Critical response
On the review aggregator website Rotten Tomatoes, 87% of 52 critics' reviews are positive, with an average rating of 6.9/10. The website's consensus reads: "Extraordinarily daring for a Hollywood film, Altered States attacks the viewer with its inventive, aggressive mix of muddled sound effects and visual pyrotechnics." Metacritic, which uses a weighted average, assigned the film a score of 58 out of 100, based on 13 critics, indicating "mixed or average" reviews.
The initial reviews were generally strong. "It's been a while since I've gotten the acclaim I've gotten on Altered States," said Russell.
Janet Maslin of The New York Times termed the film a "methodically paced fireworks display, exploding into delirious special-effects sequences at regular intervals, and maintaining an eerie calm the rest of the time. If it is not wholly visionary at every juncture, it is at least dependably—even exhilaratingly—bizarre. Its strangeness, which borders cheerfully on the ridiculous, is its most enjoyable feature." She also called it "in fine shape as long as it revels in its own craziness, making no claims on the viewer's reason. But when it asks you to believe that what you're watching may really be happening, and to wonder what it means, it is asking far too much. By the time it begins straining for an ending both happy and hysterical, it has lost all of its mystery, and most of its magic."
Richard Corliss began his review of the film:
This one has everything: sex, violence, comedy, thrills, tenderness. It's an anthology and apotheosis of American pop movies: Frankenstein, Murders in the Rue Morgue, The Nutty Professor, 2001, Alien, Love Story. It opens at fever pitch and then starts soaring—into genetic fantasy, into a precognitive dream of delirium and delight. Madness is its subject and substance, style and spirit. The film changes tone, even form, with its hero's every new mood and mutation. It expands and contracts with his mind until both almost crack. It keeps threatening to go bonkers, then makes good on its threat, and still remains as lucid as an aerialist on a high wire. It moves with the loping energy of a crafty psychopath, or of film makers gripped with the potential of blowing the moviegoer's mind out through his eyes and ears. Ladies and gentlemen, welcome to Altered States.
Corliss calls the film a "dazzling piece of science fiction"; he recognizes the film's dialogue as clearly Chayefsky's, with characters that are "endlessly reflective and articulate, spitting out litanies of adjectives, geysers of abstract nouns, chemical chains of relative clauses", dialogue that's a "welcome antidote to all those recent...movies in which brutal characters speak only words of one syllable and four letters." But the film is ultimately Russell's, who inherited a "cast of unknowns" chosen by its original director and "gets an erotic, neurotic charge from the talking-heads scenes that recall Penn at his best."
Pauline Kael, on the other hand, wrote that the "grotesquely inspired" combination of "Russell, with his show-biz-Catholic glitz mysticism, and Chayefsky, with his show-biz-Jewish ponderousness" results in an "aggressively silly picture" that "isn't really enjoyable."
John C. Lilly liked the film, and noted the following in an Omni magazine interview published in January 1983:
The scene in which the scientist becomes cosmic energy and his wife grabs him and brings him back to human form is straight out of my Dyadic Cyclone (1976) ... As for the scientist's regression into an ape-like being, the late Dr. Craig Enright, who started me on K (ketamine) while taking a trip with me here by the isolation tank, suddenly "became" a chimp, jumping up and down and hollering for twenty-five minutes. Watching him, I was frightened. I asked him later, "Where the hell were you?" He said, "I became a pre-hominid, and I was in a tree. A leopard was trying to get me. So I was trying to scare him away." The manuscript of The Scientist (1978) was in the hands of Bantam, the publishers. The head of Bantam called and said, "Paddy Chayefsky would like to read your manuscript. Will you give him your permission?" I said, "Only if he calls me and asks permission." He didn't call. But he probably read the manuscript.
Christopher John reviewed Altered States in Ares Magazine #6 and commented that "Simply put, Altered States is very good at what it proposes to do – luckily it proposed to do very little."
In Ready for My Close-Up!: Great Movie Speeches (2007), screenwriter Denny Martin Flinn called Chayefsky's screenplay "brilliant" and selected Emily's speech as "Chayefsky's last great take on life and love."
In 2023, Christian Zilko of IndieWire included the film in a list of "the 20 best body horror movies", and wrote that, "The film's psychedelic scenes are visual marvels in and of themselves, and a strong early career performance by William Hurt (in his first film role) ensures that Altered States is still highly watchable four decades after its release".
According to TV Guide, Basil Dearden's 1963 film The Mind Benders "is the direct predecessor of Altered States."
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