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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?


Psychedelia and the future of religion

David E. Nichols presenting his work on new psychedelic compounds

I spent the last few days at a weird and wonderful conference. It was called Breaking Convention 2015, the third conference on ‘psychedelic consciousness, culture and clinical research’ at the University of Greenwich. There, in the regal litoral digs of the university, facing the steel snarl of Canary Wharf, 800 ‘breakeroos’ gathered, dreadlocked witches, underground psychedelic therapists, mainstream scientists, Peruvian shamans and long-haired barefoot beatniks, to attend lectures, open their minds, explore light shows and virtual reality spaces, sign up to workshops on shamanic drumming or psychedelic orgasms, and dance away at the ‘Nite of Eleusis’ after-parties.

The conference was a unique marriage of science and spirituality. You could see chemist David E.Nichols presenting on the molecular structure of LSD-type compounds (while DIY chemists scribbled notes in the audience), then go to see shamans talking about ayahuasca ceremonies or classicists talking about the rites of Eleusis and Dionysus. How many conferences go from the cellular to the celestial in one session?

These are exciting times for psychedelic research. Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies (MAPS), said to the youngish audience: ‘This is the first generation where you can say ‘I want a career in psychedelics’, and that’s a reasonable thing to say’. After a 50-year hiatus, scientific research into psychedelics has re-started, and is finding remarkable results.

For example, researchers at John Hopkins Medical Hospital found that, after three doses of magic-mushroom drug psilocybin, 80% of smokers in a trial gave up smoking and had still given up six months later. The most successful anti-smoking therapy programmes at the moment have success rates of 30-35%. Several other recent studies have found psychedelics to be successful in treating addiction to alcohol, cocaine and heroin.

LSD, psilocybin, ketamine and MDMA has also been found to be effective in the treatment of depression, anxiety and PTSD. An ongoing study at Imperial College has given psilocybin to seven volunteers with chronic depression – four are currently in remission. Several trials have also found psychedelics reduce depression and anxiety in people with terminal illnesses. Roland Griffiths, lead researcher at the Johns Hopkins psychedelic research project, says: ‘A single moderate-high dose of psilocybin can produce substantial and enduring decreases in anxiety and depression in patients with life-threatening cancer diagnosis. There’s nothing else like that in psychopharmacology.’

Rick Doblin of MAPS imagines a future of psychedelic therapy clinics
Rick Doblin of MAPS imagines a future of psychedelic therapy clinics

The conference’s optimism and energy arose from the sense that the more proof there is of the therapeutic benefits of psychedelics, the more likely they will be legalized for therapeutic use in clinical settings. Attendees spoke of the ‘post-prohibition era’ as if it was just over the next hill. But David Nutt, former chief drugs advisor to the UK government, warned the conference not to be too complacent, particularly when our government is poised to pass the Psychoactive Substances Bill, banning people’s ability to make and sell ‘legal highs’.

When psychonauts go psychonuts

The main barrier to decriminalization is the sense – which I happen to share – that psychedelics are risky, that when you open the door to the unconscious you are dicing with your health and sanity. Ernst Junger wrote to the discoverer of LSD, Albert Hoffman, in 1948: ‘These are experiments in which one sooner or later embarks on truly dangerous paths, and may be considered lucky to escape with only a black eye.’

Personally, I had a bad trip on LSD when I was 18 which left me with post-traumatic stress symptoms for five years. Looking back, I was too young, and had no sense of the proper ‘set and setting’ for a trip. I took it at a techno warehouse party and then went to an after-party where I didn’t really know anyone, and intense paranoia ensued. I then didn’t speak to anyone about my traumatic experience for several years. Not very smart. The symptoms did eventually pass, but I’m not the same person I was before the experience – I’m more introverted, probably more neurotic, though also perhaps more compassionate and able to help others.

