One: Dying
AT NEW YORK UNIVERSITY, psilocybin trips take place in a treatment room carefully decorated to look more like a cozy den than a hospital suite. The effect almost works, but not entirely, for the stainless steel and plastic fittings of modern medicine peek through the domestic scrim here and there, chilly reminders that the room you are tripping in is still in the belly of a big city hospital complex.
Against one wall is a comfortable couch long enough for a patient to stretch out on during a session. An abstract painting—or is it a cubist landscape?—hangs on the opposite wall, and on the bookshelves large-format books about art and mythology share space with native craft items and spiritual knickknacks—a large glazed ceramic mushroom, a Buddha, a crystal. This could be the apartment of a well-traveled shrink of a certain age, one with an interest in Eastern religions and the art of what used to be called primitive cultures. Yet the illusion crumbles as soon as you lift your gaze to the ceiling, where the tracks that would ordinarily support the curtains dividing one hospital bed from another traverse the white acoustic tiles. And then there is the supersized bathroom, ablaze with fluorescent light and outfitted with the requisite grab bars and pedals.
It was here in this room that I first heard the story of Patrick Mettes, a volunteer in NYU’s psilocybin cancer trial who, in the course of a turbulent six-hour psilocybin journey on the couch where I now sat, had a life-changing—or perhaps I should say death-changing—experience. I had come to interview Tony Bossis, the palliative care psychologist who guided Mettes that day, and his colleague Stephen Ross, the Bellevue psychiatrist who directed the trial, which sought to determine whether a single high dose of psilocybin could alleviate the anxiety and depression that often follow a life-threatening cancer diagnosis.
While Bossis, hirsute and bearish, looks the part of a fifty-something Manhattan shrink with an interest in alternative therapies, Ross, who is in his forties, comes across as more of a straight arrow; neatly trimmed in a suit and tie, he could pass for a Wall Street banker. A bookish teenager growing up in L.A., Ross says he had no personal experience of psychedelics and knew next to nothing about them before a colleague happened to mention that LSD had been used successfully to treat alcoholics in the 1950s and 1960s. This being his psychiatric specialty, Ross did some research and was astonished to discover a “completely buried body of knowledge.” By the 1990s, when he began his residency in psychiatry at Columbia and the New York State Psychiatric Institute, the history of psychedelic therapy had been erased from the field, never to be mentioned.
The trial at NYU, along with a sister study conducted in Roland Griffiths’s lab at Johns Hopkins, represents one of a handful of efforts to pick up the thread of inquiry that got dropped in the 1970s when sanctioned psychedelic therapy ended. While the NYU and Hopkins trials are assessing the potential of psychedelics to help the dying, other trials now under way are exploring the possibility that psychedelics (usually psilocybin rather than LSD, because, as Ross explained, it “carries none of the political baggage of those three letters”) could be used to lift depression and break addictions—to alcohol, cocaine, and tobacco.
None of this work is exactly new: to delve into the history of clinical research with psychedelics is to realize that most of this ground has already been tilled. Charles Grob, the UCLA psychiatrist whose 2011 pilot study of psilocybin for cancer anxiety cleared the path for the NYU and Hopkins trials, acknowledges that “in a lot of ways we are simply picking up the torch from earlier generations of researchers who had to put it down because of cultural pressures.” But if psychedelics are ever to find acceptance in modern medicine, all this buried knowledge will need to be excavated and the experiments that produced it reprised according to the prevailing scientific standards.
Yet even as psychedelic therapies are being tested by modern science, the very strangeness of these molecules and their actions upon the mind is at the same time testing whether Western medicine can deal with the implicit challenges they pose. To cite one obvious example, conventional drug trials of psychedelics are difficult if not impossible to blind: most participants can tell whether they’ve received psilocybin or a placebo, and so can their guides. Also, in testing these drugs, how can researchers hope to tease out the chemical’s effect from the critical influence of set and setting? Western science and modern drug testing depend on the ability to isolate a single variable, but it isn’t clear that the effects of a psychedelic drug can ever be isolated, whether from the context in which it is administered, the presence of the therapists involved, or the volunteer’s expectations. Any of these factors can muddy the waters of causality. And how is Western medicine to evaluate a psychiatric drug that appears to work not by means of any strictly pharmacological effect but by administering a certain kind of experience in the minds of the people who take it?
Add to this the fact that the kind of experience these drugs sponsor often goes under the heading of “spiritual,” and you have, with psychedelic therapy, a very large pill for modern medicine to swallow. Charles Grob well appreciates the challenge but is also refreshingly unapologetic about it: he describes psychedelic therapy as a form of “applied mysticism.” This is surely an odd phrase to hear on the lips of a scientist, and to many ears it sounds dangerously unscientific.
“For me that is not a medical concept,” Franz Vollenweider, the pioneering psychedelic researcher, told Science magazine, when asked to comment on the role of mysticism in psychedelic therapy. “It’s more like an interesting shamanic concept.” But other researchers working on psychedelics don’t run from the idea that elements of shamanism might have a role to play in psychedelic therapy—as indeed it has probably done for several thousand years before there was such a thing as science. “If we are to develop optimal research designs for evaluating the therapeutic utility of hallucinogens,” Grob has written, “it will not be sufficient to adhere to strict standards of scientific methodology alone. We must also pay heed to the examples provided us by such successful applications of the shamanic paradigm.” Under that paradigm, the shaman/therapist carefully orchestrates “extrapharmacological variables” such as set and setting in order to put the “hyper-suggestible properties” of these medicines to best use. This is precisely where psychedelic therapy seems to be operating: on a frontier between spirituality and science that is as provocative as it is uncomfortable.
Yet the new research into psychedelics comes along at a time when mental health treatment in this country is so “broken”—to use the word of Tom Insel, who until 2015 was director of the National Institute of Mental Health—that the field’s willingness to entertain radical new approaches is perhaps greater than it has been in a generation. The pharmacological toolbox for treating depression—which afflicts nearly a tenth of all Americans and, worldwide, is the leading cause of disability—has little in it today, with antidepressants losing their effectiveness* and the pipeline for new psychiatric drugs drying up. Pharmaceutical companies are no longer investing in the development of so-called CNS drugs—medicines targeted at the central nervous system. The mental health system reaches only a fraction of the people suffering from mental disorders, most of whom are discouraged from seeking treatment by its cost, social stigma, or ineffectiveness. There are almost forty-three thousand suicides every year in America (more than the number of deaths from either breast cancer or auto accidents), yet only about half of the people who take their lives have ever received mental health treatment. “Broken” does not seem too harsh a characterization of such a system.
Jeffrey Guss, a Manhattan psychiatrist and a coinvestigator on the NYU trial, thinks the moment could be ripe for psychotherapy to entertain a completely new paradigm. Guss points out that for many years now “we’ve had this conflict between the biologically based treatments and psychodynamic treatments. They’ve been fighting one another for legitimacy and resources. Is mental illness a disorder of chemistry, or is it a loss of meaning in one’s life? Psychedelic therapy is the wedding of those two approaches.”
In recent years, “psychiatry has gone from being brainless to being mindless,” as one psychoanalyst has put it. If psychedelic therapy proves successful, it will be because it succeeds in rejoining the brain and the mind in the practice of psychotherapy. At least that’s the promise.
For the therapists working with people approaching the end of life, these questions are of more than academic interest. As I chatted with Stephen Ross and Tony Bossis in the NYU treatment room, I was struck by their excitement, verging on giddiness, at the results they were observing in their cancer patients—after a single guided psilocybin session. At first, Ross couldn’t believe what he was seeing: “I thought the first ten or twenty people were plants—that they must be faking it. They were saying things like ‘I understand love is the most powerful force on the planet’ or ‘I had an encounter with my cancer, this black cloud of smoke.’ People were journeying to early parts of their lives and coming back with a profound new sense of things, new priorities. People who had been palpably scared of death—they lost their fear. The fact that a drug given once could have such an effect for so long is an unprecedented finding. We have never had anything like that in the psychiatric field.”
This is when Tony Bossis first told me about his experience sitting with Patrick Mettes as he journeyed to a place in his mind that, somehow, lifted the siege of his terror.
“You’re in this room, but you’re in the presence of something large. I remember how, after two hours of silence, Patrick began to cry softly and say, twice, ‘Birth and death is a lot of work.’ It’s humbling to sit there. It’s the most rewarding day of your career.”
As a palliative care specialist, Bossis spends a lot of his time with the dying. “People don’t realize how few tools we have in psychiatry to address existential distress.” Existential distress is what psychologists call the complex of depression, anxiety, and fear common in people confronting a terminal diagnosis. “Xanax isn’t the answer.” If there is an answer, Bossis believes, it is going to be more spiritual in nature than pharmacological.
“So how do we not explore this,” he asks, “if it can recalibrate how we die?”
IT WAS ON AN APRIL MONDAY in 2010 that Patrick Mettes, a fifty-three-year-old television news director being treated for a cancer of his bile ducts, read the article on the front page of the New York Times that would change his death. His diagnosis had come three years earlier, shortly after his wife, Lisa Callaghan, noticed that the whites of his eyes had suddenly turned yellow. By 2010, the cancer had spread to Patrick’s lungs, and he was buckling under the weight of an especially debilitating chemotherapy regime and the dawning realization that he might not survive. The article, headlined “Hallucinogens Have Doctors Tuning In Again,” briefly mentioned research at NYU, where psilocybin was being tested to relieve existential distress in cancer patients. According to Lisa, Patrick had no experience with psychedelics, but he immediately determined to call NYU and volunteer.
Lisa was against the idea. “I didn’t want there to be an easy way out,” she told me. “I wanted him to fight.”
Patrick placed the call anyway and, after filling out some forms and answering a long list of questions, was accepted into the trial. He was assigned to Tony Bossis. Tony was roughly the same age as Patrick; he is also a soulful man of uncommon warmth and compassion, and the two immediately hit it off.
At their first meeting, Bossis told Patrick what to expect. After three or four preparatory sessions of talking therapy, Patrick would be scheduled for two dosings—one of them an “active placebo” (in this case a high dose of niacin, which produces a tingling sensation), and the other a capsule containing twenty-five milligrams of psilocybin. Both sessions would take place in the treatment room where I met Bossis and Ross. During each session, which would last the better part of a day, Patrick would lie on the couch wearing eyeshades and listening through headphones to a playlist of carefully curated music—Brian Eno, Philip Glass, Pat Metheny, and Ravi Shankar, as well as some classical and New Age compositions. Two sitters—one of them male (Bossis) and the other female (Krystallia Kalliontzi)—would be in attendance for the duration, saying very little but available to help should he run into any trouble. In preparation, the two shared with Patrick the set of “flight instructions” written by the Hopkins researcher Bill Richards.
Bossis suggested that Patrick use the phrase “Trust and let go” as a kind of mantra for his journey. Go wherever it takes you, he advised: “Climb staircases, open doors, explore paths, fly over landscapes.” But the most important advice for the journey he offered is always to move toward, rather than try to flee, anything truly threatening or monstrous you encounter—look it straight in the eyes. “Dig in your heels and ask, ‘What are you doing in my mind?’ Or, ‘What can I learn from you?’”
THE IDEA OF GIVING a psychedelic drug to the dying was first broached not by a therapist or scientist but by Aldous Huxley in a letter to Humphry Osmond, proposing a research project involving “the administration of LSD to terminal cancer cases, in the hope that it would make dying a more spiritual, less strictly physiological process.” Huxley himself had his wife, Laura, give him an injection of LSD when he was on his own deathbed, on November 22, 1963.
