What It's Like to Treat Your OCD With Psychedelics
“Anything that anyone mentioned that offered some sort of hope, I tried."
Adam Strauss was trying to choose a shirt to wear—not a project that had ever before given him any trouble. He was in his twenties and his girlfriend had moved out a few weeks earlier, so maybe he was just feeling extra self-conscious about his appearance. Somehow, though, the anxious pursuit of the perfect shirt had become consuming. This one, with its wide collar, he thought, put too much of his chest on display. The next fit well but wasn't his color; he looked jaundiced. If he didn't choose, he was going to be late.
One more try, he told himself, then it was time to go. This one looked good—maybe too good. He needed to get out of his head, collect some real-world data. What if he wore his two favorite shirts, compared the number of spontaneous compliments he received on each, then bought ten identical copies of the winner? That'd be the perfect way to choose, right?
In his off-Broadway one-man show, The Mushroom Cure, playing now in New York City and opening soon in Berkeley, California, Strauss recounts how this almost-everyday moment of indecision later flowered into paralyzing obsessive-compulsive disorder. Over the course of years, he talked to specialists, went to therapy, tweaked his medication. He went to a 12-step meeting for people with OCD. He tried alternative treatments: yoga (two years), meditation (five years), acupuncture, hypnotherapy, homeopathy.
“Anything that anyone mentioned that I found online that offered some sort of hope, I tried. Because it was out of control,” Strauss says. The shirt trick, for example, worked until with washing and wearing the ten identical copies started to become unique. Then his mind returned to the ceaseless litany of considerations he had to navigate to make the perfect choice. And choices were everywhere, from picking a shirt to deciding which bagel to order for breakfast to finding the best side of the street to walk down. He ended up zigzagging, trying to balance sunshine on one side with trees on the other. “It was debilitating,” he says. “It was difficult to function really in any domain of my life.”
One day, deep in the results of a Google search for “OCD cures,” he stumbled upon a small proof-of concept study published in 2006. Nine people who'd previously failed to respond to more conventional treatments for OCD received psilocybin, the active ingredient in magic mushrooms, in a controlled hospital environment. The researchers wanted to test anecdotal reports that psilocybin had benefited OCD patients. One man, for example, used shrooms for years, developing a tolerance that kept him from getting high, but it still quelled his OCD. The study bore out those stories, finding that most participants saw their symptoms temporarily reduced.
“I read this study in absolute desperation,” Strauss says. “I had very little experience with psychedelics, but my attitude was sort of, 'Well, I really don't have anything to lose at this point.'” That's the jumping off point for The Mushroom Cure. It's not a spoiler to tell you that Strauss's informal self-experimentation worked—it's right there in the title, after all. But it wasn't as simple as just scarfing a handful of mushrooms and becoming a different person. First, there were the practical considerations.
At the time, Strauss says, it was hard to get shrooms in New York City. In a bit of coincidence, Strauss had recently met a woman who’d inadvertently used psychedelics to help treat her depression. Instead of shrooms, though, she’d used readily available cacti—the kind you can sometimes even find at Home Depot—that contained not psilocybin but a potent psychedelic called mescaline.
The most famous mescaline-containing cactus is peyote, which is used in legally protected Native American religious rituals; outside of those practices, peyote is a Schedule I drug. Other cacti, though, also contain mescaline. So Strauss’s first psychedelic experience was with a cactus. Or it would have been, but he was also taking Lexapro, a prescription drug used for treating anxiety and depression. It’s a selective serotonin reuptake inhibitor (SSRI), meaning it helps maintain higher levels of serotonin in the brain. That elevates mood, but SSRIs can dampen the effects of psychedelics for some people. That’s exactly what happened with Strauss—the magic cactus didn’t work.
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But he didn’t give up; in fact, he went off his SSRI to pursue his experiment. “The idea was that psychedelics could cure my OCD,” Strauss says. The hypothesis was based on anecdotes and a single, small study of one psychedelic, but he was committed to it. He went off his prescription medication to try the cactus; he experimented with research chemicals delivered from China. He spaced out his trips, but admits it was a pretty ad-hoc approach. “Basically I did it in not a very intelligent way,” he says. “I was really driven by desperation. I was doing a lot of different drugs. It wasn't a very well-controlled experiment to say the least.”
