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Why do psychedelics reduce anxiety in the terminally ill?

st-francis-measuredTwo new studies just published in the Journal of Psychopharmacology showed that a single dose of psilocybin (the psychedelic drug found in magic mushrooms) significantly reduces anxiety and depression in people with terminal cancer. You can read them for free here.

The first trial, by a team at NYU medical school led by Stephen Ross, found ‘immediate, substantial and sustained clinical benefits of reduction of anxiety and depression’ in participants who took a single dose of psilocybin, versus a control group. Many cancer patients suffer from depression, anxiety and existential distress. The NYU study found that, after the treatment, 80% were in remission for depression at 6.5 month follow-up, and 75% were also in remission for anxiety.

This is unprecedented for a pharmacological intervention. It’s twice as effective in reducing depression and anxiety as anti-depressants and, unlike them, only has to be taken once. The study notes:

This pharmacological finding is novel in psychiatry in terms of a single dose of a medication leading to immediate anti-depressant and anxiolytic effects with enduring (e.g. weeks to months) clinical benefits.

The second study, by a team at Johns Hopkins medical school led by Roland Griffiths, was similar in set-up and found similar results – a 78% remission rate for depression after six months, and an 83% remission rate for anxiety.  Two previous studies, by UCLA and the Heffter Research Centre in Zurich, also found psychedelics significantly reduce anxiety in terminally-ill cancer patients.

The question is: how? How does a single dose of a chemical cause such dramatic and sustained changes in a person’s attitudes? The studies are somewhat coy, but they point to something called ‘the mystical state of consciousness’:

This finding suggests a potential psycho-spiritual mechanism of action: the mystical state of consciousness. The mystical experience is likely to be one of several mediators that transmit the effect of psilocybin to changes in anxiety and/or depression.

It’s strange to find the phrase ‘mystical state of consciousness’ tucked away in all the bland statistical analysis of the modern scientific journal article. Of course, ‘mystical states of consciousness’ are quite hard to define – indeed, one of William James’ definitions of them is they are ‘ineffable’. So how can scientists measure them?

The scientists in these studies used various psychometric tests to measure people’s subjective experiences. Some of them are fairly standard, such as the Beck Depression Inventory (BDI), which measures how depressed someone is by asking them to what extent they agree with questions like ‘I sometimes want to kill myself’ – this scale is widely used to see if someone with depression is in remission after a course of therapy.

To measure mystical experiences, the scientists used a variety of scales. One is the Pahnke-Richards Mystical Experience Questionnaire, developed by Walter Pahnke, a religious scholar who did pioneering research into psychedelics and mystical experience at Harvard in the 1960s. The scale asks people to what extent their experience felt like the following (I’ll just give a sample of the statements):

teresaI. Internal Unity
26. Loss of your usual identity.
35. Freedom from the limitations of your personal self and feeling a unity or bond with what was felt to be greater than your personal self.
41. Experience of pure Being and pure awareness (beyond the world of sense impressions).
77. Experience of the fusion of your personal self into a larger whole.
83. Experience of unity with ultimate reality.

II. External Unity

14. Experience of oneness or unity with objects and/or persons perceived in your surroundings
47. Experience of the insight that “all is One”.
51. Loss of feelings of difference between yourself and objects or persons in your surroundings.
74. Awareness of the life or living presence in all things.

III. Transcendence of Time and Space

2. Loss of your usual sense of time.
12. Feeling that you experienced eternity or infinity.
34. Sense of being “outside of” time, beyond past and future.

IV. Ineffability and Paradoxicality
6. Sense that the experience cannot be described adequately in words.
23. Feeling that you could not do justice to your experience by describing it in words.
59. Sense that in order to describe parts of your experience you would have to use statements that appear to be illogical, involving contradictions and paradoxes.

V. Sense of Sacredness
5. Experience of amazement.
8. Sense of the limitations and smallness of your everyday personality in contrast to the Infinite.
31. Sense of profound humility before the majesty of what was felt to be sacred or holy.
80. Sense of awe or awesomeness.

VI. Noetic Quality
3. Feeling that the consciousness experienced during part of the session was more real than your normal awareness of everyday reality.
9. Gain of insightful knowledge experienced at an intuitive level.
22. Certainty of encounter with ultimate reality (in the sense of being able to “know” and “see” what is really real ) at some time during your session.

VII. Deeply-Felt Positive Mood
10. Experience of overflowing energy.
30. Feelings of peace and tranquility.
43. Experience of ecstasy.
60. Feelings of universal or infinite love.

Another scale is the Mysticism Scale, developed by Ralph Hood. It measures very similar attitudes – timelessness, sense of unity with all things – though in a slightly less obvious way. A third scale is the Spiritual Transcendence Scale developed by Ralph Piedmont (clearly if you want your child to be a mysticism researcher, call them Ralph). This scale measures sense of connectedness to humanity, sense of the unitive nature of life, and sense of joy from personal encounter with a transcendent reality.