By then, Huxley’s idea had been tested on a number of cancer patients in North America. In 1965, Sidney Cohen wrote an essay for Harper’s (“LSD and the Anguish of Dying”) exploring the potential of psychedelics to “alter[] the experience of dying.” He described treatment with LSD as “therapy by self-transcendence.” The premise behind the approach was that our fear of death is a function of our egos, which burden us with a sense of separateness that can become unbearable as we approach death. “We are born into an egoless world,” Cohen wrote, “but we live and die imprisoned within ourselves.”
The idea was to use psychedelics to escape the prison of self. “We wanted to provide a brief, lucid interval of complete egolessness to demonstrate that personal intactness was not absolutely necessary, and that perhaps there was something ‘out there’”—something greater than our individual selves that might survive our demise. Cohen quoted a patient, a woman dying of ovarian cancer, describing the shift in her perspective following an LSD session:
My extinction is not of great consequence at this moment, not even for me. It’s just another turn in the swing of existence and non-existence. I feel it has little to do with the church or talk of death. I suppose that I’m detached—that’s it—away from myself and my pain and my decaying. I could die nicely now—if it should be so. I do not invite it, nor do I put it off.
In 1972, Stanislav Grof and Bill Richards, who were working together at Spring Grove, wrote that LSD gave patients an experience “of cosmic unity” such that death, “instead of being seen as the absolute end of everything and a step into nothingness, appears suddenly as a transition into another type of existence . . . The idea of possible continuity of consciousness beyond physical death becomes much more plausible than the opposite.”
VOLUNTEERS IN THE NYU psilocybin trial are required to write an account of their journey soon after its completion, and Patrick Mettes, who worked in journalism, took the assignment seriously. His wife, Lisa, said that after his Friday session Patrick labored all weekend to make sense of the experience and write it down. Lisa agreed to share his account with me and also gave Patrick’s therapist, Tony Bossis, permission to show me the notes he took during the session, as well as his notes from several follow-up psychotherapy sessions.
Lisa, who at the time worked as a marketing executive for a cookware company, had an important meeting on that January morning in 2011, so Patrick came by himself to the treatment room in the NYU dental school on First Avenue and Twenty-fourth Street, taking the subway from their apartment in Brooklyn. (The treatment room was in the dental college because, at the time, both Bellevue and NYU’s cancer center wanted to keep their distance from a trial involving psychedelics.) Tony Bossis and Krystallia Kalliontzi, his guides, greeted him, reviewed the day’s plans, and then at 9:00 a.m. presented Patrick with a chalice containing the pill; whether it contained psilocybin or the placebo, none of them would know for at least thirty minutes. Patrick was asked to state his intention, which he said was to learn to cope better with the anxiety and depression he felt about his cancer and to work on what he called his “regret in life.” He placed a few photographs around the room, of himself and Lisa on their wedding day and of their dog, Arlo.
At 9:30, Patrick lay down on the couch, put on the headphones and eyeshades, and fell quiet. In his account, Patrick likened the start of the journey to the launch of a space shuttle: “a physically violent and rather clunky liftoff which eventually gave way to the blissful serenity of weightlessness.”
Many of the volunteers I interviewed reported initial episodes of intense fear and anxiety before giving themselves up to the experience, as the guides encourage them to do. This is where the flight instructions come in. Their promise is that if you surrender to whatever happens (“trust, let go, and be open” or “relax and float downstream”), whatever at first might seem terrifying will soon morph into something else, and likely something pleasant, even blissful.
Early in his journey, Patrick encountered his brother’s wife, who died of cancer more than twenty years earlier, at forty-three. “Ruth acted as my tour guide,” he wrote, and “didn’t seem surprised to see me. She ‘wore’ her translucent body so I would know her . . . This period of my journey seemed to be about the feminine.” Michelle Obama made an appearance. “The considerable feminine energy all around me made clear the idea that a mother, any mother, regardless of her shortcomings . . . could never NOT love her offspring. This was very powerful. I knew I was crying . . . it was here that I felt as if I was coming out of the womb . . . being birthed again. My rebirth was smooth . . . comforting.”
Outwardly, however, what was happening to Patrick appeared to be anything but smooth. He was crying, Bossis noted, and breathing heavily. This is when he first said, “Birth and death is a lot of work,” and seemed to be convulsing. Then Patrick reached out and clutched Kalliontzi’s hand while pulling up his knees and pushing, as if he were delivering a baby. From Bossis’s notes:
11:15 “Oh God.”
11:25 “It’s really so simple.”
11:47 “Who knew a man could give birth?” And then,
“I gave birth, to what I don’t know.”
12:10 “It’s just too amazing.” Patrick is alternately laughing and crying at this point. “Oh God, it all makes sense now, so simple and beautiful.”
Now Patrick asked to take a break. “It was getting too intense,” he wrote. He removed the headphones and eyeshades. “I sat up and spoke with Tony and Krystallia. I mentioned that everyone deserved to have this experience . . . that if everyone did, no one could ever do harm to another again . . . wars would be impossible to wage. The room and everything in it was beautiful. Tony and Krystallia, sitting on [their] pillows, were radiant!” They helped him to the bathroom. “Even the germs (if there were any present) were beautiful, as was everything in our world and universe.”
Afterward, he voiced some reluctance to “go back in.”
“The work was considerable but I loved the sense of adventure.” Eventually, he put his eyeshades and headphones on and lay back down.
“From here on, love was the only consideration . . . It was and is the only purpose. Love seemed to emanate from a single point of light . . . and it vibrated . . . I could feel my physical body trying to vibrate in unity with the cosmos . . . and, frustratingly, I felt like a guy who couldn’t dance . . . but the universe accepted it. The sheer joy . . . the bliss . . . the nirvana . . . was indescribable. And in fact there are no words to accurately capture my experience . . . my state . . . this place. I know I’ve had no earthly pleasure that’s ever come close to this feeling . . . no sensation, no image of beauty, nothing during my time on earth has felt as pure and joyful and glorious as the height of this journey.” Aloud, he said, “Never had an orgasm of the soul before.” The music loomed large in the experience: “I was learning a song and the song was simple . . . it was one note . . . C . . . it was the vibration of the universe . . . a collection of everything that ever existed . . . all together equaling God.”
Patrick then described an epiphany having to do with simplicity. He was thinking about politics and food, music and architecture, and—his field—television news, which he realized was, like so much else, “over-produced. We put too many notes in a song . . . too many ingredients in our recipes . . . too many flourishes in the clothes we wear, the houses we live in . . . it all seemed so pointless when really all we needed to do was focus on the love.” Just then he saw Derek Jeter, then the Yankee shortstop, “making yet another balletic turn to first base.”
“I was convinced in that moment I had figured it all out . . . It was right there in front of me . . . love . . . the only thing that mattered. This was now to be my life’s cause.”
Then he said something that Bossis jotted down at 12:15: “Ok, I get it! You can all punch out now. Our work is done.”
But it wasn’t done, not yet. Now “I took a tour of my lungs . . . I remember breathing deeply to help facilitate the ‘seeing.’” Bossis noted that at 2:30 Patrick had said, “I went into my lungs and saw two spots. They were no big deal.
“I was being told (without words) not to worry about the cancer . . . it’s minor in the scheme of things . . . simply an imperfection of your humanity and that the more important matter . . . the real work to be done is before you. Again, love.”
Now Patrick experienced what he called “a brief death.”
“I approached what appeared to be a very sharp, pointed piece of stainless steel. It had a razor blade quality to it. I continued up to the apex of this shiny metal object and as I arrived, I had a choice, to look or not look, over the edge and into the infinite abyss . . . the vastness of the universe . . . the eye of everything . . . [and] of nothing. I was hesitant but not frightened. I wanted to go all in but felt that if I did, I would possibly leave my body permanently . . . death from this life. But it was not a difficult decision . . . I knew there was much more for me here.” Telling his guides about his choice, Patrick explained that he “was not ready to jump off and leave Lisa.”
Then, rather suddenly around 3:00 p.m., it was over. “The transition from a state where I had no sense of time or space to the relative dullness of now, happened quickly. I had a headache.”
When Lisa arrived to take him home, Patrick “looked like he had run a race,” she recalled. “The color in his face was not good, he looked tired and sweaty, but he was on fire. He was lit up with all the things he wanted to tell me and all the things he couldn’t.” He told her he “had touched the face of God.”
EVERY PSYCHEDELIC JOURNEY is different, yet a few common themes seem to recur in the journeys of those struggling with cancer. Many of the cancer patients I interviewed described an experience of either giving birth or being reborn, though none quite as intense as Patrick’s. Many also described an encounter with their cancer (or their fear of it) that had the effect of shrinking its power over them. I mentioned earlier the experience of Dinah Bazer, a petite and mild New Yorker in her sixties, a figure-skating instructor, who was diagnosed with ovarian cancer in 2010. When we met in the NYU treatment room, Dinah, who has auburn curls and wore large hoop earrings, told me that even after a successful course of chemotherapy she was paralyzed by the fear of a recurrence and wasted her days “waiting for the other shoe to drop.”
She too worked with Tony Bossis and in the difficult first moments of her session imagined herself trapped in the hold of a ship, rocking back and forth, consumed by fear. “I stuck my hand out from under the blanket and said, ‘I am so scared.’ Tony took my hand and told me to just go with it. His hand became my anchor.
“I saw my fear. Almost as in a dream, my fear was located under my rib cage on the left side; it was not my tumor, but it was this black thing in my body. And it made me immensely angry; I was enraged by my fear. I screamed, ‘Get the fuck out! I won’t be eaten alive.’ And you know what? It was gone! It went away. I drove it away with my anger.” Dinah reports that years later it hasn’t returned. “The cancer is something completely out of my control, but the fear, I realized, is not.”
Dinah’s epiphany gave way to feelings of “overwhelming love” as her thoughts turned from her fear to her children. She told me she was and remains a “solid atheist,” and yet “the phrase that I used—which I hate to use but it’s the only way to describe it—is that I felt ‘bathed in God’s love.’” Paradox is a hallmark of the mystical experience, and the contradiction between the divine love Dinah felt and “not having a shred of belief” didn’t seem to faze her. When I pointed this out, she shrugged and then smiled: “What other way is there to express it?”
Not surprisingly, visions of death loom large in the journeys taken by the cancer patients I interviewed at NYU and Hopkins. A breast cancer survivor in her sixties (who asked to remain anonymous) described zipping merrily through space as if in a video game until she arrived smack at the wall of a crematorium and realized, with a fright, “I’ve died and now I’m going to be cremated. (But I didn’t have the experience of burning—how could I? I was dead!) The next thing I know, I’m belowground in this gorgeous forest, deep woods, loamy and brown. There are roots all around me and I’m seeing the trees growing, and I’m part of them. I had died but I was there in the ground with all these roots and it didn’t feel sad or happy, just natural, contented, peaceful. I wasn’t gone. I was part of the earth.”
Several cancer patients described edging up to the precipice of death and looking over to the other side before drawing back. Tammy Burgess, diagnosed with ovarian cancer at fifty-five, found herself peering across “the great plane of consciousness. It was very serene and beautiful. I felt alone, but I could reach out and touch anyone I’d ever known.
“When my time came, that’s where my life would go once it left me, and that was okay.”
The uncanny authority of the psychedelic experience might help explain why so many cancer patients in the trials reported that their fear of death had lifted or at least abated: they had stared directly at death and come to know something about it, in a kind of dress rehearsal. “A high-dose psychedelic experience is death practice,” says Katherine MacLean, the former Hopkins psychologist. “You’re losing everything you know to be real, letting go of your ego and your body, and that process can feel like dying.” And yet the experience brings the comforting news that there is something on the other side of that death—whether it is the “great plane of consciousness” or one’s ashes underground being taken up by the roots of trees—and some abiding, disembodied intelligence to somehow know it. “Now I am aware that there is a whole other ‘reality,’” one NYU volunteer told a researcher a few months after her journey. “Compared to other people, it is like I know another language.”