Apparently, I’m one of the unlucky ones: a survey by Johanson and Krebs of 130,000 people found that the 15% of the US population which has used psychedelics have better mental health than the rest of the population, and there was little or no evidence of any long-term psychological problems among them. Roland Griffiths of John Hopkins did his own survey, where 1993 respondents reported distressing psychedelic experiences, and some were hospitalised – though most saw them as good in the long-term. Only 10% of respondents said the negative experiences had long-term consequences. He thinks the experience can be made almost completely safe in a clinical setting.

I would suggest that the reason psychedelics can be so therapeutic is also the reason they can potentially be harmful: they lead to what Imperial College’s Robin Carhart-Harris calls ‘ego dissolution’.

An illustration from Jung's Red Book
An illustration from Jung’s Red Book.

As we become adults, our construction of self and of reality is rendered into a stable configuration, an automatic programme that starts running the moment we wake up. Our construction can be bad for us. We may have integrated very negative beliefs or traumatic memories, which have become habituated into unconscious, physical, autonomic and even molecular patterns. Psychedelics dissolve this rigid construction, or bring the automatic to consciousness. They ‘lower the threshold of consciousness’ as Carl Jung put it, enabling us to re-encounter traumatic or repressed memories, to re-consider habitual or archetypal patterns and choose new patterns, to alter autonomic processes like auto-immune illnesses, perhaps even to intervene in our bodies at the cellular level. We can see the stitching in our reality-construction and we can unstitch and restich.

That can be liberating. We can have a sense of ego-dissolution into the blissful ocean of our creative unconscious. The unconscious that we meet on psychedelics is more the benign archetypal fairy-land of Jungian therapy than the nihilistic jungle of sexual violence that Freud suggested. We descend into that underworld, and can emerge with a sense of rebirth. In Griffiths’ studies at Johns Hopkins, 60% of participants said their psilocybin trip was one of the most meaningful experiences of their life.

But, as Jungian psychologist Scott J. Hill noted, ego-dissolution can also be terrifying – our ego resists dissolution. We are confronted with trauma or darkness, and we can’t handle it. We run and hide, and we can keep running for a long time. 62% of Griffiths’ participants also said their trip was one of the most difficult or challenging experiences of their life.

A Kosmicare ‘psychedelic harm reduction’ tent at a festival

That’s why it’s important to have guides – friends, doctors, nurses, care-givers – to help you through any dark patches. I was impressed with the wok of ‘psychedelic harm reduction’ organizations like Kosmicare, who provide support to trippers at festivals and help them to accept that ‘difficult trips are not necessarily bad trips’ as Rick Doblin put it. Too often, if someone is having a ‘transient psychotic episode’ on psychedelics, the reaction of health professionals is to tranquilize and hospitalize them – denying their experience any kind of spiritual meaning or worth, and perhaps even slamming a psychotic or schizophrenic label on them for life. That’s a curse. Trying to talk people through difficult phases of trips so they find a therapeutic or transcendent interpretation seems a much, much better approach.

Revealing spiritual reality?

Psychedelics, then, reveal very interesting things to us about the mind, consciousness, unconsciousness, the ego, and how we can change the ego’s beliefs and behaviour. Do they also tell us interesting things about the nature of reality?

Participants at the ancient Greek rites of Eleusis came away thinking they would ‘die with a better hope’. Is that, I wondered, why psychedelics decrease anxiety and depression in the terminally ill? Do they come away from the experience with a new belief in the afterlife? I asked Thorsten Passie from Harvard, who has studied how LSD reduces anxiety in those with life-threatening illness. He replied: ‘We didn’t ask them, but I think so.’ I also asked Roland Griffiths, who has undertaken a similar study. 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.’

Of course, a new experience-based belief in the afterlife is not scientific proof. But it’s interesting. And it’s also interesting that decreased anxiety and and an increased belief in the afterlife is a reliable consequence of near-death experiences.

A DMT creature depicted by psychedelic artist Luke Brown
A DMT creature depicted by psychedelic artist Luke Brown

Another common phenomenon in psychedelic experiences is a sense of encounter with spirits, deities, or creatures from another universe or dimension. A survey of 800 psychonauts by Fountonglou and Freimoser found that 46% of ayahuasca-takers reported ‘encounters with suprahuman or spiritual entities’, as well as 36% of DMT-takers, 17% of LSD takers, and 12% of psilocybin-takers. Similar percentages reported ‘experiences of other universes and encounters with their inhabitants.’

