In M.B. Bowers. (1974). Retreat from sanity: The structure of emerging psychosis. Baltimore: Penguin.

In the following account we are presented with an example of an acute psychotic reaction associated with psychedelic drugs, used during a period of personal experimentation and attempted innovation. As Nancy describes it, "I had spent the whole summer testing out life styles." The conflict which was evoked by this testing led to an acute psychotic reaction in which guilt was apparently the initial driving emotion. The drug-precipitated psychotic reaction is an extreme important phenomenon for the understanding of psychotic states. It has long been recognized that certain pharmacologic substances, most notably cannabis, mescaline, amphetamine derivatives, lysergic acid diethylamine (LSD),and other indolalkylamines can produce an acute alteration of consciousness which bears a similarity some forms of acute psychosis. In recent years clinicians have recognized another related phenomenon, namely instances in which the drug-induced alteration of consciousness persists and trails off into a psychotic state which is virtually indistinguishable from a psychotic reaction unrelated to drug use. We call this phenomenon a drug-precipitated psychosis. As yet we are unable to specify the unique constellation of ingredients that lead to such an outcome. Experience suggests, however, that certain individuals, by taking one of these drugs at particular times of developmental crisis, may evoke such a flood of unmanageable personal concerns that defensive structures are seriously breached for an extended period of time.

Nancy was a 20-year-old student in her second year at college. She was basically rather easy-going, but was particularly impressed by her father whom she described as a "man of principle." She felt implicitly his continual striving for achievement, as typified by his being awarded a Ph.D. just prior to her trip "out west to see what I could learn form others." There followed a series of attempt to live in the midst of a musical group she had met, but the behavior required of her in that context primarily with regard to sexual experimentation and drug use evoked an unmanageable degree of guilt and self-doubt. The psychosis which resulted was later described by Nancy during her recovery in the following terse phrases:

I had spent the whole summer testing out life styles. I got involved with the student strike and was going to do street theater. There seemed to be too much polarization and I just wanted to talk to people. So I decided to take a trip out west to see what I could learn from others. I left after my father's graduation; he finally got his Ph.D. in June. I have always respected him for his intellect. When I got back from the trip I decided to go to Carolina to visit some kids who had a band there. That's when I met this fellow Ray. I was fascinated by the life the lived-lots of drugs and sex. I felt this was the opening of sex for me. However, this Ray turned out to be a real bum and sexually deviant. Still until I went to Carolina I had not had a boyfriend for three years. It was very intense. He told me he only had three jars of peanut butter and 66 capsules of mescaline. You have to understand that this was a complete change in life style for me, a new world completely. Some parts were beautiful. I felt I had to give up everything for sex. It was the only thing I could offer and I felt trapped. I took several capsules of mescaline over the two week period and began to see significance in things. They mentioned a dog and I thought I had become dog sexually. Maybe, I thought, they were trying to teach me not to be up tight about sex. I began to have the notion that I would have a sex change operation. Maybe I was a guy trapped in a woman's body. My mind was running like crazy. Finally a friend agreed to drive me back home and during the trip things got much worse. Everything meant something more than it really was. I had the idea that was supposed to approach my friend sexually. I felt I was trying very hard to understand the time in Carolina. When I finally got home my parents took me to a psychiatrist. I had a terrible fear of him. The whole waiting room of his office seemed to be filled with "props" to test me. I thought I was adopted, maybe sterile or suffering from mental retardation. I thought that the doctor would find something wrong with my body. A lady in the waiting room was giggling, and I thought that was a homosexual attempt. I saw a double rainbow and that made me believe there was hope. Noises were especially loud. My parents said I never slept. Anything I had ever had as a problem my mind dug up. Particularly problems with my father and with church. I thought I was going to have to choose between family and friends. I had written earlier to the minister asking that my church membership be dropped when I was 21 years old. My father really blew up after the minister told him. When I was sick at home, then, I had this idea that I had to marry my father in the Episcopal church. I thought the clock in the room was a camera and was taking pictures of my father and me as we sat on the sofa. I thought that I would be shot but would be born again. All the books I had ever read in my life seemed to come back to me. We went to see the family doctor who said I had just freaked out on drugs, but I had the idea something was seriously wrong with me. I thought I might have a terminal disease, be sterile or pregnant. When I told my mother I believed in God, I meant that I could take the bad news. So much was hitting my head at once. Every book I had read, every movie I had seen got involved. I remembered Rosemary's Baby and thought my father was the devil and would have intercourse with me. I though an atomic bomb had been dropped and that there were people scratching on the window asking to be helped. This was one of the most vivid ideas I had. After my parents sat with me for nearly 3 days straight, they dressed me. I was seeing yellow halos around their heads. I thought I could tell my friends from my enemies by noticing whose arm was hot and whose was cold. I thought the police might want information about my friends and drugs from me. I often had a very strong urge to laugh. My body was supersensitive. I thought my bed would separate and that I would be torn in half, that the top half of me belonged to the devil and I would pay for what I had done. I believed I had to eat my sister and put her in my stomach. I had read these creation myths in the past so I had these bits of knowledge. They seemed to return distorted and related to myself. I thought of another fellow I knew named Buck, thought his name meant "kick," that I had a drug habit. In bed an image of a movie I'd once seen came to me -- a coke bottle tapping out a teletype message which signified the end of the world. I thought my head must be attached to a computer. I thought my brain was being damaged and that I could feel cracks in it. On my way to a hospital I noticed that everything behind me was being burned or destroyed. Again the idea of the atom bomb having been dropped came to me. thought I would die and be reborn. In the hospital I thought one of the nurses was the devil. That meant I was split in quarters -- half of me was a devil and half a woman. I could snap my finger and hear a lady repeat "It's all right, dear, we are all here to help you." A black technician drew my blood, then stood in the window and spread her arms. I thought she had crucified herself, and I began to think about the political things I had been involved with such as getting more black children into school during the student strike. When I returned home I thought my parents wanted to hear about my sex life. I must have felt very guilty, for it upset my father greatly when I told him. At home I "felt" noises in my body. A loud sound would register inside of me like a short shock. Also was afraid to move for fear that something terrible would happen. I thought there was something registering my movements. I had an idea that I had to save the neighborhood. Sometimes I felt only capable of destruction, other times I thought I could save.