There are moments when the boundaries of ordinary reality begin to blur—experiences that shake our sense of stability, open a doorway to another dimension of existence, and at times profoundly transform our perception of ourselves and the world. Such experiences may arise following a psychological crisis, trauma, deep meditation, a significant journey, spiritual practice, or the use of psychedelic substances. For some people, these experiences are understood as moments of revelation—a deeply challenging yet meaningful inner journey that gives rise to insight and personal growth. For others, the same experiences may be perceived as a frightening collapse of the self and of reality itself. What shapes the way such an experience is understood? What tips the balance towards healing and growth, and what leads instead to prolonged suffering and confusion? Throughout this article, I refer to these phenomena as threshold experiences or transformative experiences, reflecting the way they cross ordinary psychological boundaries and have the potential to bring about profound personal change. My central argument is that it is not only the experience itself that matters, but, more importantly, the context in which it occurs-the psychological, social, and cultural environment that contains it, interprets it, and helps give it meaning.
Set and Setting as Architects of Experience
During the 1960s, Timothy Leary and Ralph Metzner introduced the concepts of set and setting, which have since become foundational in understanding psychedelic experiences. I believe these concepts are equally relevant to understanding transformative experiences more broadly. Set refers to the individual’s internal characteristics: personality, emotional state, expectations, intentions, level of psychological preparation, and previous experience. Setting refers to the external context in which the experience unfolds: the physical environment, the social and cultural surroundings, the presence of guides or companions, and the broader framework within which the experience takes place. Together, these two variables play a crucial role in shaping both the course of the experience and its potential to become either healing or harmful (Leary et al., 1963, 1964; Metzner & Leary, 1967, as cited in Hartogsohn, 2017). Ordinarily, consciousness tends to operate in a relatively modular way, separating perception, thought, and emotion into distinct processes. Threshold experiences, however, are often characterised by an increased openness to novel ways of perceiving reality and constructing meaning. This openness may facilitate profound psychological insight and creative “outside-the-box” thinking, but it may also lead to disorganisation, confusion, fear, and overwhelming emotional distress (Rios de Dobkin, 1976; Beyer, 2010, as cited in Hartogsohn, 2017). For this reason, set and setting become particularly important during transformative experiences. More than in many other psychological interventions, they shape meaning,
influence the individual’s sense of safety, and determine the significance ultimately attributed to the experience (Horvath, 2018). A compelling illustration of the importance of cultural context comes from the work of anthropologist Anthony Wallace. While participants in early Western psychedelic research often reported anxiety, confusion, and dramatic fluctuations in mood, Indigenous groups such as the Huichol and Navajo, who used peyote within traditional ceremonial settings, commonly described emotional stability, a sense of communal connection, awe, and an enhanced feeling of belonging. The primary difference was not the substance itself, but the cultural framework through which the experience was understood, supported, and interpreted.
Context, Trauma, and Attachment
For many years, psychosis was understood primarily as the inevitable consequence of genetic vulnerability. Contemporary research, however, suggests that personal and social history play a far more significant role in shaping psychotic experiences than was once believed. One of the most consistent findings in the literature is the association between childhood trauma and psychosis. Meta-analyses indicate that individuals who experienced severe childhood trauma are approximately three times more likely to develop psychosis later in life. Among psychiatric inpatients, reported rates of childhood trauma have, in some studies, reached as high as 90%. In Israel, this relationship is further shaped by a unique historical and social context. Studies of military veterans have demonstrated a direct association between combat- related trauma accompanied by psychotic features and the intensity of combat exposure. Chronic exposure to threat appears to lower the threshold for psychotic experiences, while experiences of war often provide persecutory beliefs with specific themes that reflect the individual’s lived reality. Research has also found higher rates of psychotic disorders among Holocaust survivors compared with populations that were not exposed to such atrocities. Work by Rachel Yehuda and colleagues further suggests that trauma may be transmitted not only through family narratives but also through epigenetic mechanisms and patterns of attachment. Consequently, psychotic experiences among second- and third-generation descendants of Holocaust survivors may sometimes take on themes of persecution, annihilation, and betrayal, reflecting echoes of collective trauma. The relationship between trauma and psychosis extends beyond Israel. Studies of refugees fleeing armed conflicts, including those from Syria and Afghanistan, have consistently reported rates of psychosis several times higher than those observed in host populations. These findings are often understood in relation to the combined effects of severe trauma and social defeat-the chronic experience of exclusion, marginalisation, and loss of belonging. At the same time, our understanding of genetic vulnerability has become more nuanced. Earlier estimates frequently suggested that schizophrenia was approximately 80%
heritable. More recent genome-wide association studies (GWAS) and large-scale statistical analyses indicate that currently identified genetic variants account for a substantially smaller proportion of the observed variation. For certain dimensions of psychosis, including persecutory thinking, known genetic factors explain only a modest percentage of the variance. Among all identified psychosocial risk factors, the association between childhood trauma and psychosis remains one of the strongest and most consistently replicated findings in the literature (Varese et al., 2012).
