Do hallucinations automatically indicate a schizophrenia diagnosis?

In his live Table Talk session at the Sana Symposium, Rick Doblin, PhD, Founder and Executive Director, Multidisciplinary Association for Psychedelic Studies (MAPS), answers the question of whether or not hallucinations automatically indicate a schizophrenia diagnosis.

Read the transcript:

Dr Doblin: A patient assigned to me at an outpatient clinic, used Ecstasy, street bought, at age 17. Since, he has developed auditory hallucinations, command, though he knows the difference between the auditory voices.

My question is, would you use the diagnosis schizophrenia or what, assuming the Ecstasy resulted in the ongoing symptoms? I appreciate any feedback you offer on this tough diagnosis.

What I would do is I would give him another MDMA therapy session because what I think probably happened is he took street Ecstasy, who knows what was in it, and I think that these auditory hallucinations are probably this idea that he didn't fully process whatever came up.

We've worked with people that have had difficult LSD experiences 35 or 40 years before that under the influence of MDMA, they can work through those difficult LSD experiences.

They're imprinted. They're not gone. They're in your mind. They're in your psyche.

I don't think I would use the diagnosis schizophrenia for this person but, again, whether it was Ecstasy is, a lot of times, not pure MDMA. We don't really know what it was.

My thought would be is if it was under MDMA, let's assume it was MDMA, and in the context where he wasn't fully able to process things, my first response would be let's bring him back into that state in a supportive setting where he can revisit whatever those emotions were from that site, hopefully work through them, and not have these auditory hallucinations and the paranoia, the fear.

A lot of it can be done as he did it at age 17. You're scared about getting arrested, scared about your parents finding out. There's a lot of this fear baked into the exact situation that he used it in.

In the future, when people have panic reactions and they end up at emergency rooms, ideally, we give them MDMA, if they were there for panic to LSD or psilocybin. MDMA is not a tranquilizer in the normal sense of it. It cuts the fear so people can process it. You want people to work through it.