Variability in Outcomes and Subjective Effects of Classic and Non-classic Psychedelic Use in Psychotic Populations: Case-Based Evidence from Naturalistic Settings

This paper presents qualitative data reported by individuals with histories of psychotic symptoms and experiences who engaged in naturalistic psychedelic use compiled as a case series. Through detailed first-person narratives, we explore how both classic and non-classic psychedelic experiences were subjectively experienced and integrated by individuals in this population, which is usually excluded from psychedelic research. Selected cases illustrate potential benefits—including individual growth, insight, increased spirituality, and symptom reappraisal—as well as challenging experiences and adverse effects, particularly when the set and setting are unfavorable. These findings contribute to the ongoing debate over the categorical exclusion of people with psychotic conditions and symptoms from psychedelic treatment and research and call for more holistic, ethically guided inquiry into the benefits and risks of psychedelic-assisted therapy (PAT) for this underserved, stigmatized, and pathologized subpopulation.