At a follow-up session with Tony Bossis a few weeks after his journey, Patrick Mettes—whom his wife, Lisa, describes as “an earthy, connected person, a doer”—discussed the idea of an afterlife. Bossis’s notes indicate that Patrick interpreted his journey as “pretty clearly a window . . . [on] a kind of afterlife, something beyond this physical body.” He spoke of “the plane of existence of love” as “infinite.” In subsequent sessions, Patrick talked about his body and cancer “as [a] type of illusion.” It also became clear that, psychologically at least, Patrick was doing remarkably well in the aftermath of his session. He was meditating regularly, felt he had become better able to live in the present, and “described loving [his] wife even more.” In a session in March, two months out from his journey, Bossis noted that Patrick, though slowly dying of cancer, “feels the happiest in his life.”
“I am the luckiest man on earth.”
HOW MUCH SHOULD THE AUTHENTICITY of these experiences concern us? Most of the therapists involved in the research take a scrupulously pragmatic view of the question. They’re fixed on relieving their patients’ suffering and exhibit scant interest in metaphysical theories or questions of truth. “That’s above my pay grade,” Tony Bossis said with a shrug when I asked him whether he thought the experiences of cosmic consciousness described by his patients were fictive or real. Asked the same question, Bill Richards cited William James, who suggested we judge the mystical experience not by its veracity, which is unknowable, but by “its fruits”: Does it turn someone’s life in a positive direction?
Many researchers acknowledge that a strong placebo effect may be at work when a drug as suggestible as psilocybin is administered by medical professionals with legal and institutional sanction: under such conditions, the expectations of the therapist are much more likely to be fulfilled by the patient. (And bad trips are much less likely to occur.) Here we bump into one of the richer paradoxes of the psilocybin trials: while it succeeds in no small part because it has the sanction and authority of science, its effectiveness seems to depend on a mystical experience that leaves people convinced there is more to this world than science can explain. Science is being used to validate an experience that would appear to undermine the scientific perspective in what might be called White-Coat Shamanism.
Are questions of truth important, if the therapy helps people who are suffering? I had difficulty finding anyone involved in the research who was troubled by such questions. David Nichols, the retired Purdue University chemist and pharmacologist who founded the Heffter Research Institute in 1993 to support psychedelic research (including the trials at Hopkins, for which he synthesized the psilocybin), puts the pragmatic case most baldly. In a 2014 interview with Science magazine, he said, “If it gives them peace, if it helps people to die peacefully with their friends and their family at their side, I don’t care if it’s real or an illusion.”
For his part, Roland Griffiths acknowledges that “authenticity is a scientific question not yet answered. All we have to go by is the phenomenology”—that is, what people tell us about their internal experiences. That’s when he began querying me about my own spiritual development, which I confessed was still fairly rudimentary; I told him my worldview has always been staunchly materialist.
“Okay, then, but what about the miracle that we are conscious? Just think about that for a second, that we are aware and that we are aware that we are aware! How unlikely is that?” How can we be certain, he was suggesting, that our experience of consciousness is “authentic”? The answer is we can’t; it is beyond the reach of our science, and yet who doubts its reality? In fact, the evidence for the existence of consciousness is much like the evidence for the reality of the mystical experience: we believe it exists not because science can independently verify it but because a great many people have been convinced of its reality; here, too, all we have to go on is the phenomenology. Griffiths was suggesting that insofar as I was on board for one “miracle” well beyond the reach of materialist science—“the marvel of consciousness,” as Vladimir Nabokov once called it, “that sudden window swinging open on a sunlit landscape amidst the night of non-being”—maybe I needed to keep a more open mind to the possibility of others.
IN DECEMBER 2016, a front-page story in the New York Times reported on the dramatic results of the Johns Hopkins and NYU psilocybin cancer studies, which were published together in a special issue of the Journal of Psychopharmacology, along with nearly a dozen commentaries from prominent voices in the mental health establishment—including two past presidents of the American Psychiatric Association—hailing the findings.
In both the NYU and the Hopkins trials, some 80 percent of cancer patients showed clinically significant reductions in standard measures of anxiety and depression, an effect that endured for at least six months after their psilocybin session. In both trials, the intensity of the mystical experience volunteers reported closely correlated with the degree to which their symptoms subsided. Few if any psychiatric interventions of any kind have demonstrated such dramatic and sustained results.*
The trials were small—eighty subjects in all—and will have to be repeated on a larger scale before the government will consider rescheduling psilocybin and approving the treatment.* But the results were encouraging enough to win the attention and cautious support of the mental health community, which has called for more research. Dozens of medical schools have asked to participate in future trials, and funders have stepped forward to underwrite those trials. After decades in the shadows, psychedelic therapy is suddenly respectable again, or nearly so. New York University, which proudly promoted the results of a trial it had once only tolerated somewhat grudgingly, invited Stephen Ross to move his treatment room from the dental college into the main hospital. Even the NYU cancer center, which had initially been reluctant to refer patients to the psilocybin trial, asked Ross to set up a treatment room on its premises for an upcoming trial.
The papers offered little in the way of a theory to explain the effects of psilocybin, except to point out that the patients with the best outcomes were the ones who had the most complete mystical experience. But exactly why should that experience translate into relief from anxiety and depression? Is it the intimation of some kind of immortality that accounts for the effect? This seems too simple and fails to account for the variety of experiences people had, many of which did not dwell on an afterlife. And some of the ones that did conceived of what happens after death in naturalistic terms, as when the anonymous volunteer imagined herself as “part of the earth,” molecules of matter being taken up by the roots of trees. This really happens.
Of course the mystical experience consists of several components, most of which don’t require a supernatural explanation. The dissolution of the sense of self, for example, can be understood in either psychological or neurobiological terms (as possibly the disintegration of the default mode network) and may explain many of the benefits people experienced during their journeys without resort to any spiritual conception of “oneness.” Likewise, the sense of “sacredness” that classically accompanies the mystical experience can be understood in more secular terms as simply a heightened sense of meaning or purpose. It’s still early days in our understanding of consciousness, and no single one of our vocabularies for approaching the subject—the biological, the psychological, the philosophical, or the spiritual—has yet earned the right to claim it has the final word. It may be that by layering these different perspectives one upon the other, we can gain the richest picture of what might be going on.
In a follow-up study to the NYU trial, “Patient Experiences of Psilocybin-Assisted Psychotherapy,” published in the Journal of Humanistic Psychology in 2017, Alexander Belser, a member of the NYU team, interviewed volunteers to better understand the psychological mechanisms underlying the transformations they experienced. I read the study as a subtle attempt to move beyond the mystical experience paradigm to a more humanistic one and at the same time to underscore the importance of the psychotherapist in the psychedelic experience. (Note the use of the term “psilocybin-assisted psychotherapy” in the title; neither of the papers in Psychopharmacology mentioned psychotherapy in its title, only the drug.)
A few key themes emerged. All of the patients interviewed described powerful feelings of connection to loved ones (“relational embeddedness” is the term the authors used) and, more generally, a shift “from feelings of separateness to interconnectedness.” In most cases, this shift was accompanied by a repertoire of powerful emotions, including “exalted feelings of joy, bliss, and love.” Difficult passages during the journey were typically followed by positive feelings of surrender and acceptance (even of their cancers) as people’s fears fell away.
Jeffrey Guss, a coauthor on the paper and a psychiatrist, interprets what happens during the session in terms of the psilocybin’s “egolytic” effects—the drug’s ability to either silence or at least muffle the voice of the ego. In his view, which is informed by his psychoanalytic training, the ego is a mental construct that performs certain functions on behalf of the self. Chief among these are maintaining the boundary between the conscious and the unconscious realms of the mind and the boundary between self and other, or subject and object. It is only when these boundaries fade or disappear, as they seem to do under the influence of psychedelics, that we can “let go of rigid patterns of thought, allowing us to perceive new meanings with less fear.”
The whole question of meaning is central to the approach of the NYU therapists,* and is perhaps especially helpful in understanding the experience of the cancer patients on psilocybin. For many of these patients, a diagnosis of terminal cancer constitutes, among other things, a crisis of meaning. Why me? Why have I been singled out for this fate? Is there any sense to life and the universe? Under the weight of this existential crisis, one’s horizon shrinks, one’s emotional repertoire contracts, and one’s focus narrows as the mind turns in on itself, shutting out the world. Loops of rumination and worry come to occupy more of one’s mental time and space, reinforcing habits of thought it becomes ever more difficult to escape.
Existential distress at the end of life bears many of the hallmarks of a hyperactive default network, including obsessive self-reflection and an inability to jump the deepening grooves of negative thinking. The ego, faced with the prospect of its own extinction, turns inward and becomes hypervigilant, withdrawing its investment in the world and other people. The cancer patients I interviewed spoke of feeling closed off from loved ones, from the world, and from the full range of emotions; they felt, as one put it, “existentially alone.”
By temporarily disabling the ego, psilocybin seems to open a new field of psychological possibility, symbolized by the death and rebirth reported by many of the patients I interviewed. At first, the falling away of the self feels threatening, but if one can let go and surrender, powerful and usually positive emotions flow in—along with formerly inaccessible memories and sense impressions and meanings. No longer defended by the ego, the gate between self and other—Huxley’s reducing valve—is thrown wide open. And what comes through that opening for many people, in a great flood, is love. Love for specific individuals, yes, but also, as Patrick Mettes came to feel (to know!), love for everyone and everything—love as the meaning and purpose of life, the key to the universe, and the ultimate truth.
So it may be that the loss of self leads to a gain in meaning. Can this be explained biologically? Probably not yet, but recent neuroscience offers a few intriguing clues. Recall that the Imperial College team found that when the default mode network disintegrates (taking with it the sense of self), the brain’s overall connectivity increases, allowing brain regions that don’t ordinarily communicate to form new lines of connection. Is it possible that some of these new connections in the brain manifest in the mind as new meanings or perspectives? The connecting of formerly far-flung dots?
It may also be that psychedelics can directly imbue otherwise irrelevant sensory information with meaning. A recent paper in Current Biology* described an experiment in which pieces of music that held no personal relevance for volunteers were played for them while on LSD. Under the influence of the psychedelic, however, volunteers attributed marked and lasting personal meaning to the same songs.These medicines may help us construct meaning, if not discover it.
No doubt the suggestibility of the mind on psychedelics and the guiding presence of psychotherapists also play a role in attributing meaning to the experience. In preparing volunteers for their journeys, Jeffrey Guss speaks explicitly about the acquisition of meaning, telling his patients “that the medicine will show you hidden or unknown shadow parts of yourself; that you will gain insight into yourself, and come to learn about the meaning of life and existence.” (He also tells them they may have a mystical or transcendent experience but carefully refrains from defining it.) “As a result of this molecule being in your body, you’ll understand more about yourself and life and the universe.” And more often than not this happens. Replace the science-y word “molecule” with “sacred mushroom” or “plant teacher,” and you have the incantations of a shaman at the start of a ceremonial healing.
But however it works, and whatever vocabulary we use to explain it, this seems to me the great gift of the psychedelic journey, especially to the dying: its power to imbue everything in our field of experience with a heightened sense of purpose and consequence. Depending on one’s orientation, this can be understood either in humanistic or in spiritual terms—for what is the Sacred but a capitalized version of significance? Even for atheists like Dinah Bazer—like me!—psychedelics can charge a world from which the gods long ago departed with the pulse of meaning, the immanence with which they once infused it. The sense of a cold and arbitrary universe governed purely by chance is banished. Especially in the absence of faith, these medicines, in the right hands, may offer powerful antidotes for the existential terrors that afflict not only the dying.
