Background:

The October 7th, 2023, attack at the Nova rave represents an unprecedented scenario in trauma research: A mass casualty event in which most participants were under the influence of psychedelics.

Methods:

Using a mixed-methods phenomenological design, 45 survivors were interviewed. Participants were categorized by substance use: classic psychedelics (n = 24), empathogens (n = 19), and ketamine (n = 2). Data were analyzed within a critical realist framework across three temporal domains: immediate survival, in-event emotional coping, and post-event integration.

Results:

Findings point toward a dissociative phenomenon we name “adaptive psychedelic dissociation,” characterized by a combination of traumatic and psychedelic dissociative features: emotional detachment, derealization and depersonalization, automatic behaviors, and preserved functionality. Participants’ awareness and knowledge about their substance use created an “epistemic container,” which may have facilitated real-time containment of traumatic input while complicating later meaning-making. A neurophenomenological pattern emerged wherein psychedelic subjective effects appeared suppressed during the acute trauma exposure, resurging after the threat was over. Quantitative analysis showed a predominantly positive subjective impact of substance use on immediate survival (75%–79%) and emotional coping (83%–84%) but mixed outcomes in aftermath processing (42%–53% positive and 25%–26% negative).

Conclusions:

Psychedelic-induced dissociation during trauma exposure may confer acute adaptive benefits while causing integration challenges a paradox with significant implications on trauma research. This singular perspective on the psychedelic–trauma interface invites further research into these complex neuropsychological interactions. Psychedelics may serve as epistemological instruments, revealing cognitive processes and unique prisms through which trauma response, psychopathology, resilience, and the adaptive capacities of the human mind under extreme conditions can be re-examined.