Today I want to write about something I have never addressed publicly, but that I believe needs to be talked about: what happens when someone living with psychosis, or vulnerable to it, drinks Ayahuasca?
I want to be clear from the start that I am not writing from a medical or clinical perspective, but from an experiential one. Over the years I have accompanied people with all kinds of symptoms and behaviors that I did not always know how to understand. Most of us who work with plant medicine are in that position. We are not trained clinicians, and that is exactly why I think this conversation matters.
The stories below are real, but I have changed or left out every detail that could identify the people involved. My intention is educational: to help you recognize some signs, respond calmly, and understand why careful screening is part of responsible work with this medicine.
We tend to assume that someone experiencing psychosis is dangerous, "out of this world," or about to do something unpredictable. The reality is quite different. People living with these conditions are among us every day, and depending on where they fall on the spectrum, many hide it very well. Some do not even know they have it. Research consistently shows that they are far more likely to be victims of violence than to commit it.
The first thing to understand is that you cannot diagnose someone from the symptoms you observe. That takes a professional who can run the medical tests needed to reach an accurate answer. What I can offer is a way to recognize that something may be going on, enough to encourage someone toward medical attention and to protect yourself if you ever encounter someone in acute distress.
Psychosis can look like hallucinations, delusions, deep distrust of others, a belief of being watched, or a conviction of having special messages or a special mission. It is also worth knowing that psychotic symptoms do not always come from schizophrenia. They can appear after heavy substance use, after a major trauma, or from an unrelated medical condition. Many people hold spiritual beliefs about synchronicity or past lives and are completely well, so no single belief is a sign on its own.
Several years ago, a volunteer came to stay with us. He was gentle and kind, but visibly tense, and spent much of his time on his own. Something in my intuition told me he was not ready for ceremony, so we agreed he would not take part in any until we knew each other better. Looking back, I am grateful I trusted that feeling.
One evening, about a week after he arrived, he suddenly began experiencing intense hallucinations. I want to be completely clear that he had never taken Ayahuasca or any other psychedelic, with us or before that night. What happened came entirely from his own condition. He was terrified, and so was I. I tried to stay calm and simply follow what he was experiencing without contradicting it. In his reality, everything had become chaotic, and he was frightened of me. I kept telling him that everything was okay. He eventually asked for the comfort of a member of our team, shared a prayer with her, and slowly calmed down. I stayed up watching over him for the rest of the night.
I understand now what I should have done: call emergency services. I treated that night as if it were a ceremony, and it was not. It was an acute mental health crisis that needed medical care. If you ever find yourself in a similar situation, do not wait it out. Call an ambulance, and if there is any risk of violence, involve the authorities. In Costa Rica, the emergency number is 911.
The next morning we gave him breakfast, explained calmly that we could not safely host him, and informed his emergency contact. We took him to a safe hotel and paid for a few nights ourselves so he could rest and feel better. I believe that day we did the right thing by not allowing him to take part in a ceremony. If someone in that state is given Ayahuasca, it does not end well.
That experience was deeply unsettling for me, and it pushed me to learn everything I could. I took courses, sought out psychoeducation, and exchanged insights with psychologists who visited or volunteered with us. Our intake process changed completely. We now ask direct questions about personal and family history, medications, and any past hospitalizations, and I am honest with every applicant about what this medicine can and cannot do.
A few years later, a young participant arrived for a ceremony with a companion. He was articulate, polite, and well put together, a pleasant person to talk with about the plants and the land. I mention this because appearance tells you very little. People in the middle of a mental health struggle can look entirely composed, and it is easy to miss what is underneath.
What I did not know was that he had been hearing voices for some time and had never mentioned it. He came to us hoping to heal, and I think, deep down, hoping Ayahuasca might quiet them. That is an understandable hope.
His first dose did nothing at all. This can happen when psychosis is already present, since the plant sometimes has trouble getting through, and the right response is to stop there. At the time, I did not know that. So I gave him a second dose.
About ten minutes later he stood up and began shouting, over and over, that he was a religious figure from the Bible. It was the loudest, most startling moment I have experienced in ceremony, and it shook my composure. He was unsteady on his feet, so I guided him to the floor for safety and stayed beside him. He could not hear us or respond. For close to two hours I stayed with him while my team supported the rest of the group, and I focused on one thing only: keeping him safe.
Slowly he began to respond to his name for a few seconds at a time, then for longer. We did not return to the ceremony space. I stayed with him outside, close enough that he could see me but not crowding him. When he was ready to talk, he looked at me and said what he had never told anyone there.
"I hear voices in my head. One of them is kind and encouraging. Another one I am still trying to understand. And one of them is ugly and cruel." He told me he lived with them every day.