These scales suggest that psychedelics give rise to some unusual beliefs about reality, such as the belief one is suddenly in touch with ‘ultimate reality’, the belief that there is ‘spirit in all things’, a sense one has reached ‘pure consciousness’ or the belief one is in touch with ‘universal love’. None of these beliefs could be exactly checked by science. Indeed, some of them might be outright rejected by traditional materialist science, such as the belief there is a spirit in all things.

The studies tip-toe around the big question: do psychedelics reduce anxiety and depression in the terminally ill by changing their beliefs about the afterlife? This, after all, is one of the most common insights from the mystics of the past – there is something in us beyond the ego which is immortal and divine. Contemporary psychedelic scientists, eager for acceptance in the mainstream scientific community, duck this metaphysical question by pointing to quantitative reductions in depression or ‘increases in the transcendence / mysticism scales’.

This sort of quantitative analysis would be well supplemented by qualitiative research – interviews with the participants where they describe their trip.  UCLA’s earlier study of LSD for terminal cancer patients did more qualitative interviews, and sure enough, people said things like ‘For the first time in my life, I felt like there was a creator of the universe, a force greater than myself, and that I should be kind and loving’. There are also some interviews with participants of the recent Johns Hopkins study on YouTube – you can see them struggling to put their experience into words (they’re ‘ineffable’ after all).

Time magazine interviewed one participant in the Johns Hopkins study, who described her trip:

suddenly I saw my fear. It was a black mass inside my body. I felt a volcanic anger toward my fear and I screamed, “Get the f-ck out, I won’t be eaten alive!”As soon as I screamed at it, the black mass of fear disappeared. I began to feel like I was floating in the instrumental music playing from the headphones I had on, and I started to feel love. I felt like I was being bathed in love and it was overwhelming, amazing, wonderful.

This accords with the experience of Aldous Huxley, who famously took LSD on his deathbed. Psychedelics had showed him, he said, that ‘love is the central cosmic fact’. Again, not really an assertion one could scientifically test to see if it’s true.

When I attended Breaking Convention last year (which is the world’s biggest conference on psychedelics) I asked Thorsten Passie from Harvard, who has studied how LSD reduces anxiety in those with life-threatening illness, whether anxiety was reduced because people had new beliefs about the self and the afterlife. He replied: ‘We didn’t ask them, but I think so.’ I also asked Roland Griffiths of Johns Hopkins, lead-investigator of one of the new studies. He replied: ‘Not everyone necessarily becomes convinced there’s an afterlife, but quite often they become open to that possibility for the first time. That’s a big change to the total certainty they are facing annihilation.’

Walter Pahnke’s early research on LSD with terminal cancer patients in the 1960s was less coy. He wrote:

Our experiments have indicated that deep within every human being there are vast usually untapped resources of love, joy and peace…these feelings are released most fully when there is comolete surrender to the ego-loss experience of positive ego-transcendence, which is often experienced as a moment of death and rebirth.

He continued:

One of the greatest fears about human death is that personal individual existence and memory will be gone forever. Yet having passed through psychological ego-death in the mystical experience, a person still preserves enough self-consciousness so that at least part of individual memory is not lost.

In other words, psychedelics appear to give people near-death experiences where their lifes aren’t actually in danger. They give people the experience of ego-death, and a sense that this is OK, that the universe / God loves them. And this helps them face the future prospect of their actual death, because they think there’s something beyond the ego – whether that’s described as ‘pure consciousness’, ‘mind at large’, ‘God’, or whatever. This is very similar to what happens in actual near-death experiences, for example after cardiac arrests – people come back with reduced anxiety about death, because they no longer think death is the end. Researcher Kenneth Ring says that reduced anxiety about death is ‘the most consistent finding in NDE research’.

Clearly, more research needs to be done on this, which directly explores how psychedelics change people’s beliefs about the nature of the self, the nature of reality, and the afterlife. It’s an interesting topic, because how should science treat these new mystical beliefs – as delusions? As placebo? Or perhaps as insights that are potentially true? Does it matter if the insights are true or not, as long as they improve people’s moods?

I suspect psychedelics will soon be widely used in palliative care. How would that change our culture? How would it change our attitude to death? And to life? Could psychedelics play a role in a spiritual revival in our over-rational and materialistic culture?

Albert Hoffman, inventor of LSD, hoped that psychedelics could inspire a ‘new Eleusis’ –  he was referring to the Eleusinian Mysteries, the great religious cult of ancient Greece, which existed for 2500 years, before it was shut down by the fanatical Christian emperor Theodosius in 392 AD. No one knows precisely what happened during the secret ritual – initiates were mystes, sworn to silence, which is where the word ‘mystical’ comes from – but participants apparently drank a potion, and then went on a terrifying trip to the underworld, before being reborn as children of Demeter. The philosopher Cicero said he thought Eleusis was the greatest single contribution of Greek culture to the world. It enabled people to ‘die with a better hope’ – just as psychedelics help the terminally ill.