To believe that life has any meaning at all is of course a large presumption, requiring in some a leap of faith, but surely it is a helpful one, and never more so than at the approach of death. To situate the self in a larger context of meaning, whatever it is—a sense of oneness with nature or universal love—can make extinction of the self somewhat easier to contemplate. Religion has always understood this wager, but why should religion enjoy a monopoly? Bertrand Russell wrote that the best way to overcome one’s fear of death “is to make your interests gradually wider and more impersonal, until bit by bit the walls of the ego recede, and your life becomes increasingly merged in the universal life.” He goes on:
An individual human existence should be like a river: small at first, narrowly contained within its banks, and rushing passionately past rocks and over waterfalls. Gradually, the river grows wider, the banks recede, the waters flow more quietly, and in the end, without any visible break, they become merged in the sea, and painlessly lose their individual being.
PATRICK METTES lived seventeen months after his psilocybin session, and according to Lisa those months were filled with a great many unexpected satisfactions, alongside Patrick’s dawning acceptance that he was going to die.
Lisa had initially been wary of the NYU trial, interpreting Patrick’s desire to participate as a sign he’d given up the fight. In the event, he came away convinced he still had much to do in this life—much love to give and receive—and wasn’t yet ready to leave it and, especially, his wife. Patrick’s psychedelic journey had shifted his perspective, from a narrow lens trained on the prospect of dying to a renewed focus on how best to live the time left to him. “He had a new resolve. That there was a point to his life, that he got it, and was moving with it.
“We still had our arguments,” Lisa recalled, “and we had a very trying summer” as they endured a calamitous apartment renovation in Brooklyn. “That was hell on earth,” Lisa recalled, but Patrick “had changed. He had a sense of patience he had never had before, and with me he had real joy about things. It was as if he had been relieved of the duty of caring about the details of life, and he could let all that go. Now it was about being with people, enjoying his sandwich and the walk on the promenade. It was as if we lived a lifetime in a year.”
After the psilocybin session, Lisa somehow convinced herself that Patrick was not going to die after all. He continued with his chemo and his spirits improved, but she now thinks all this time “he knew very well he wasn’t going to make it.” Lisa continued to work, and Patrick spent his good days walking the city. “He would walk everywhere, try every restaurant for lunch, and tell me about all the great places he discovered. But his good days got fewer and fewer.” Then, in March 2012, he told her he wanted to stop chemo.
“He didn’t want to die,” Lisa says, “but I think he just decided that this is not how he wanted to live.”
That fall his lungs began to fail, and Patrick wound up in the hospital. “He gathered everyone together and said good-bye and explained that this is how he wanted to die. He had a very conscious death.” Patrick’s seeming equanimity in the face of death exerted a powerful influence on everyone around him, Lisa said, and his room in the palliative care unit at Mount Sinai became a center of gravity in the hospital. “Everyone, the nurses and the doctors, wanted to hang out in our room; they just didn’t want to leave. Patrick would talk and talk. It was like he was a yogi. He put out so much love.” When Tony Bossis visited Patrick a week before he died, he was struck by the mood in the room and by Patrick’s serenity.
“He was consoling me. He said his biggest sadness was leaving his wife. But he was not afraid.”
Lisa e-mailed me a photograph of Patrick she had taken a few days before he died, and when the image popped open on my screen, it momentarily took my breath away. Here was an emaciated man in a hospital gown, an oxygen clip in his nose, but with bright, shining blue eyes and a broad smile. On the eve of death, the man was beaming.
Lisa stayed with Patrick in his hospital room night after night, the two of them often talking into the wee hours. “I feel like I have one foot in this world and one in the next,” he told her at one point. “One of the last nights we were together, he said, ‘Honey, don’t push me. I’m finding my way.’” At the same time, he sought to comfort her. “This is simply the wheel of life,” she recalls him saying. “‘You feel like you’re being ground down by it now, but the wheel is going to turn and you’ll be on top again.’”
Lisa hadn’t had a shower in days, and her brother finally persuaded her to go home for a few hours. Minutes before she returned to his bedside, Patrick slipped away. “I went home to shower and he died.” We were speaking on the phone, and I could hear her crying softly. “He wasn’t going to die as long as I was there. My brother had told me, ‘You need to let him go.’”
Patrick was gone by the time she got back to the hospital. “He had died seconds before. It was like something had evaporated from him. I sat with him for three hours. It’s a long time before the soul is out of the room.”
“It was a good death,” Lisa told me, a fact she credits to the people at NYU and to Patrick’s psilocybin journey. “I feel indebted to them for what they allowed him to experience—the deep resources they allowed him to tap into. These were his own deep resources. That, I think, is what these mind-altering drugs do.”
“Patrick was far more spiritual than I was to begin with,” Lisa told me the last time we spoke. It was clear his journey had changed her too. “It was an affirmation of a world I knew nothing about. But there are more dimensions to this world than I ever knew existed.”
The dozen or so Apollo astronauts who have escaped Earth’s orbit and traveled to the moon had the privilege of seeing the planet from a perspective never before available to our species, and several of them reported that the experience changed them in profound and enduring ways. The sight of that “pale blue dot” hanging in the infinite black void of space erased the national borders on our maps and rendered Earth small, vulnerable, exceptional, and precious.
Edgar Mitchell, returning from the moon on Apollo 14, had what he has described as a mystical experience, specifically a savikalpa samadhi, in which the ego vanishes when confronted with the immensity of the universe during the course of a meditation on an object—in this case, planet Earth.
“The biggest joy was on the way home,” he recalled. “In my cockpit window, every two minutes: the earth, the moon, the sun, and the whole panorama of the heavens. That was a powerful, overwhelming experience.
“And suddenly I realized that the molecules of my body, and the molecules of my spacecraft, the molecules in the body of my partners, were prototyped, manufactured in some ancient generation of stars. [I felt] an overwhelming sense of oneness, of connectedness . . . It wasn’t ‘Them and Us,’ it was ‘That’s me! That’s all of it, it’s one thing.’ And it was accompanied by an ecstasy, a sense of ‘Oh my God, wow, yes’—an insight, an epiphany.”*
It was the power of this novel perspective—the same perspective that Stewart Brand, after his 1966 LSD trip on a North Beach rooftop, worked so hard to disseminate to the culture—that helped to inspire the modern environmental movement as well as the Gaia hypothesis, the idea that Earth and its atmosphere together constitute a single living organism.
I thought about this so-called overview effect during my conversations with volunteers in the psilocybin trials, and especially with those who had overcome their addictions after a psychedelic journey—to inner space, if you will. Several volunteers described achieving a new distance on their own lives, a vantage from which matters that had once seemed daunting now seemed smaller and more manageable, including their addictions. It sounded as though the psychedelic experience had given many of them an overview effect on the scenes of their own lives, making possible a shift in worldview and priorities that allowed them to let go of old habits, sometimes with remarkable ease. As one lifetime smoker put it to me in terms so simple I found it hard to believe, “Smoking became irrelevant, so I stopped.”
The smoking cessation pilot study in which this man took part—his name is Charles Bessant, and he has been abstinent now for six years—was directed by Matthew Johnson, a protégé of Roland Griffiths’s at Johns Hopkins, where the study took place. Johnson is a psychologist in his early forties who, like Griffiths, trained as a behaviorist, studying things like “operant conditioning” in rats. Tall, slender, and angular, Johnson wears a scrupulously trimmed black beard and oversized retro-nerd black glasses that make him look a little like Ira Glass. His interest in psychedelics goes back to his college days, when he read Ram Dass and learned about the Harvard Psilocybin Project, but never did he dare to imagine he would someday have a job working with them in a laboratory.
“I had it in the back of my mind that someday I wanted to do research with the psychedelic compounds,” he told me when we first met in his Hopkins office, “but I figured that was a long way off in the future.” Yet soon after Johnson arrived at Johns Hopkins to do a pharmacology postdoc in 2004, “I found out that Roland had this super hush-hush project with psilocybin. Everything lined up perfectly.”
Johnson worked on the lab’s early psilocybin studies, serving as a guide for several dozen sessions and helping to crunch the data, before launching a study of his own in 2009. The smoking study gave fifteen volunteer smokers who were trying to quit several sessions of cognitive behavioral therapy followed by two or three doses of psilocybin. A so-called open-label study, there was no placebo, so they all knew they were getting the drug. Volunteers had to stop smoking before their psilocybin session; they had their carbon-monoxide levels measured at several intervals to ensure compliance and confirm they remained abstinent.
The study was tiny and not randomized, but the results were nevertheless striking, especially when you consider that smoking is one of the most difficult addictions to break—harder, some say, than heroin. Six months after their psychedelic sessions, 80 percent of the volunteers were confirmed as abstinent; at the one-year mark, that figure had fallen to 67 percent, which is still a better rate of success than the best treatment now available. (A much larger randomized study, comparing the effectiveness of psilocybin therapy with the nicotine patch, is currently under way.) As in the cancer-anxiety studies, the volunteers who had the most complete mystical experiences had the best outcomes; they were, like Charles Bessant, able to quit smoking.
After interviewing cancer patients confronted with the prospect of death, people who had had epic journeys in which they confronted their cancers and traveled to the underworld, I wondered how the experience would compare when the stakes were lower: What kinds of journeys would ordinary people simply hoping to break a bad habit have, and what kinds of insights would they return with?
Surprisingly banal, it turns out. Not that their journeys were banal—psilocybin transported them all over the world and through history and to outer space—but the insights they brought back with them were mundane in the extreme. Alice O’Donnell, a sixtyish book editor born in Ireland, reveled “in the freedom to go everywhere” in the course of her journey. She grew feathers that allowed her to travel back in time to various scenes of European history, died three times, watched her “soul move from her body to a funeral pyre floating on the Ganges,” and found herself “standing on the edge of the universe, witnessing the dawn of creation.” She had the “humbling” realization that “everything in the universe is of equal importance, including yourself.
“Instead of being so narrowly focused, moving through this little tunnel of adult life,” she found that the journey “returned me to the child’s wider sense of wonder—to the world of Wordsworth. A part of my brain that had gone to sleep was awakened.
“The universe was so great and there were so many things you could do and see in it that killing yourself seemed like a dumb idea. It put smoking in a whole new context. Smoking seemed very unimportant; it seemed kind of stupid, to be honest.”
Alice imagined herself throwing out lots of junk from her house, emptying the attic and the basement: “I had an image of tossing everything over the ledge, all the stuff I didn’t need anymore. It’s amazing how you can whittle things down to the few really important things that are necessary for survival. And the most important thing of all is the breath. When that stops, you’re dead.” She emerged from her journey with the conviction “that you should cherish your breath.” She has not had a cigarette since her psilocybin journey. Whenever she feels a craving, she goes back in memory to her session “and thinks of all the wonderful things I experienced, and how it felt to be on that much higher plane.”
Charles Bessant had his epiphany while on a similarly “higher plane.” Bessant, a museum exhibit designer in his sixties, found himself standing on a mountaintop in the Alps, “the German states stretching out before me all the way to the Baltic.” (Wagner was playing in his headphones.) “My ego had dissolved, yet I’m telling you this. It was terrifying.” He sounded like a nineteenth-century Romantic describing an encounter with the sublime, at once terrible and awe inspiring.
“People use words like ‘oneness,’ ‘connectivity,’ ‘unity’—I get it! I was part of something so much larger than anything I had ever imagined.” We were speaking by phone on a Saturday morning, and at one point Bessant paused in his account to describe the scene before him.