In that moment I made a mistake I regret: I told him, in a challenging and rather rude way, that he should have warned me. Today I understand that nobody in that position is trying to hurt anyone. He was struggling, and the right response was compassion. We spent the rest of the night resting, and he left the next morning. Some time later he told me he had started working with a mental health professional, and as far as I know it helped.
This was, by a wide margin, the most challenging journey I have ever facilitated, and I share it as the clearest answer I can give to the question in the title. For someone living with psychosis, an Ayahuasca journey can be violent, disorganized, and frightening, and it is simply not what they need. It is also worth saying that this was not a "spiritual attack" or a failure of the medicine. When the medicine is prepared with care, it does not hurt people. What happened came from the person's condition, not from the plant.
Someone wise once told me that no matter how much I prepare and try to avoid situations like these, they might still happen. I live with that every day. I keep preparing, I keep learning, and I trust that when the moment comes I will do the right thing and not be so challenged again.
There is a specific term for what makes psychosis so hard to work with: anosognosia, the inability to recognize that something is wrong with you. Many people with schizophrenia have this to some degree, and for some of them awareness only comes with treatment, if it comes at all. Without that insight, a person cannot take part in their own recovery, and everything becomes something done to them rather than with them. This is also why asking someone to disclose their own history is not always enough, and why screening needs more than a form.
It is understandable that someone in that position would be drawn to Ayahuasca. It connects you to your inner world, and it can feel like the answer to a condition that lives there. But the experience can include visions, strong emotions, and moments of seeing meaning in everything, which overlap with features of psychosis. For someone who is vulnerable, this can destabilize rather than heal. That is why it is widely considered unsafe for people with a history of psychotic disorders, and why I consider it irresponsible to give it to anyone with a diagnosis of schizophrenia.
There is another reason, and it has to do with the way Ayahuasca is often seen. It is surrounded by a certain mystique, associated with shamans, miracles, and an imaginative, almost mythical world. For a person living with psychotic thinking, that archetypal and magical side can be deeply appealing, because it seems to match their own internal struggle. Ayahuasca also tends to become whatever you bring to it. That is why I always approach the experience as a deep cleansing and a tool for exploring your own inner terrain, never as a magic answer, and why I make a point of saying that I do not do anything magical or mystical. The medicine only shows you what is already inside. I cannot change or heal anything out of the blue.
It also happens that someone with no outward signs, completely coherent and happy, turns out to be carrying something undiagnosed. None of us working in this field are mental health professionals, so telling the difference is genuinely hard. Even after all these years, I have had to gently pause someone's process and explain they are not ready, with a full refund, rather than risk a situation that could harm them. It has cost me a few thousand dollars over the years, and it is worth every cent.
This is also why I am careful about promises. Be thoughtful with anyone who claims to know something about you without ever having talked to you, or who suggests there is something dark attached to you. A belief planted before a ceremony can become the lens the medicine works through, turning a journey into an amplification of someone else's story. A good ceremony begins with careful questions, honest listening, and clear limits about what the medicine can offer.
If you are ever in a ceremony and see someone reacting unusually strongly, unable to stay still or quiet, shouting, or clearly disconnected from the room, that is often a sign that something deeper than an ordinary hard journey is happening. Stay calm. Do not argue with what the person believes. Keep a safe distance, make sure no one is at risk, and bring in the facilitators. If it looks like a crisis rather than a difficult experience, call emergency services, and do not treat it as part of the ceremony.
I hope writing this brings a little more understanding to a subject that many people avoid or misjudge. Mental health systems around the world are under real strain, and psychosis tends to erode the relationships people need most. Friends drift away, family pulls back, and many end up with only one person in their corner. A little more understanding can make a real difference, in a ceremony space and anywhere else.
You never know when the person across from you, a driver, a colleague, a friend, a family member, might be carrying something like this quietly, sometimes without even knowing it themselves. The more you understand what it can look like, the safer you become, and the more compassion you can offer instead of fear. People living with schizophrenia can and do build full lives, as parents, professionals, and people their communities rely on. The goal was never to make you afraid. It was to help you recognize it, sit with it more calmly, and know what to do if you ever find yourself where I once was.
This post shares personal experience and is not medical advice. If you or someone near you is in crisis, please contact local emergency services or a mental health professional.
Thank you for reading. This is the first in a series I will be writing on what happens when specific conditions meet Ayahuasca. Stay with me.
Thank you for the incredible support this blog keeps receiving. If you would like to keep reading, one of our most visited posts is Do You Know What Kind of Ayahuasca You're Drinking? The Truth Behind the Brew.