This raises an interesting question for psychedelic academia – how to make sense of these spirits? There was a whole afternoon session devoted to the question of the ‘elves’ or ‘little people’ which takers of DMT regularly report encountering. Interpretations ranged from the purely materialist (it’s a brain-trick), to the Jungian (they’re archetypes from the collective unconscious) to the literal (they’re really real). As the anthropologist Jack Hunter noted, that last assertion is somewhat taboo in academia, which tends to be committed to naturalist materialist explanations. You can be anything in academia, from transgender to post-Lacanian, as long as it’s materialist.

The academics at this conference (David Luke, Dave King, Jack Hunter and others) showed a brave willingness to go over that naturalist barrier and open themselves to the possibility that the discarnate entities they encounter are ‘really real’. Hunter called this ‘ontological flooding’.

But I think we need to go further than that. We need to recognize not just that there may be discarnate entities out there, but also that not all of them are benevolent. That means opening the door to the spirit-world, but not leaving it wide open to be ‘flooded’ by any and every spirit. Indeed, several of the speakers and participants, including Hunter and the author Daniel Pinchbeck, reported having felt possessed during or after a psychedelic experience – they felt they had been invaded by a spirit which was not entirely friendly (Albert Hoffman had a similar experience on the first ever LSD trip in 1943). We need to know not just how to open the doors of our mind, but also how to close them.

This is the conclusion psychedelic researcher Rick Strassman arrived at, following his landmark study in 1990, in which 60 participants took DMT, and many reported encountering alien or insectoid beings, who were not all benevolent. He said at the conference: ‘How can we tell if these beings are for us or against us? Will we try to weaponize them, or will they try and weaponize us?’ This reminded me of the film Prometheus, in which humans search for contact with higher beings, only to discover the higher beings are utterly contemptuous of us.

Psychedelic Christianity?

Strassman concluded: ‘When opening yourself to spiritual worlds, it’s not all love and light. It’s important to know how to protect yourself, how to pray.’ He has ended up going back to his Hebrew upbringing, and to the Bible, for guidance. Certainly, both Hellenic and Judeao-Christian culture developed advanced techniques and practices for the ‘discernment of spirits’, to protect practitioners against both bad spirits and their own hyperactive imagination.

But Strassman’s return to our Judaeo-Christian heritage went down like a shit balloon with the New Agers of the conference, who tended to embrace an ABC mentality: Anything But Christianity. You were much more likely to hear enthusiastic discussions of the Maenads, or wicca, or Peruvian shamanism, or sex magick, or Aleister Crowley. The dominant tone was anarchic, liberationist, transgressive, trickster, marginal, counter-cultural.

I think this snobbery towards Christianity is a mistake – you ignore 2000 years of ecstatic culture and philosophy, and end up in the intellectual and artistic shallows with mediocre ego-maniacs like Crowley or William Burroughs. Psychedelic culture can end up all about transgression, and not about trying to create integrated, wise, safe, moral, prosocial, mainstream cults which last for thousands of years, as Eleusis and Christianity did. You need not just just cultural transgression at the margin of society, but wise cults at the centre. At the moment, we have counter-cultures but no central cult.

I wonder if, in a hundred years, some form of psychedelic Christianity will have emerged, like the Santo Daime church in Brazil, which combines ayahuasca ceremony with Christianity’s rituals and emphasis on virtue, love, beauty, forgiveness, humility and rebirth. Is that possible or conceivable?

In any case, the sense I got from BreakingCon was that psychedelic culture hopes to spread beyond the counter-culture and ‘go mainstream’. Imperial’s Robin Carhart-Harris said: ‘I like the vision of controlled places where people can have controlled psychedelic experiences.’ Controlled places to lose control – this is what the best rites are.