“Right now, I’m standing here in my garden, and the light is coming through the canopy of leaves. For me to be able to stand here in the beauty of this light, talking to you, it’s only because my eyes are open to see it. If you don’t stop to look, you’ll never see it. It’s the statement of an obvious thing, I know, but to feel it, to look and be amazed by this light” is a gift he attributes to his session, which gave him “a feeling of connectedness to everything.”
Bessant followed up on our conversation by e-mail with a series of clarifications and elaborations, striving to find the words equal to the immensity of the experience. It was in the face of this immensity that smoking suddenly seemed pitifully small. “Why quit smoking? Because I found it irrelevant. Because other things had become so much more important.”
Some volunteers marveled themselves at the simultaneous power and banality of their insights. Savannah Miller is a single mom in her thirties who works as a bookkeeper for her father’s company in Maryland. Possibly because she spent her twenties tangled in an abusive relationship with a man she describes as “a psychopath,” her trip was painful but ultimately cathartic; she remembers crying uncontrollably and producing tremendous amounts of snot (something her guides confirmed really happened). Savannah gave little thought to her habit during the journey, except toward the end when she pictured herself as a smoking gargoyle.
“You know how gargoyles look, crouched down with their shoulders hunched? That’s how I felt and saw myself, a little golem creature smoking, pulling in the smoke and not letting it out, until my chest hurts and I’m choking. It was powerful and disgusting. I can still see it now, that hideous coughing gargoyle, whenever I picture myself as a smoker.” Months later, she says the image is still helpful when the inevitable cravings arise.
In the middle of her session, Savannah suddenly sat up and announced she had discovered something important, an “epiphany” that her guides needed to write down so it wouldn’t be lost to posterity: “Eat right. Exercise. Stretch.”
Matt Johnson refers to these realizations as “duh moments” and says they are common among his volunteers and not at all insignificant. Smokers know perfectly well that their habit is unhealthy, disgusting, expensive, and unnecessary, but under the influence of psilocybin that knowing acquires a new weight, becomes “something they feel in the gut and the heart. Insights like this become more compelling, stickier, and harder to avoid thinking about. These sessions deprive people of the luxury of mindlessness”—our default state, and one in which addictions like smoking can flourish.
Johnson believes the value of psilocybin for the addict is in the new perspective—at once obvious and profound—that it opens onto one’s life and its habits. “Addiction is a story we get stuck in, a story that gets reinforced every time we try and fail to quit: ‘I’m a smoker and I’m powerless to stop.’ The journey allows them to get some distance and see the bigger picture and to see the short-term pleasures of smoking in the larger, longer-term context of their lives.”
Of course, this re-contextualization of an old habit doesn’t just happen; countless people have taken psilocybin and continued to smoke. If it does happen, it’s because breaking the habit is the avowed intention of the session, strongly reinforced by the therapist in the preparatory meetings and the integration afterward. The “set” of the psychedelic journey is carefully orchestrated by the therapist in much the same way a shaman would use his authority and stagecraft to maximize the medicine’s deep powers of suggestion. This is why it is important to understand that “psychedelic therapy” is not simply treatment with a psychedelic drug but rather a form of “psychedelic-assisted therapy,” as many of the researchers take pains to emphasize.
Yet what accounts for the unusual authority of the rather ordinary insights volunteers brought back from their journeys? “You don’t get that on any other drug,” Roland Griffiths points out. Indeed, after most drug experiences, we’re fully aware of, and often embarrassed by, the inauthenticity of what we thought and felt while under the influence. Though neither Griffiths nor Johnson mentioned it, the connection between seeing and believing might explain this sense of authenticity. Very often on psychedelics our thoughts become visible. These are not hallucinations, exactly, because the subject is often fully aware that what she is seeing is not really before her, yet these thoughts made visible are nevertheless remarkably concrete, vivid, and therefore memorable.
This is a curious phenomenon, as yet unexplained by neuroscience, though some interesting hypotheses have recently been proposed. When neuroscientists who study vision use fMRIs to image brain activity, they find that the same regions in the visual cortex light up whether one is seeing an object live—“online”—or merely recalling or imagining it, off-line. This suggests that the ability to visualize our thoughts should be the rule rather than the exception. Some neuroscientists suspect that during normal waking hours something in the brain inhibits the visual cortex from presenting to consciousness a visual image of whatever it is we’re thinking about. It’s not hard to see why such an inhibition might be adaptive: cluttering the mind with vivid images would complicate reasoning and abstract thought, not to mention everyday activities like walking or driving a car. But when we are able to visualize our thoughts—such as the thought of ourselves as a smoker looking like a coughing gargoyle—those thoughts take on added weight, feel more real to us. Seeing is believing.
Perhaps this is one of the things psychedelics do: relax the brain’s inhibition on visualizing our thoughts, thereby rendering them more authoritative, memorable, and sticky. The overview effect reported by the astronauts didn’t add anything to our intellectual understanding of this “pale blue dot” in the vast sea of space, but seeing it made it real in a way it had never been before. Perhaps the equally vivid overview effect on the scenes of their lives that psychedelics afford some people is what makes it possible for them to change their behavior.
Matt Johnson believes that psychedelics can be used to change all sorts of behaviors, not just addiction. The key, in his view, is their power to occasion a sufficiently dramatic experience to “dope-slap people out of their story. It’s literally a reboot of the system—a biological control-alt-delete. Psychedelics open a window of mental flexibility in which people can let go of the mental models we use to organize reality.”
In his view, the most important such model is the self, or ego, which a high-dose psychedelic experience temporarily dissolves. He speaks of “our addiction to a pattern of thinking with the self at the center of it.” This underlying addiction to a pattern of thinking, or cognitive style, links the addict to the depressive and to the cancer patient obsessed with death or recurrence.
“So much of human suffering stems from having this self that needs to be psychologically defended at all costs. We’re trapped in a story that sees ourselves as independent, isolated agents acting in the world. But that self is an illusion. It can be a useful illusion, when you’re swinging through the trees or escaping from a cheetah or trying to do your taxes. But at the systems level, there is no truth to it. You can take any number of more accurate perspectives: that we’re a swarm of genes, vehicles for passing on DNA; that we’re social creatures through and through, unable to survive alone; that we’re organisms in an ecosystem, linked together on this planet floating in the middle of nowhere. Wherever you look, you see that the level of interconnectedness is truly amazing, and yet we insist on thinking of ourselves as individual agents.” Albert Einstein called the modern human’s sense of separateness “a kind of optical delusion of his consciousness.”*
“Psychedelics knock the legs out from under that model. That can be dangerous in the wrong circumstances, leading to bad trips and worse.” Johnson brought up the case of Charles Manson, who reportedly used LSD to break down and brainwash his followers, a theory of the case he deems plausible. “But in the right setting, where your safety is assured, it may be a good intervention for dealing with some of the problems of the self”—of which addiction is only one. Dying, depression, obsession, eating disorders—all are exacerbated by the tyranny of an ego and the fixed narratives it constructs about our relationship to the world. By temporarily overturning that tyranny and throwing our minds into an unusually plastic state (Robin Carhart-Harris would call it a state of heightened entropy), psychedelics, with the help of a good therapist, give us an opportunity to propose some new, more constructive stories about the self and its relationship to the world, stories that just might stick.
This is a very different kind of therapy than we are accustomed to in the West, because it is neither purely chemical nor purely psychodynamic—neither mindless nor brainless. Whether Western medicine is ready to accommodate such a radically novel—and ancient—model for mental transformation is an open question. In taking people safely through the liminal state psychedelics occasion, with its radical suggestibility, Johnson acknowledges that the doctors and researchers “play the same role as shamans or elders.
“Whatever we’re delving into here, it’s in the same realm as the placebo. But a placebo on rocket boosters.”
THE WHOLE IDEA of using a psychedelic drug to treat addiction is not new. Native Americans have long used peyote as both a sacrament and a treatment for alcoholism, a scourge of the indigenous community since the arrival of the white man. Speaking at a meeting of the American Psychiatric Association in 1971, the psychiatrist Karl Menninger said that “peyote is not harmful to these people . . . It is a better antidote to alcohol than anything the missionaries, the white man, the American Medical Association, and the public health services have come up with.”*
Thousands of alcoholics were treated with LSD and other psychedelics in the 1950s and 1960s, though until recently it’s been hard to say anything definitive about the results. For a time, the therapy was deemed effective enough to become a standard treatment for alcoholism in Saskatchewan. Clinical reports were enthusiastic, yet most of the formal studies conducted were poorly designed and badly controlled, if at all. Results were notably impressive when the studies were performed by sympathetic therapists (and especially by therapists who themselves had taken LSD) and notably dismal when conducted by inexperienced investigators who gave mammoth doses to patients with no attention to set or setting.
The record was a complete muddle until 2012, when a meta-analysis that combined data from the six best randomized controlled studies done in the 1960s and 1970s (involving more than five hundred patients in all) found that indeed there had been a statistically robust and clinically “significant beneficial effect on alcohol misuse” from a single dose of LSD, an effect that lasted up to six months. “Given the evidence for a beneficial effect of LSD on alcoholism,” the authors concluded, “it is puzzling why this treatment has been largely overlooked.”
Since then, psychedelic therapy for alcohol and other addictions has undergone a modest and so far encouraging revival, both in university studies and in various underground settings.* In a 2015 pilot study conducted at the University of New Mexico ten alcoholics received psilocybin, combined with “motivational enhancement therapy,” a type of cognitive behavioral therapy designed expressly to treat addiction. By itself, the psychotherapy had little effect on drinking behavior, but after the psilocybin session drinking decreased significantly, and these changes were sustained during the thirty-six weeks of follow-up. Michael Bogenschutz, the lead investigator, reported a strong correlation between the “strength of the experience and the effect” on drinking behavior. The New Mexico results were encouraging enough to warrant a much larger phase 2 trial, involving 180 volunteers, which Bogenschutz is now conducting at NYU in collaboration with Stephen Ross and Jeffrey Guss.
“Alcoholism can be understood as a spiritual disorder,” Ross told me the first time we met, in the treatment room at NYU. “Over time you lose your connection to everything but this compound. Life loses all meaning. At the end, nothing is more important than that bottle, not even your wife and your kids. Eventually, there is nothing you won’t sacrifice for it.”
It was Ross who first told me the story of Bill W., the founder of AA, how he got sober after a mystical experience on belladonna and in the 1950s sought to introduce LSD into the fellowship. To use a drug to promote sobriety might sound counterintuitive, even crazy, yet it makes a certain sense when you consider how reliably psychedelics can sponsor spiritual breakthroughs as well as the conviction, central to the AA philosophy, that before she can hope to recover, the alcoholic must first acknowledge her “powerlessness.” AA takes a dim view of the human ego and, like psychedelic therapy, attempts to shift the addict’s attention from the self to a “higher power” as well as to the consolations of fellowship—the sense of interconnectedness.
Michael Bogenschutz put me in touch with a woman I’ll call Terry McDaniels, a volunteer in his alcoholism pilot study in New Mexico—a surprising introduction, I came to think, because hers wasn’t the kind of unqualified success story researchers like to give journalists. I spoke to McDaniels by phone from her trailer park outside Albuquerque, where she lives on disability a few trailers down from her daughter. She hasn’t been able to work since 1997, when “my ex-husband beat my head in with a cast-iron skillet. Since that occurred, I’ve had a real problem with my memory.”
McDaniels, who was born in 1954, has had a tough life, going back to her childhood, when her parents left her for long periods in the indifferent care of older siblings. “Even to this day I have a hard time laughing.” She told me she spends many of her days mired in feelings of regret, anger, envy, self-loathing, and, especially, a deep sense of guilt toward her children. “I feel very bad I haven’t given them the life I could have if I had stayed away from drink. I think about that other life I might have had all the time.”