Attachment and Psychosis
Attachment theory offers another important perspective for understanding psychosis. As described in theories of belonging and attachment (Baumeister & Leary), disruptions in early attachment relationships may contribute to the development of internal working models in which the world is dangerous and other people cannot be trusted. Research has consistently shown a substantial overlap between psychosis and insecure- particularly disorganised-attachment. Meta-analyses suggest that between 50% and 70% of people diagnosed with psychosis display insecure attachment patterns, with fearful- avoidant and disorganised attachment being especially common
Ancient Traditions and “Inner Territory”: Context as a Map for the Journey In cultures where altered states of consciousness formed an integral part of communal life, they were embedded within spiritual traditions and ritual practices. Such experiences were not regarded as ineffable or incomprehensible, as they are often portrayed in contemporary Western culture. Amazonian healers, Siberian shamans, yoga practitioners, Buddhist monks, and many Indigenous traditions developed remarkably detailed maps describing the inner landscapes, beings, transitions, and pathways encountered during these journeys. The Tibetan Book of the Dead, for example, provides a detailed guide to mandalas, forces, beings, and dimensions encountered during intermediate states-not only after death, but also during profound meditative practice. Similarly, Amazonian ayahuasca traditions developed sophisticated cosmologies describing encounters with spirits, mythical animals, and personified forces of nature experienced during psychedelic states (Schrei, 2021). Research by archaeologist David Lewis-Williams on prehistoric rock art and shamanic traditions across cultures suggests that although the specific content of visionary experiences is shaped by cultural context-an Amazonian healer may encounter jaguars, an Inuit practitioner may encounter polar bears and seals, while a medieval Christian nun may encounter angels and saints-the underlying experiential structure often remains strikingly similar. Recurring phenomena such as spirals, luminous points, energetic vortices, portals, and transitions between worlds appear across cultures. These findings suggest that while culture influences the symbolic content of an experience, its experiential “grammar” may be far more universal. Similar recurring themes have also been described
by Benny Shanon in his work on ayahuasca experiences throughout the Amazon Basin (Shanon, 2002)
The Risks of Losing Context: When Transformative Experiences Become Pathologised
In recent years, there has been growing public attention to people reporting profound psychological difficulties following psychedelic journeys, intensive meditation retreats, or other forms of spiritual practice. Similarly, many young travellers describe struggling to reintegrate into everyday life after deeply transformative journeys abroad. These individuals often report experiences that are both profound and difficult to contain: feelings of disconnection, confusion, the dissolution of familiar assumptions about themselves and the world, and intense existential anxiety that may lead to despair or depression (St Arnaud & Cormier, 2017). When someone undergoing a dramatic shift in consciousness seeks help and encounters only the language of pathology, the experience itself may become a source of additional trauma. Mental health systems that lack conceptual frameworks for understanding or supporting such experiences may interpret them solely in terms of chemical imbalance, loss of reality testing, or psychiatric illness. In doing so, they risk invalidating the person’s lived experience and the meaning they attribute to it. This form of pathologisation may deepen feelings of alienation, defectiveness, and loneliness at precisely the time when the individual most needs understanding and support. In some cases, it may also foster profound mistrust toward others, which itself can later be interpreted as paranoia. At the same time, it is equally important to acknowledge the other side of the picture. For individuals with a history of significant psychological difficulties or unresolved trauma, intense spiritual experiences-particularly those that occur without skilled guidance or a supportive cultural framework-may exacerbate existing symptoms and, in some cases, contribute to the emergence of psychotic or depressive episodes (Clarke & Tilda, 2023).
Meditation-Related Experiences
The Varieties of Contemplative Experience (VCE) research project reached remarkably similar conclusions in the context of meditation. Its findings suggest that when individuals undergo unusual, intense, or destabilising contemplative experiences, both their responses and the meanings they assign to those experiences depend to a large extent on the religious, cultural, and communal framework within which they occur (Lindahl et al., 2017; Lindahl et al., 2022). Drawing on extensive interviews with experienced Western meditation practitioners and teachers from Theravāda, Zen, and Tibetan Buddhist traditions, the VCE project documented dozens of different contemplative experiences. One of its central findings was that identical experiences could be interpreted-and consequently lived-in dramatically different ways depending on their context. Within Buddhist traditions, experiences such as seeing lights, hearing voices, or experiencing a temporary dissolution of the sense of self are sometimes understood as part of contemplative development and are met with guidance from experienced teachers.