Nonetheless, the drugs kept showing him glimpses of a different person he could become. Often he got short-term relief from his OCD symptoms, so he kept trying: new settings, new doses, new drugs. He also happened to be working at a time when psychedelics were undergoing a renaissance in medicine, so he drew on research showing they have potential to treat depression, anxiety, and post-traumatic stress disorder. He still hadn't had shrooms, but that seemed less important. “The key thing, it seemed to me,” he says, “wasn't mushrooms, but the psychedelic experience.” (When he finally did get shrooms—a particularly potent strain called the penis envy mushroom—he wound up calling 911 for help answering his most burning existential questions.)
What the psychedelic experience offered him was a new, deeper understanding of something he'd only grasped intellectually before: acceptance. Growing up, he'd received mental health diagnoses that included depression and generalized anxiety disorder; he took medication and went to therapy. Later, a therapist treating his OCD told him that he'd have to accept the anxiety produced by his intrusive thoughts. Every decision, Strauss explains, would make him anxious, but committing to an action made it go away. The relief, though, was only temporary—the anxiety would soon build, demanding he reverse his original choice. “Of course,” he says, “life is constant decision-making, so I'd get paralyzed.”
The cycle of anxious decision-making could only be broken if he, as his therapist had advised, stopped trying to avoid feeling anxious. He had to accept that feeling, uncomfortable as it was. And that proved very difficult. “I understood this intellectually,” he says, “but acceptance is a fascinating thing. It's not really an intellectual thing. I think of it as more of a visceral thing. Or a spiritual practice.”
Psychedelics helped him grasp acceptance as more than a concept. “It was only while using psychedelics that I had the actual visceral experience of acceptance,” he says. His obsessive thoughts would arrive as usual, but he didn't feel beholden to them. They were separate from him, placed at a remove. He could just let them be there. “I found that when I did that,” he says, “they didn't necessarily go away, but they didn't have the same power over me.” Recent research has shed light on what users of psychedelics intuited long ago: Tripping can profoundly affect the way we see ourselves, by producing an “ego-dissolution” that lets us step outside the models we use to navigate everyday reality. It can produce a detachment from all the thoughts and fears we call the “self.”
It took a long time, but with practice, Strauss was able to feel that same detachment when he wasn't tripping. Therapy exposed him to the concept of acceptance, psychedelics brought him to a visceral understanding of it, and with diligent effort he made it work for him. He's not “cured,” he says, but he's had a pretty remarkable recovery, thanks to his idiosyncratic, self-directed course of psychedelic therapy.
The drugs weren't a panacea as much as a tool. Studies of psychedelic-assisted therapy begin from a similar premise, and they’ve shown that ecstasy could improve therapy by making people more open. In early studies, it’s been used alongside therapy to treat PTSD and eating disorders. At least one adventurous DIYer has combined MDMA with couples therapy.
“I don't think it would have happened without psychedelics,” Strauss says, “but I also don't think psychedelics would have been sufficient in and of themselves.” Even Timothy Leary eventually realized you can't just give people potent, mind-expanding drugs and assume they'll come out better on the other side. They need a supportive, respectful environment.
Recent research supports this view, with studies showing how psychedelics in conjunction with therapy can provide real benefits for patients with depression, anxiety, and post-traumatic stress disorder, among others. Based on his own experience, Strauss would like to see more of that kind of study, and laments that it's so expensive to do that work. (MAPS, the Multidisciplinary Association for Psychedelic Studies, which funded the original study that sent Strauss on his odyssey, is also sponsoring his show.)
Beyond encouraging more research, though, Strauss says that what he most wants to convey to audiences is the sense of wonder he still has about his journey through psychedelics. Paralyzed with OCD, he took a desperate—if relatively informed—gamble and experimented on himself, along the way confronting some of his deepest and most persistent fears. And basically, it worked. “The story itself,” he says, “is pretty amazing.”
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