Extreme states can be psychospiritual and “functional” in origin or they can be “organic” and driven by biological dysfunction. Contemporary psychiatry largely rejects this distinction, preferring to insist that everything “extreme” is biological in origin; but the distinction is important for understanding and helping people. Psychospiritual crises, including those labeled bipolar or schizophrenic, are “functional” and express meaning. As “bizarre” as the language or the symbols may seem, meanings that often reflect childhood abuse can be explored in a trusting, kind, and caring therapeutic relationship. The more that a real biological or organic dysfunction, such as traumatic head injury or neurotoxic exposure, is the root cause of the extreme state, the less sense its manifestations will make. Nonetheless, drug-induced extreme states, even when caused by hallucinogens or by psychiatric “medicines,” often leave sufficient brain function operational to reveal important meanings about the person’s experience, along with the otherwise senseless intoxication. With so many people prescribed psychiatric drugs, these neurotoxic chemicals are now the most common cause of extreme states in clinical practice, and withdrawal from these offending agents is critical to recovery (Breggin, 2013). However, even when the extreme state is driven by neurological dysfunction, a safe space and skilled therapists can help relieve the individual’s otherwise overwhelming feelings of anxiety or terror.