“The Trip Treatment” by Michael Pollin. The New Yorker, 2/9/2015.
As the end of life approaches, many are gripped with a tangible fear of the unknown and of the physical suffering that may precede the transition. Some with strong religious beliefs expect a shift into a continuing existence that they can easily imagine as very similar to the life they know, only better, reuniting with loved ones, streets of gold, heavenly choirs, and all of that. Those with a more philosophical bent accept death as another example of the impermanence of all things and is nothing to fear. Both are often a form of whistling in the dark, hiding an underlying terror. But there may be help to ease this difficult time.
Two familiar psychedelics of the 1960s, LSD and psilocybin (the active ingredient in psychedelic mushrooms) are being seriously studied for the treatment of terminal cancer patients to relieve their “end-of-life anxiety and existential distress.” For many patients, the results are an outstanding success. And needed. A diagnosis of terminal cancer understandably devastates the patient, and their distress devastates their family and friends. An entire group of people are affected by such a diagnosis.
The initial flood of research on psychedelics was shut down in 1970 in a classic over-reaction when President Nixon signed the Controlled Substance Act and put most of the psychedelics on Schedule 1 that prohibits their use for any purpose. The early studies were largely forgotten, and no other ones were proposed. New pharmacy students today know little about psychedelics, but lately the government is gingerly allowing a small number of scientists to resume work on them.
Most of the new studies are being done on psilocybin whose psychological effects are shorter and not as intense as LSD. Some researchers feel the term “psychedelic” has too many negative connotations and prefer “entheogen” (generating the divine within).
Stephen Ross, who co-directs a current trial on psilocybin at NYU’s medical school, says “I thought the first 10 or 20 people . . . must be faking it. People who had been palpably scared of death, they lost their fear. The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.” Like an actual religious or mystical experience, only one episode made a permanent change in attitude.
Anthony Bossis, Ross’s co-director, adds, “People don’t realize how few tools we have in psychiatry to address existential distress. Xanax is not the answer. So how can we not explore this if it can recalibrate how we die?”
In 1962, a double-blind study was done with psilocybin on 20 divinity students. Eight of the ten receiving the psilocybin had experiences that were indistinguishable from the classic mystical experiences. In 1991, a researcher was able to track down seven of those receiving psilocybin. They all reported the experience shaped their lives and work in profound and enduring ways. That the effects remained so long suggested they resulted from the experience itself rather than a change in brain chemistry, as with Prozac.
However, the researcher learned several subjects struggled with anxiety during the study. One had to be restrained when he thought he had been chosen to announce that the Messiah had arrived.
Psychedelic research today is tightly regulated and closely scrutinized. A license must first be obtained from the Drug Enforcement Administration to use a Schedule 1 substance. Nevertheless, a recent study concluded psilocybin induced mystical experiences similar to naturally-occurring ones. Participants ranked these experiences as among the most meaningful in their lives, comparable to the birth of a child or the death of a parent. One third ranked the experience as the top-most significant one of their lives. Two-thirds ranked it in the top five. With proper guidance during the experience (a designated driver is required) no significant adverse effects were found in over 500 subjects.
Several volunteers used the metaphor of a camera being pulled back on their lives, to a point where matters that had once seemed daunting now appeared manageable—smoking, cancer, even death. . . . Many also described an encounter with their cancer that had the effect of diminishing its power over them. The narratives they reconstruct [were] seamless and fully accessible even years later. They don’t regard these narratives as “just a dream” . . . but rather as genuine and sturdy experiences . . . with the durability of objective truth.
The quick and easy use of chemicals to achieve spiritual insight seems like cheating, but we have no qualms about taking an aspirin to relieve a physical pain. Almost everyone would agree mystical peace and understanding should come naturally from lengthy prayer and meditation, but near the end of life is too late for many to begin such an approach to a fundamental change in attitude.
Hmm . . . I think I do have a bucket list after all, with just one item.