Ergot, which contains lystergic acid, may have been consumed at the Eleusinian Mysteries
Ergot, which contains lystergic acid

In the 1960s, mycologist Gordon Wasson speculated that the Eleusinian potion contained ergot, a fungus that grows on corn which contains an LSD-type compound. Certainly, there are similarities between descriptions of the mystery rites and LSD experiences. Plutarch, who was a priest of Eleusis, described the inititation as ‘wandering through the dark … terrors, shivering, trembling … after this a strange and wondrous light, voices, dances and the majesty of holy sounds and sacred visions’. Compare this to the account of one participant in a 2014 trial of LSD for those with terminal cancer: ‘It was just really black … I was afraid, shaking … It was total exhaustion … like an endless marathon … Suddenly a phase of relaxation came … It became bright. Everything was light … It was really gorgeous … The key experience is when you get from dark to light.’

Quite similar, no?

 

Do ecstatic experiences tell us anything reliable about the universe?

There is a growing consensus among secular psychologists that experiences of ecstasy and ego-transcendence are good for us, and tell us interesting things about the nature of the mind. But do they tell us anything interesting or reliable about the nature of the universe? I’m trying to figure this out. Here are my thoughts so far – please respond in the comments.

New Atheist Sam Harris says that ecstatic experiences tell us reliable things about the nature of the self – that the ego is not a stable, permanent entity, and when we go beyond the ego with the proper care and guidance, it’s very good for us and for our societies, leading to greater well-being and compassion. He is prepared to accept as reliable this subjective evidence from contemplation and psychedelics.

However, it’s also true that, when people go beyond the ego, they feel connected to the universe and to other beings. They feel their consciousness is intimately connected to other consciousnesses, and they often feel that the universe itself is somehow filled with consciousness, in some sense or other. Harris rejects this subjective insight as unreliable and ‘specious’. So he’s prepared to accept one ecstatic insight as reliable – there is no ego and to discover that is broadly good for you. But he dismisses another ecstatic insight – our consciousness is connected to other consciousnesses – as specious and unreliable. Indeed, he calls Deepak Chopra a ‘charlatan’ for making claims about the universe based on people’s spiritual experiences.

There is, I think, an inconsistency here. He’s accepting some forms of subjective experience as evidence, but not others. Why should the insight that there is no stable self be reliable? And if the ‘point’ of transdendent experiences is that they make people happier and more compassionate, then is that not an argument for a form of benign religion? After all, religious communities have led to many more people having transcendent experiences than atheist communities. Harris is something of a prophet in the wilderness as an atheist who insists these experiences are valuable.

Never mind the ‘religion is good / bad’ argument, which is not my concern in this blog. I want to argue that ecstatic experiences do tell us something about the nature of the universe. They tell us that this is the kind of universe that creates conscious minds which seek transcendence. It also tells us something about evolution – that, on this planet at least, evolution has led to conscious minds which seek a transcendence beyond survival and reproduction, and which finds that transcendence to be the most meaningful aspect of existence.

What’s the point of ego-transcendence, from an evolutionary perspective? Why should we pursue it so relentlessly, and value it so highly? After all, ego-transcendence helps us accept death, which isn’t adaptive at all from an evolutionary perspective. Evolutionary psychologists have put forward four theories of transcendence. Firstly, it’s a consequence of the accidental evolution of self-awareness. Consciousness is broadly adaptive, but it has the side-effect of making us self-aware of our smallness, isolation and mortality, which causes us suffering. In ego-transcendence, we create mechanisms to overcome this anxiety, through illusions of unity and immortality. So these experiences which humans value above all others are really consoling delusions. That’s possible, although rather depressing.

The second theory, put forward by social psychologist Jonathan Haidt, is that ego-transcendence allows humans to shift into the ‘hive mind’, which improves group-bonding and makes your tribe more competitive. That’s partly true, but it misses out a lot about ego-transcendence. These aren’t just collective experiences, they’re also individual experiences in which an individual feels healed and made whole. And they’re moments of connection to nature and the cosmos, not just the tribe.

A third theory, put forward by William James, Frederic Myers, Aldous Huxley and others, is that the universe is a machine for generating ecstasy. The universe creates conscious minds that seek transcendence, wisdom and love-connection.Not just our conscious minds, but our entire psyches seek self-transcendence – through reason, but also through dreams, epiphanies, trips and states of flow. The pursuit of transcendence is deep in our nature, like a seed waiting to flower. Conscious minds seek transcendence on Earth, and also presumably on thousands of other planets throughout the hundred billion galaxies. Ecstasy is the universe waking up, knowing itself, and dancing. That’s the theory I am inclined to believe.

The fourth explanation, which I think Harris would put forward, is that ego-transcendence helps humans beyond the fiction of the ego, which can make us happier and more compassionate, but it’s entirely something that happens in the brain, with no relevance to the fundamental nature of reality or life after death. I can accept the logic of this, but why bother seeking ego-transcendence – which is a very difficult and dangerous thing to seek – if it just means you may eventually feel a bit happier and more compassionate? Why not just take oxytocin pills, which are a much quicker short-cut? Why bother sitting on your bum meditating for several months?