When I asked McDaniels how long she had been sober, she surprised me: she wasn’t. She’d actually been on a bender just a few weeks earlier, after her daughter “hurt my feelings by asking for money I owed her.” But the binge lasted only a day, and she had only had beer and wine to drink; in the years before her psychedelic session, she would binge on hard liquor for two weeks at a time, the drinking interrupted only when she blacked out. For McDaniels, a one-day binge now and again represents progress.
McDaniels read about the psilocybin trial in the local alternative weekly. She had never before used a psychedelic but felt desperate and willing to try something new. She had made many attempts to get sober, had been in rehab, therapy, and AA, but always fell back on the bottle. She worried that her head injury might disqualify her from the trial, but she was accepted and in the event had a powerful spiritual experience.
The first part of the trip was unbearably dark: “I saw my children and I was bawling and bawling, for the life they never had.” But eventually it turned into something awe inspiring.
“I saw Jesus on the cross,” she recalled. “It was just his head and shoulders, and it was like I was a little kid in a tiny helicopter circling around his head. But he was on the cross. And he just sort of gathered me up in his hands, you know, the way you would comfort a small child. I felt such a great weight lift from my shoulders, felt very much at peace. It was a beautiful experience.”
The teaching of the experience, she felt, was self-acceptance. “I spend less time thinking about people who have a better life than me. I realize I’m not a bad person; I’m a person who’s had a lot of bad things happen. Jesus might have been trying to tell me it was okay, that these things happen. He was trying to comfort me.” Now, McDaniels says, “I read my Bible every day and keep a conscious contact with God.”
By her own lights, McDaniels is doing, if not well exactly, then somewhat better. The experience has helped her begin to rethink the story of her life she tells herself: “I don’t take everything so personally, like I used to. I have more self-acceptance, and that is a gift, because for a lot of years, I did not like myself. But I am not a bad person.”
That one’s perspective could shift in such a way in the absence of any change in circumstance strikes me as both hopeful and poignant. I was reminded of an experiment that several of the addiction researchers I interviewed had told me about—the so-called rat park experiment. It’s well known in the field of drug abuse research that rats in a cage given access to drugs of various kinds will quickly addict themselves, pressing the little levers for the drug on offer in preference to food, often to the point of death. Much less well known, however, is the fact that if the cage is “enriched” with opportunities for play, interaction with other rats, and exposure to nature, the same rats will utterly ignore the drugs and so never become addicted. The rat park experiments lend support to the idea that the propensity to addiction might have less to do with genes or chemistry than with one’s personal history and environment.
Now comes a class of chemicals that may have the power to change how we experience our personal history and environment, no matter how impoverished or painful they may be. “Do you see the world as a prison or a playground?” is the key question Matt Johnson takes away from the rat park experiment. If addiction represents a radical narrowing of one’s perspective and behavior and emotional repertoire, the psychedelic journey has the potential to reverse that constriction, open people up to the possibility of change by disrupting and enriching their interior environment.
“People come out of these experiences seeing the world a little more like a playground.”
ONE GOOD WORD to describe the experiences of both the Apollo astronauts and the volunteers on their psilocybin journeys is “awe,” a human emotion that can perhaps help weave together the disparate strands of psychological interpretation proposed by the psychedelic researchers with whom I spoke. It was Peter Hendricks, a young psychologist at the University of Alabama conducting a trial using psilocybin to treat cocaine addicts, who first suggested to me that the experience of awe might offer the psychological key to explain the power of psychedelics to alter deeply rooted patterns of behavior.
“People who are addicted know they’re harming themselves—their health, their careers, their social well-being—but they often fail to see the damage their behavior is doing to others.” Addiction is, among other things, a radical form of selfishness. One of the challenges of treating the addict is getting him to broaden his perspective beyond a consuming self-interest in his addiction, the behavior that has come to define his identity and organize his days. Awe, Hendricks believes, has the power to do this.
Hendricks mentioned the research of Dacher Keltner, a psychologist at Berkeley who happens to be a close friend. “Keltner believes that awe is a fundamental human emotion, one that evolved in us because it promotes altruistic behavior. We are descendants of those who found the experience of awe blissful, because it’s advantageous for the species to have an emotion that makes us feel part of something much larger than ourselves.” This larger entity could be the social collective, nature as a whole, or a spirit world, but it is something sufficiently overpowering to dwarf us and our narrow self-interest. “Awe promotes a sense of the ‘small self’ that directs our attention away from the individual to the group and the greater good.”
Keltner’s lab at Berkeley has done a clever series of experiments demonstrating that after people have had even a relatively modest experience of awe, such as looking at soaring trees, they’re more likely to come to the assistance of others. (In this experiment, conducted in a eucalyptus grove on the Berkeley campus, volunteers spent a minute looking either at the trees or at the façade of a nearby building. Then a confederate walked toward the participants and stumbled, scattering pens on the ground. Bystanders who had looked at the trees proved more likely to come to her aid than those who had looked at the building.) In another experiment, Keltner’s lab found that if you ask people to draw themselves before and after viewing awe-inspiring images of nature, the after-awe self-portraits will take up considerably less space on the page. An experience of awe appears to be an excellent antidote for egotism.
“We now have a pharmacological intervention that can occasion truly profound experiences of awe,” Hendricks pointed out. Awe in a pill. For the self-obsessed addict, “it can be blissful to feel a part of something larger and greater than themselves, to feel reconnected to other people”—to the weave of social and family relations that addiction reliably frays. “Very often they come to recognize the harm they’re doing not only to themselves but to loved ones. That’s where the motivation to change often comes from—a renewed sense of connection and responsibility, as well as the positive feeling of being a small self in the presence of something greater.”
The concept of awe, I realized, could help connect several of the dots I’d been collecting in the course of my journey through the landscape of psychedelic therapy. Whether awe is a cause or an effect of the mental changes psychedelics sponsor isn’t entirely clear. But either way, awe figures in much of the phenomenology of psychedelic consciousness, including the mystical experience, the overview effect, self-transcendence, the enrichment of our inner environment, and even the generation of new meanings. As Keltner has written, the overwhelming force and the mystery of awe are such that the experience can’t readily be interpreted according to our accustomed frames of thought. By rocking those conceptual frameworks, awe has the power to change our minds.
Something unexpected happened when, early in 2017, Roland Griffiths and Stephen Ross brought the results of their clinical trials to the FDA, hoping to win approval for a larger, phase 3 trial of psilocybin for cancer patients. Impressed by their data—and seemingly undeterred by the unique challenges posed by psychedelic research, such as the problem of blinding, the combining of therapy and medicine, and the fact that the drug in question is still illegal—the FDA staff surprised the researchers by asking them to expand their focus and ambition: to test whether psilocybin could be used to treat the much larger and more pressing problem of depression in the general population. As the regulators saw it, the data contained a strong enough “signal” that psilocybin could relieve depression; it would be a shame not to test the proposition, given the enormity of the need and the limitations of the therapies now available. Ross and Griffiths had focused on cancer patients because they thought it would be easier to win approval to study a controlled substance in people who were already seriously ill or dying. Now the government was telling them to raise their sights. “It was surreal,” Ross told me, twice, as he recounted the meeting, still somewhat stunned at the response and outcome. (The FDA declined to confirm or deny this account of the meeting, explaining that it doesn’t comment on drugs in development or under regulatory review.)
Much the same thing happened in Europe, when, in 2016, researchers approached the European Medicines Agency (EMA)—the European Union’s drug-regulating body—seeking approval to use psilocybin in the treatment of anxiety and depression in patients with life-changing diagnoses. “Existential distress” is not an official DSM diagnosis, the regulators pointed out, so the national health services won’t cover it. But there’s a signal here that psilocybin could be useful in treating depression, so why don’t you do a big, multisite trial for that?
The EMA was responding not only to the Hopkins and NYU data but also to the small “feasibility study” of the potential of using psilocybin to treat depression that Robin Carhart-Harris had directed in David Nutt’s lab at Imperial College. In the study, the initial results of which appeared in Lancet Psychiatry in 2016, researchers gave psilocybin to six men and six women suffering from “treatment-resistant depression”—meaning they had already tried at least two treatments without success. There was no control group, so everyone knew he or she was getting psilocybin.
After a week, all of the volunteers showed improvement in their symptoms, and two-thirds of them were depression-free, in some cases for the first time in years. Seven of the twelve volunteers still showed substantial benefit after three months. The study was expanded to include a total of twenty volunteers; after six months, six remained in remission, while the others had relapsed to one degree or another, suggesting the treatment might need to be repeated. The study was modest in scale and not randomized, but it demonstrated that psilocybin was well tolerated in this population, with no adverse events, and most of the subjects had seen benefits that were marked and rapid.* The EMA was sufficiently impressed with the data to suggest a much larger trial for treatment-resistant depression, which afflicts more than 800,000 people in Europe. (This is out of a total of some 40 million Europeans with depressive disorders, according to the World Health Organization.)
Rosalind Watts was a young clinical psychologist working for the National Health Service when she read an article about psychedelic therapy in the New Yorker.* The idea that you might actually be able to cure mental illness rather than just manage its symptoms inspired her to write to Robin Carhart-Harris, who hired her to help out with the depression study, the lab’s first foray into clinical research. Watts guided several sessions and then conducted qualitative interviews with all of the volunteers six months after their treatments, hoping to understand exactly how the psychedelic session had affected them.
Watts’s interviews uncovered two “master” themes. The first was that the volunteers depicted their depression foremost as a state of “disconnection,” whether from other people, their earlier selves, their senses and feelings, their core beliefs and spiritual values, or nature. Several referred to living in “a mental prison,” others to being “stuck” in endless circles of rumination they likened to mental “gridlock.” I was reminded of Carhart-Harris’s hypothesis that depression might be the result of an overactive default mode network—the site in the brain where rumination appears to take place.
The Imperial depressives also felt disconnected from their senses. “I would look at orchids,” one told Watts, “and intellectually understand that there was beauty, but not experience it.”
For most of the volunteers, the psilocybin experience had sprung them from their mental jails, if only temporarily. One woman in the study told me that the month following her session was the first time she had been free from depression since 1991. Others described similar experiences:
“It was like a holiday away from the prison of my brain. I felt free, carefree, reenergized.”
“It was like the light switch being turned on in a dark house.”
“You’re not immersed in thought patterns; the concrete coat has come off.”
“It was like when you defrag the hard drive on your computer . . . I thought, ‘My brain is being defragged, how brilliant is that!’”
For many of the volunteers, these changes in the experience of their own minds persisted:
“My mind works differently. I ruminate much less, and my thoughts feel ordered, contextualized.”
Several reported reconnecting to their senses:
“A veil dropped from my eyes, things were suddenly clear, glowing, bright. I looked at plants and felt their beauty. I can still look at my orchids and feel that: that is one thing that has really lasted.”
Some reconnected to themselves:
“I had an experience of tenderness toward myself.”
“At its most basic, I feel like I used to before the depression.”
Others reconnected to other people:
“I was talking to strangers. I had these full long conversations with everybody I came into contact with.”
“I would look at people on the street and think, ‘How interesting we are’—I felt connected to them all.”
And to nature:
“Before, I enjoyed nature; now I feel part of it. Before I was looking at it as a thing, like TV or painting. You’re part of it, there’s no separation or distinction, you are it.”
“I was everybody, unity, one life with 6 billion faces. I was the one asking for love and giving love, I was swimming in the sea, and the sea was me.”
The second master theme was a new access to difficult emotions, emotions that depression often blunts or closes down completely. Watts hypothesizes that the depressed patient’s incessant rumination constricts his or her emotional repertoire. In other cases, the depressive keeps emotions at bay because it is too painful to experience them.