By contrast, Western practitioners who undergo similar experiences outside a supportive spiritual framework often interpret them as signs of mental breakdown, hallucinations, or psychosis (Lindahl et al., 2020). Another important insight emerging from the VCE research concerns duration. Many contemplative traditions possess detailed maps describing stages of practice, including periods of difficulty, crisis, and breakthrough. Within these traditions, certain challenging experiences are expected to be temporary phases of development. Without such a framework, however, the same experiences may be interpreted as pathological, becoming a source of persistent fear that can prolong suffering rather than alleviate it. For this reason, a supportive context is not merely helpful—it may be essential in preventing unnecessary escalation of distress (Lindahl et al., 2021). 1
Creating New Frameworks of Meaning
People engaged in spiritual practice or the use of psychedelics often face the challenge of navigating multiple-and sometimes conflicting-cultural narratives in order to make sense of their experiences. They seek to understand these experiences both within a spiritual framework and within the realities of their everyday lives. When the original traditions from which these practices emerged are ignored, there is a risk of losing the broader context and meaning that once gave them coherence. For this reason, one of the central therapeutic tasks is the translation of experience: helping people develop a language, a context, and a framework through which difficult experiences can be understood. The goal is to allow a painful experience to become not merely a moment of breakdown, but an opportunity for learning and transformation. Validation and containment are therefore of particular importance, even when an experience appears strange or difficult to understand. Rather than dismissing it, we should seek to acknowledge it, listen carefully to it, and understand the meaning the individual attributes to it. Human experience exists along a continuum, and our capacity to enter unusual states of consciousness may lead either to creativity and spiritual growth or to suffering and psychological distress, depending largely on the context in which those experiences unfold and the resources available to the individual (Clarke, 2022).
Towards New Frameworks of Understanding
In recent years, increasing attention has been given to the importance of cultural humility and interpretive humility in mental health care. Across many areas of clinical practice, there is growing recognition that therapists should strive to understand individuals within the cultural frameworks that shape their experiences rather than assuming that a single explanatory model applies to everyone. A similar attitude is needed when working with spiritual, contemplative, psychedelic, or other transformative experiences that fall outside conventional psychiatric frameworks. In these situations, collaboration between mental health professionals, spiritual teachers, guides, and individuals with relevant lived experience may offer a richer and more 1 An interview between Dr. Willoughby Britton and His Holiness the Dalai Lama discussing findings from the Varieties of Contemplative Experience (VCE) project is available online: https://www.youtube.com/watch?v=etii18s9RKU
comprehensive understanding than any one perspective alone. Such collaboration requires mutual respect and recognition that each perspective may contribute important forms of knowledge. Understanding transformative experiences therefore requires a broad therapeutic perspective. Psychotherapists, psychologists, psychiatrists, family members, close communities, spiritual teachers, and peers may each play an important role in supporting someone experiencing a threshold experience or a period of profound confusion. Approaches such as Acceptance and Commitment Therapy (ACT), trauma-informed mindfulness, Open Dialogue, and Cognitive Behavioural Therapy for Psychosis (CBTp) increasingly acknowledge the importance of personal and cultural context, although even these approaches require continued humility, openness to alternative interpretations, and a willingness to learn collaboratively with those they seek to help. At the same time, it is important to avoid unnecessary pathologisation of spiritual experiences while also recognising the limits of spiritual interpretations. An integrative approach acknowledges that a transformative experience and a psychological crisis may occur simultaneously. Profound spiritual experiences may expose existing psychological vulnerabilities without necessarily causing them. Distinguishing between a transformative experience and a psychotic episode therefore requires careful assessment of the individual’s personal history, psychological vulnerabilities, current functioning, and-perhaps most importantly-the context within which the experience occurs.
Conclusion
The stories people tell about their experiences are not merely passive descriptions; they actively shape the experiences themselves and influence their long-term consequences. Whether an experience becomes a source of growth or of enduring suffering depends to a considerable extent on the psychological, social, and cultural context in which it unfolds. Traditional cultures recognised this reality and developed ritual, communal, and spiritual frameworks capable of supporting, interpreting, and integrating encounters with expanded states of consciousness. Contemporary Western society, by contrast, has often separated such experiences from their context, interpreting them primarily through the language of pathology and, in doing so, sometimes overlooking their potential meaning. Bridging this gap requires an integrative approach—one that recognises the complexity of transformative experience, respects its subjective richness, and develops supportive ways of accompanying, interpreting, and integrating these experiences without rushing to categorise, suppress, or dismiss them. Such an approach may restore to these experiences one of their oldest and most important functions: serving as a gateway to profound psychological transformation, deeper self-understanding, and renewed connection with both the world and other people
This article was originally published in Hebrew. Read the original publication.