4. there would be no sex during the experience, 5. the client had to agree to follow Zeffs directions no matter what, the client had to agree to follow his commands without question and have faith in him. Prior to taking the medicine they would then read a prayer aloud. The clients were asked to bring in photographs of family and important people and places in their lives as well as personal articles which would stimulate a therapeutic conversation which would take place prior to the effects of the medicine. Once the medicine took effect the client would lie down, put a cover over their eyes and headphones on so that they could listen to music.
"Music was played the entire time during the experience. Zeff believed this to be very important. This is one area in which I wish the conversation/text had delved deeper. The music which was considered so important is barely discussed other than to say that it was always on. It is mentioned that the music would very based upon the clients tastes, the impression I get is that classical or jazz were the main genres."
Here is the beginning of a much more recent account of psychedelic therapy (I encourage reading the full article[2], as it is excellent), the methodology of which is clearly influenced either by Zeff or other early psychedelic therapy pioneers:
"When Mettes arrived at the treatment room, at First Avenue and Twenty-fifth Street, Tony Bossis and Krystallia Kalliontzi, his guides, greeted him, reviewed the day’s
plan, and, at 9 A.M., presented him with a small chalice containing the pill. None of them knew whether it contained psilocybin or the placebo. Asked to state his
intention, Mettes said that he wanted to learn to cope better with the anxiety and the fear that he felt about his cancer. As the researchers had suggested, he’d brought a
few photographs along--of Lisa and him on their wedding day, and of their dog, Arlo--and placed them around the room.
"At nine-thirty, Mettes lay down on the couch, put on the headphones and eye mask, and fell silent."
I read another article recently (posted on here I think) saying that most of the clinical protocols are borrowed from the rituals and advice of underground new age healer types. These people likely have the most experience in avoiding a bad time.
Doubtful, most clinical practices are very unaware of how their setups affect the results. They understand “set and setting” intellectually, but not viscerally. So they act surprised when patients dosed DMT in a hospital experience contact with bizarre alien entities that coincidentally resemble hospital workers. (See nick sand’s critque of strassman’s DMT study as one example)
Check our Michael Pollen's new book, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, if you're interested in getting a stronger historical context of the use of these drugs in all sorts of settings.
Psychedelics show promise for some mental health conditions (like depression and addiction), but no one would advocate giving a bunch of LSD to someone teetering on the edge of schizophrenia... It's about focusing on the right diseases that are safe to treat with these drugs. Plus, trials would be done under controlled conditions by professionals. That seems the safest possible environment for having a psychedelic experience.
I have to disagree with you here. Psychedelics help people - the idea that they should only be taken by individuals who are in a 'good' place is missing so much of the point IMO. I began experimenting with psychedelics during the darkest period of my life and it was absolutely the right decision. Yes, there are things that can go wrong - even to a 'healthy' mind. To those out there in all-encompassing pain and darkness - don't think that a trip will necessarily amplify your current mental state - I argue that psychs are a ladder to help you climb out of whatever hole has you trapped. FWIW I believe marijuana has a higher risk of throwing someone into nasty thought loops than psychedelics.
I would actually advise against anyone undergoing moderate mental health issues to avoid LSD, psilocybin and especially DMT (in fact, DMT should only be tackled by people with considerable experience with psychedelics and ONLY when it a good mental space, even then it can easily be a terrible and jarring experience).
Instead I'd probably nudge them towards MDMA perhaps under proper medical treatment until they can work through their issues and actually get to the underlying problem (if it is in fact something that therapy can work through and not some chemical imbalance that needs treated by chemical means).
On top of the clinical supervision mentioned in the other comment, therapeutic dosage is probably much lower than the ones used to go on a trip (same is true for many other hypothetically abusable medication that is already being prescribed for a whole range of mental illnesses).
I've been reading Michael Pollan's new book on this (How to Change Your Mind - really good read, incidentally) and according to him it's actually the opposite in some of the clinical trials he looked at. In the book he describes clinical settings that involve relatively large doses of psychedelics, primarily psilocybin but also DMT and LSD, because the goal is to induce "ego death" and/or a profound or mystical experience. This tends to correlate with the type of dosage where you are basically not inhabiting your familiar reality/not aware of your body for several hours at a time.
To put that in perspective, I've probably taken psychedelics around a dozen times and only truly achieved something I would call "ego death" once (a truly fascinating and moving experience, but that's for another time!). And a lot of the people I know would take fairly low doses and do things like go to parties or walk around Central Park. By comparison, the clinical amounts Pollan is describing make it virtually impossible to move around or talk in a coherent way, let alone go out into the world.
I am guessing that by "out into the world" you mean primarily into a human-made / urban / artificial built environment with other people in it, as opposed to out into the natural world (i.e. wilderness), which I think many would argue could be the most ideal setting for the types of experiences that you're discussing.
That being said I would never recommend LSD to someone undergoing serious mental health issues. IMO not safe at all, you can really end up in a bad place.