This is especially true in cases of childhood trauma. Watts put me in touch with a thirty-nine-year-old man in the study, a music journalist named Ian Rouiller, who, along with his older sister, had been abused by his father as a child. As adults, the siblings brought charges against their father that put him in jail for several years, but this hadn’t relieved the depression that has trailed Ian for most of his life.
“I can remember the moment when the horrible cloud first came over me. It was in the family room of a pub called the Fighting Cocks in St. Albans. I was ten.” Antidepressants helped for a while, but “putting the plaster over the wound doesn’t heal anything.” On psilocybin, he was able for the first time to confront his lifelong pain—and his father.
“Normally, when Dad comes up in my head, I just push the thought away. But this time I went the other way.” His guide had told him he should “go in and through” any frightening material that arose during his journey.
“So this time I looked him in the eye. That was a really big thing for me, to literally face the demon. And there he was. But he was a horse! A military horse standing on its hind legs, dressed in a military outfit with a helmet, and holding a gun. It was terrifying, and I wanted to push the image aside, but I didn’t. In and through: Instead, I looked the horse in the eyes—and promptly started to laugh, it was so ridiculous.
“That’s when what had been a bad trip really turned. Now I had every sort of emotion, positive, negative, it didn’t matter. I thought about the [Syrian] refugees in Calais and started crying for them, and I saw that every emotion is as valid as any other. You don’t cherry-pick happiness and enjoyment, the so-called good emotions; it was okay to have negative thoughts. That’s life. For me, trying to resist emotions just amplified them. Once I was in this state, it was beautiful—a feeling of deep contentment. I had this overwhelming feeling—it wasn’t even a thought—that everything and everyone needs to be approached with love, including myself.”
Ian enjoyed several months of relief from his depression as well as a new perspective on his life—something no antidepressant had ever given him. “Like Google Earth, I had zoomed out,” he told Watts in his six-month interview. For several weeks after his session, “I was absolutely connected to myself, to every living thing, to the universe.” Eventually, Ian’s overview effect faded, however, and he ended up back on Zoloft.
“The sheen and shine that life and existence had regained immediately after the trial and for several weeks after gradually faded,” he wrote one year later. “The insights I gained during the trial have never left and will never leave me. But they now feel more like ideas,” he says. He says he’s doing better than before and has been able to hold down a job, but his depression has returned. He told me he wishes he could have another psilocybin session at Imperial. Because that’s currently not an option, he’ll sometimes meditate and listen to the playlist from his session. “That really does help put me back in that place.”
More than half of the Imperial volunteers saw the clouds of their depression eventually return, so it seems likely that psychedelic therapy for depression, should it prove useful and be approved, will not be a onetime intervention. But even the temporary respite the volunteers regarded as precious, because it reminded them there was another way to be that was worth working to recapture. Like electroconvulsive therapy for depression, which it in some ways resembles, psychedelic therapy is a shock to the system—a “reboot” or “defragging”—that may need to be repeated every so often. (Assuming the treatment works as well when repeated.) But the potential of the therapy has regulators and researchers and much of the mental health community feeling hopeful.
“I believe this could revolutionize mental health care,” Watts told me. Her conviction is shared by every other psychedelic researcher I interviewed.
“IF MANY REMEDIES are prescribed for an illness,” wrote Anton Chekhov, who was a physician as well as a writer, “you may be certain that the illness has no cure.” But what about the reverse of Chekhov’s statement? What are we to make of a single remedy being prescribed for a great many illnesses? How could it be that psychedelic therapy might be helpful for disorders as different as depression, addiction, the anxiety of the cancer patient, not to mention obsessive-compulsive disorder (about which there has been one encouraging study) and eating disorders (which Hopkins now plans to study)?
We shouldn’t forget that irrational exuberance has afflicted psychedelic research since the beginning, and the belief that these molecules are a panacea for whatever ails us is at least as old as Timothy Leary. It could well be that the current enthusiasm will eventually give way to a more modest assessment of their potential. New treatments always look shiniest and most promising at the beginning. In early studies with small samples, the researchers, who are usually biased in favor of finding an effect, have the luxury of selecting the volunteers most likely to respond. Because their number is so small, these volunteers benefit from the care and attention of exceptionally well-trained and dedicated therapists, who are also biased in favor of success. Also, the placebo effect is usually strongest in a new medicine and tends to fade over time, as observed in the case of antidepressants; they don’t work nearly as well today as they did upon their introduction in the 1980s. None of these psychedelic therapies have yet proven themselves to work in large populations; what successes have been reported should be taken as promising signals standing out from the noise of data, rather than as definitive proofs of cure.
Yet the fact that psychedelics have produced such a signal across a range of indications can be interpreted in a more positive light. When a single remedy is prescribed for a great many illnesses, to paraphrase Chekhov, it could mean those illnesses are more alike than we’re accustomed to think. If a therapy contains an implicit theory of the disorder it purports to remedy, what might the fact that psychedelic therapy seems to address so many indications have to tell us about what those disorders might have in common? And about mental illness in general?
I put this question to Tom Insel, the former head of the National Institute of Mental Health. “It doesn’t surprise me at all” that the same treatment should show promise for so many indications. He points out that the DSM—the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition—draws somewhat arbitrary lines between mental disorders, lines that shift with each new edition.
“The DSM categories we have don’t reflect reality,” Insel said; they exist for the convenience of the insurance industry as much as anything else. “There’s much more of a continuum between these disorders than the DSM recognizes.” He points to the fact that SSRIs, when they work, are useful for treating a range of conditions besides depression, including anxiety and obsessive-compulsive disorder, suggesting the existence of some common underlying mechanism.
Andrew Solomon, in his book The Noonday Demon: An Atlas of Depression, traces the links between addiction and depression, which frequently co-occur, as well as the intimate relationship between depression and anxiety. He quotes an expert on anxiety who suggests we should think of the two disorders as “fraternal twins”: “Depression is a response to past loss, and anxiety is a response to future loss.” Both reflect a mind mired in rumination, one dwelling on the past, the other worrying about the future. What mainly distinguishes the two disorders is their tense.
A handful of researchers in the mental health field seem to be groping toward a grand unified theory of mental illness, though they would not be so arrogant as to call it that. David Kessler, the physician and former head of the FDA, recently published a book called Capture: Unraveling the Mystery of Mental Suffering that makes the case for such an approach. “Capture” is his term for the common mechanism underlying addiction, depression, anxiety, mania, and obsession; in his view, all these disorders involve learned habits of negative thinking and behavior that hijack our attention and trap us in loops of self-reflection. “What started as a pleasure becomes a need; what was once a bad mood becomes continuous self-indictment; what was once an annoyance becomes persecution,” in a process he describes as a form of “inverse learning.” “Every time we respond [to a stimulus], we strengthen the neural circuitry that prompts us to repeat” the same destructive thoughts or behaviors.
Could it be that the science of psychedelics has a contribution to make to the development of a grand unified theory of mental illness—or at least of some mental illnesses? Most of the researchers in the field—from Robin Carhart-Harris to Roland Griffiths, Matthew Johnson, and Jeffrey Guss—have become convinced that psychedelics operate on some higher-order mechanisms in the brain and mind, mechanisms that may underlie, and help explain, a wide variety of mental and behavioral disorders, as well as, perhaps, garden-variety unhappiness.
It could be as straightforward as the notion of a “mental reboot”—Matt Johnson’s biological control-alt-delete key—that jolts the brain out of destructive patterns (such as Kessler’s “capture”), affording an opportunity for new patterns to take root. It could be that, as Franz Vollenweider has hypothesized, psychedelics enhance neuroplasticity. The myriad new connections that spring up in the brain during the psychedelic experience, as mapped by the neuroimaging done at Imperial College, and the disintegration of well-traveled old connections, may serve simply to “shake the snow globe,” in Robin Carhart-Harris’s phrase, a predicate for establishing new pathways.
Mendel Kaelen, a Dutch postdoc in the Imperial lab, proposes a more extended snow metaphor: “Think of the brain as a hill covered in snow, and thoughts as sleds gliding down that hill. As one sled after another goes down the hill, a small number of main trails will appear in the snow. And every time a new sled goes down, it will be drawn into the preexisting trails, almost like a magnet.” Those main trails represent the most well-traveled neural connections in your brain, many of them passing through the default mode network. “In time, it becomes more and more difficult to glide down the hill on any other path or in a different direction.
“Think of psychedelics as temporarily flattening the snow. The deeply worn trails disappear, and suddenly the sled can go in other directions, exploring new landscapes and, literally, creating new pathways.” When the snow is freshest, the mind is most impressionable, and the slightest nudge—whether from a song or an intention or a therapist’s suggestion—can powerfully influence its future course.
Robin Carhart-Harris’s theory of the entropic brain represents a promising elaboration on this general idea, and a first stab at a unified theory of mental illness that helps explain all three of the disorders we’ve examined in these pages. A happy brain is a supple and flexible brain, he believes; depression, anxiety, obsession, and the cravings of addiction are how it feels to have a brain that has become excessively rigid or fixed in its pathways and linkages—a brain with more order than is good for it. On the spectrum he lays out (in his entropic brain article) ranging from excessive order to excessive entropy, depression, addiction, and disorders of obsession all fall on the too-much-order end. (Psychosis is on the entropy end of the spectrum, which is why it probably doesn’t respond to psychedelic therapy.)
The therapeutic value of psychedelics, in Carhart-Harris’s view, lies in their ability to temporarily elevate entropy in the inflexible brain, jolting the system out of its default patterns. Carhart-Harris uses the metaphor of annealing from metallurgy: psychedelics introduce energy into the system, giving it the flexibility necessary for it to bend and so change. The Hopkins researchers use a similar metaphor to make the same point: psychedelic therapy creates an interval of maximum plasticity in which, with proper guidance, new patterns of thought and behavior can be learned.
All these metaphors for brain activity are just that—metaphors—and not the thing itself. Yet the neuroimaging of tripping brains that’s been done at Imperial College (and that has since been replicated in several other labs using not only psilocybin but also LSD and ayahuasca) has identified measurable changes in the brain that lend credence to these metaphors. In particular, the changes in activity and connectivity in the default mode network on psychedelics suggest it may be possible to link the felt experience of certain types of mental suffering with something observable—and alterable—in the brain. If the default mode network does what neuroscientists think it does, then an intervention that targets that network has the potential to help relieve several forms of mental illness, including the handful of disorders psychedelic researchers have trialed so far.
So many of the volunteers I spoke to, whether among the dying, the addicted, or the depressed, described feeling mentally “stuck,” captured in ruminative loops they felt powerless to break. They talked about “prisons of the self,” spirals of obsessive introspection that wall them off from other people, nature, their earlier selves, and the present moment. All these thoughts and feelings may be the products of an overactive default mode network, that tightly linked set of brain structures implicated in rumination, self-referential thought, and metacognition—thinking about thinking. It stands to reason that by quieting the brain network responsible for thinking about ourselves, and thinking about thinking about ourselves, we might be able to jump that track, or erase it from the snow.
The default mode network appears to be the seat not only of the ego, or self, but of the mental faculty of time travel as well. The two are of course closely related: without the ability to remember our past and imagine a future, the notion of a coherent self could hardly be said to exist; we define ourselves with reference to our personal history and future objectives. (As meditators eventually discover, if we can manage to stop thinking about the past or future and sink into the present, the self seems to disappear.) Mental time travel is constantly taking us off the frontier of the present moment. This can be highly adaptive; it allows us to learn from the past and plan for the future. But when time travel turns obsessive, it fosters the backward-looking gaze of depression and the forward pitch of anxiety. Addiction, too, seems to involve uncontrollable time travel. The addict uses his habit to organize time: When was the last hit, and when can I get the next?
