Schizophrenia from the Inside

“Osmond thought the most important thing a psychiatrist could do was take mescaline. Not to get high, to understand what their patients were experiencing.”

Humphry Osmond's first insight about psychedelics was clinical and it was simple: they gave him access to what his schizophrenic patients were experiencing.

At Weyburn Mental Hospital in Saskatchewan in the early 1950s, Osmond was working with patients whose subjective experience was, by definition, inaccessible to him. They reported visions, heard voices, experienced the texture of reality differently from how he experienced it. He could observe the behavioral consequences; he could adjust the medications; he could not know what it was actually like to be where they were. The gap between clinician and patient was experiential. No amount of training or empathy could bridge it without some access to the territory.

Mescaline provided that access. Not perfectly, not identically, the comparison between mescaline intoxication and schizophrenia is inexact in ways that subsequent research has documented at length. But sufficiently: what Osmond experienced under mescaline was enough to make him understand what his patients meant when they said the world had become strange and terrible and significant in ways that ordinary language couldn't carry.

He began having his clinical staff take mescaline and LSD for the same reason. This was standard practice at Weyburn before it became controversial everywhere else. The idea was not that clinicians needed the experience to function, but that they needed it to understand, to reduce the experiential gap between the person who administered the treatment and the person who needed it.

Huxley formalized this insight in Doors, writing that the mescaline experience provided a 'gratuitous grace' of understanding that was 'of inestimable value to everyone and especially to the intellectual.' But the origin of the insight was clinical, not philosophical. It came from Osmond watching his patients and realizing that the thing they most needed, to be understood rather than merely managed, required him to go somewhere he'd never been.

The contemporary movement to have clinical researchers undergo psychedelic sessions as part of their training is this same insight, sixty years later. Johns Hopkins and NYU now include guided psilocybin sessions in their clinical psychedelic research programs. The rationale: knowing the territory is part of professional formation. Osmond understood this in 1951.

Sources

• Osmond, H. A Review of the Clinical Effects of Psychotomimetic Agents, Ann. NY Acad. Sci. (1957)
• Huxley, The Doors of Perception (1954)
• Vollenweider & Preller, Nat Rev Neurosci (2020)