Psychedelic Adverse Effects, Spiritual Experience, and the Science We Still Need: A Conversation with Roman Palitsky, PhD

We talk a lot in this field about what psychedelics can do for people. We talk less about what happens when things don't go the way we hoped.

That's exactly what made my recent conversation with Roman Palitsky, PhD so valuable, and so necessary.

Roman is assistant professor of psychiatry and behavioral sciences at Emory University, director of research projects in spiritual health, and faculty in the Emory Center for Psychedelics and Spirituality. His work is focused on making psychedelic therapies rigorous, effective, and accountable — including to the people who experience harm.

What Drew Him to This Work

Roman describes himself as someone who fell into psychedelic research sideways.

He came to Emory to work in spiritual health research — a discipline spanning chaplaincy, behavioral science, and the earnest study of how spirituality shapes health outcomes. When psychiatry and spiritual health both recognized the relevance of psychedelics at the same moment, the Emory Center for Psychedelics and Spirituality was born, and Roman was right there at its founding.

What keeps him here, he says, is two things: a deep fascination with the mind as the faculty through which we experience everything, and a commitment to going where the need is greatest. Right now, one of those places is adverse effects.

The Dialectic We Need to Move Past

There is an unfortunate split in this field.

On one side: the belief that there is no such thing as a bad trip — that everything difficult is just grist for the mill, that whatever comes up is exactly what's supposed to happen.

On the other: the assumption that anything unpleasant is automatically a harm.

Neither is true, and both cause problems.

Roman put it simply: benefits and harms co-occur. A person can have a profound, life-changing psychedelic experience and also suffer real adverse effects. These are not mutually exclusive. And as clinicians, we need to be honest about that — not to frighten people away, but because the people sitting across from us deserve candor.

If someone is coming in for treatment — not because they're invested in a psychedelic movement, but because they are suffering and hoping for relief — they deserve to know the full range of what's possible.

The Research Gap

Here is a number that stopped me when Roman shared it.

In the current psychedelic renaissance, less than 25% of studies that administer psychedelics to humans include any systematic assessment of adverse effects.

Less than 25%.

This is not just a scientific problem. It is an ethical one. And it is part of what got MDMA research into trouble — the criticism that adverse effects weren't being tracked seriously enough.

Roman and his team at Emory have developed a method for systematically assessing the adverse effects that clinical trials most often miss. This includes relational harms — because wherever there is a human relationship, there is the possibility of a breach of trust. It also includes the full range of cultural, transpersonal, spiritual, and behavioral effects that have simply not been on the map.

Spiritual Adverse Effects Are Real

One of the most important things Roman is tracking is what he calls psychospiritual adverse effects.

Consider a deeply religious person who enters a psychedelic experience hoping to encounter the divine — and encounters nothing. That is a moment of crisis.

Or consider someone who returns from an experience with expansive new ideas about the nature of reality, only to find those ideas create a rift with their faith community. Nobody was watching for that. And yet it happens.

These are not fringe cases. They are predictable outcomes of a potent intervention operating on the very registers where people hold their deepest meaning — and we need to be prepared for them.

The Study: Your Story Matters

Roman is currently recruiting for a study I think is one of the most important in the field right now.

It's an enriched study — meaning every participant is someone who has already experienced an adverse effect from a psychedelic. Someone who took a psychedelic and experienced impairment or distress after the acute effects wore off.

They're aiming for 800 participants. The data collection is rich and detailed: symptoms, contributing factors, how people understood and interpreted their experience, what they tried, and what helped. They're tracking participants for a full year.

The goal is to understand which situations are most concerning, which symptoms tend to persist, and what actually helps people heal.

The headline for this study is simple: your story matters.

Because one of the quieter harms of the current psychedelic exuberance is that people who have difficult experiences often feel like they are the only ones. They crawl off to the side while everyone else is talking about breakthroughs. They feel shame. They feel like they failed. And sometimes they encounter a kind of victim blaming — you must not have prepared right, you must have shadow work you haven't dealt with, you should do more.

That is not okay. Naming it, studying it, and building real support around it is exactly the right response.

What Clinicians Can Do Now

Roman's guidance for clinicians working with people who have had adverse effects was clear and grounded.

First: validate the person's experience. Don't skip the sense-making. Don't map their narrative onto a framework that works for you.

Second: resist the urge to rush toward meaning.

There is often pressure — especially in psychedelic spaces — to quickly find the gift in a difficult experience. And the meaning may well come. But for someone in distress, pushing toward meaning before the foundation is stable is not always helpful. Get the house in order first. Is this person sleeping? Are they functional? Are they safe? The meaning-making can follow.

I would add: suspend the need to know. That is something I tell my own clients regularly. You do not have to understand it yet. If we trust in any kind of inner healing intelligence, then we trust that understanding will come — when the system is ready to hold it.

On Spirituality as a Clinical Variable

One of the things I love most about the Emory Center's work is the insistence that spirituality is not a soft add-on to clinical care.

It is a health variable. It is a multicultural factor. And it cannot be ignored in psychedelic work, because psychedelics are, among other things, profoundly spiritual interventions — whether or not that is the intention.

Roman used a phrase I haven't been able to stop thinking about: we may be producing a generation of accidental mystics. Someone comes in for depression treatment. They have an encounter with something they would describe as divine. Nobody prepared them for that. Nobody is following up on what that means for their life, their relationships, their faith. That is a gap — and it is exactly the kind of gap that rigorous, spiritually informed research can begin to close.

If You've Had a Difficult Experience

If you or someone you know has experienced adverse effects from a psychedelic, Roman's team wants to hear from you.

The study is paid. The data is being used to build something that doesn't yet exist: an evidence base for treating psychedelic-related adverse effects.

Find them at psychedelicchallenges.org, or reach Roman directly at roman.palitsky@emory.edu. You can also explore the Emory Center for Psychedelics and Spirituality's broader work at their website.

Your story matters. Please share it.

Thank you so much for reading and listening. This work is done in community, and I am so grateful for your support.

With care,
Dr. Sandy Newes