To say the default mode network is the seat of the self is not a simple proposition, especially when you consider that the self may not be exactly real. Yet we can say there is a set of mental operations, time travel among them, that are associated with the self. Think of it simply as the locus of this particular set of mental activities, many of which appear to have their home in the structures of the default mode network.
Another type of mental activity that neuroimaging has located in the DMN (and specifically in the posterior cingulate cortex) is the work performed by the so-called autobiographical or experiential self: the mental operation responsible for the narratives that link our first person to the world, and so help define us. “This is who I am.” “I don’t deserve to be loved.” “I’m the kind of person without the willpower to break this addiction.” Getting overly attached to these narratives, taking them as fixed truths about ourselves rather than as stories subject to revision, contributes mightily to addiction, depression, and anxiety. Psychedelic therapy seems to weaken the grip of these narratives, perhaps by temporarily disintegrating the parts of the default mode network where they operate.
And then there is the ego, perhaps the most formidable creation of the default mode network, which strives to defend us from threats both internal and external. When all is working as it should be, the ego keeps the organism on track, helping it to realize its goals and provide for its needs, notably for survival and reproduction. It gets the job done. But it is also fundamentally conservative. “The ego keeps us in our grooves,” as Matt Johnson puts it. For better and, sometimes, for worse. For occasionally the ego can become tyrannical and turn its formidable powers on the rest of us.* Perhaps this is the link between the various forms of mental illness that psychedelic therapy seems to help most: all involve a disordered ego—overbearing, punishing, or misdirected.*
In a college commencement address he delivered three years before his suicide, David Foster Wallace asked his audience to “think of the old cliché about ‘the mind being an excellent servant but a terrible master.’ This, like many clichés, so lame and unexciting on the surface, actually expresses a great and terrible truth,” he said.
“It is not the least bit coincidental that adults who commit suicide with firearms almost always shoot themselves in the head. They shoot the terrible master.”
OF ALL THE PHENOMENOLOGICAL EFFECTS that people on psychedelics report, the dissolution of the ego seems to me by far the most important and the most therapeutic. I found little consensus on terminology among the researchers I interviewed, but when I unpack their metaphors and vocabularies—whether spiritual, humanistic, psychoanalytic, or neurological—it is finally the loss of ego or self (what Jung called “psychic death”) they’re suggesting is the key psychological driver of the experience. It is this that gives us the mystical experience, the death rehearsal process, the overview effect, the notion of a mental reboot, the making of new meanings, and the experience of awe.
Consider the case of the mystical experience: the sense of transcendence, sacredness, unitive consciousness, infinitude, and blissfulness people report can all be explained as what it can feel like to a mind when its sense of being, or having, a separate self is suddenly no more.
Is it any wonder we would feel one with the universe when the boundaries between self and world that the ego patrols suddenly fall away? Because we are meaning-making creatures, our minds strive to come up with new stories to explain what is happening to them during the experience. Some of these stories are bound to be supernatural or “spiritual,” if only because the phenomena are so extraordinary they can’t be easily explained in terms of our usual conceptual categories. The predictive brain is getting so many error signals that it is forced to develop extravagant new interpretations of an experience that transcends its capacity for understanding.
Whether the most magnificent of these stories represent a regression to magical thinking, as Freud believed, or access to transpersonal realms such as the “Mind at Large,” as Huxley believed, is itself a matter of interpretation. Who can say for certain? Yet it seems to me very likely that losing or shrinking the self would make anyone feel more “spiritual,” however you choose to define the word, and that this is apt to make one feel better.
The usual antonym for the word “spiritual” is “material.” That at least is what I believed when I began this inquiry—that the whole issue with spirituality turned on a question of metaphysics. Now I’m inclined to think a much better and certainly more useful antonym for “spiritual” might be “egotistical.” Self and Spirit define the opposite ends of a spectrum, but that spectrum needn’t reach clear to the heavens to have meaning for us. It can stay right here on earth. When the ego dissolves, so does a bounded conception not only of our self but of our self-interest. What emerges in its place is invariably a broader, more openhearted and altruistic—that is, more spiritual—idea of what matters in life. One in which a new sense of connection, or love, however defined, seems to figure prominently.
“The psychedelic journey may not give you what you want,” as more than one guide memorably warned me, “but it will give you what you need.” I guess that’s been true for me. It might have been nothing like the one I signed up for, but I can see now that the journey has been a spiritual education after all.
I got the opportunity—a non-pharmacological opportunity—to peer into my own default mode network soon after I interviewed Judson Brewer, the psychiatrist and neuroscientist who studies the brains of meditators. It was Brewer, you’ll recall, who discovered that the brains of experienced meditators look much like the brains of people on psilocybin: the practice and the medicine both dramatically reduce activity in the default mode network.
Brewer invited me to visit his lab at the Center for Mindfulness at the University of Massachusetts medical school in Worcester to run some experiments on my own default mode network. His lab has developed a neural feedback tool that allows researchers (and their volunteers) to observe in real time the activity in one of the key brain structures in the default mode network: the posterior cingulate cortex.
Until now I have tried to spare you the names and functions of specific parts of brain anatomy, but I do need to describe this one in a bit more detail. The posterior cingulate cortex is a centrally located node within the default mode network involved in self-referential mental processes. Situated in the middle of the brain, it links the prefrontal cortex—site of our executive function, where we plan and exercise will—with the centers of memory and emotion in the hippocampus. The PCC is believed to be the locus of the experiential or narrative self; it appears to generate the narratives that link what happens to us to our abiding sense of who we are. Brewer believes that this particular operation, when it goes awry, is at the root of several forms of mental suffering, including addiction.
As Brewer explains it, activity in the PCC is correlated not so much with our thoughts and feelings as with “how we relate to our thoughts and feelings.” It is where we get “caught up in the push and pull of our experience.” (This has particular relevance for the addict: “It’s one thing to have cravings,” as Brewer points out, “but quite another to get caught up in your cravings.”) When we take something that happens to us personally? That’s the PCC doing its (egotistical) thing. To hear Brewer describe it is to suspect neuroscience might have at last found the address for the “But enough about you” center of the brain.
Buddhists believe that attachment is at the root of all forms of mental suffering; if the neuroscience is right, a lot of these attachments have their mooring in the PCC, where they are nurtured and sustained. Brewer thinks that by diminishing its activity, whether by means of meditation or psychedelics, we can learn “to be with our thoughts and cravings without getting caught up in them.” Achieving such a detachment from our thoughts, feelings, and desires is what Buddhism (along with several other wisdom traditions) teaches is the surest path out of human suffering.
Brewer took me into a small, darkened room where a comfortable chair faced a computer monitor. One of his laboratory assistants brought in the contraption: a red rubber bathing cap with 128 sensors arrayed in a dense grid across every centimeter of its surface. Each of the sensors was linked to a cable. After the assistant carefully fitted the cap onto my skull, she squirted a dab of conductive gel beneath each of the 128 electrodes to ensure the faint electrical signals emanating from deep within my brain could readily traverse my scalp. Brewer took a picture of me on my phone: I had sprouted a goofy tangle of high-tech dreadlocks.
To calibrate a baseline level of activity for my PCC, Brewer projected a series of adjectives on the screen—“courageous,” “cheap,” “patriotic,” “impulsive,” and so on. Simply reading the list does nothing to activate the PCC, which is why he told me now to think about how these adjectives either applied or didn’t apply to me. Take it personally, in other words. This is precisely the thought process that the PCC exists to perform, relating thoughts and experiences to our sense of who we are.
Once he had established a baseline, Brewer, from another room, led me through a series of exercises to see if I could alter the activity of my PCC by thinking different kinds of thoughts. At the completion of each “run”—lasting a few minutes—he would project a bar graph on the screen in front of me; the length of each bar indicates to what extent the activity in my PCC had exceeded or dropped below baseline, in ten-second increments. I could also follow the ups and downs of my PCC activity by listening to rising and falling tones on a monitor, but I found that too distracting.
I began by trying to meditate, something I’d gotten into the habit of doing early in my foray into the science and practice of psychedelic consciousness. A brief daily meditation had become a way for me to stay in touch with the kind of thinking I’d done on psychedelics. I discovered my trips had made it easier for me to drop into a mentally quiet place, something that in the past had always eluded me. So I closed my eyes and began to follow my breath. I had never tried to meditate in front of other people, and it felt awkward, but when Brewer put the graph up on the screen, I could see that I had succeeded in quieting my PCC—not by a lot, but most of the bars dipped below baseline. Yet the graph was somewhat jagged, with several bars leaping above baseline. Brewer explained that this is what happens when you’re trying too hard to meditate and become conscious of the effort. There it was in black and white: the graph of my effortfulness and self-criticism.
Next Brewer asked me to do a “loving-kindness” meditation. This is one where you’re supposed to close your eyes and think warm and charitable thoughts about people: first yourself, then those closest to you, and finally people you don’t know—humanity at large. The bars dropped smartly below baseline, deeper than before: I was good at this! (A self-congratulatory thought that no doubt shot a bar skyward.)
For the next and last run, I told Brewer I had an idea for a mental exercise I wanted to try but didn’t want to tell him what it was until afterward. I closed my eyes and tried to summon scenes from my psychedelic journeys. The one that came to mind first was an image of a pastoral landscape, a gently rolling quilt of field and forest and pond, directly above which hovered some kind of gigantic rectangular frame made of steel. The structure, which was a few stories tall but hollow, resembled a pylon for electrical transmission lines or something a kid might build from an Erector set—a favorite toy of my childhood. Anyway, by the odd logic of psychedelic experience, it was clear to me even in the moment that this structure represented my ego, and the landscape above which it loomed was, I presumed, the rest of me.
The description makes it sound as though the structure were menacing, hovering overhead like a UFO, but in fact the emotional tone of the image was mostly benign. The structure had revealed itself as empty and superfluous and had lost its purchase on the ground—on me. The scene had given me a kind of overview effect: behold your ego, sturdy, gray, empty, and floating free, like an untethered pylon. Consider how much more beautiful the scene would be were it not in the way. The phrase “child’s play” looped in my mind: the structure was nothing more than a toy that a child could assemble and disassemble at will. During the trip the structure continued to loom, casting an intricate shadow over the scene, but now in my recollection I could picture it drifting off, leaving me . . . to be.
Who knows what kinds of electrical signals were leaking from my default mode network during this reverie, or for that matter what the image symbolized. You’ve read this chapter: obviously, I’ve been giving a lot of thought to the ego and its discontents. Here was some of that thinking rendered starkly visible. I had succeeded in detaching myself from my ego, at least imaginatively, something I would never have thought possible before psychedelics. Aren’t we identical with our ego? What’s left of us without it? The lesson of both psychedelics and meditation is the same: No! on the first count, and More than enough on the second. Including this lovely landscape of the mind, which became lovelier still when I let that ridiculous steel structure float away, taking its shadow with it.
A beep indicated the run was over. Brewer’s voice came on the loudspeaker: “What in the world were you thinking?” Apparently, I’d dropped way below baseline. I told him, in general terms. He sounded excited by the idea that the mere recollection of a psychedelic experience might somehow replicate what happens in the brain during the real thing. Maybe that’s what was going on. Or maybe it was the specific content of the image, and the mere thought of bidding adieu to my ego, watching it float away like a hot-air balloon, that had the power to silence my default mode network.
Brewer started spouting hypotheses. Which is really all that science can offer us at this point: hunches, theories, so many more experiments to try. We have plenty of clues, and more now than before the renaissance of psychedelic science, but we remain a long way from understanding exactly what happens to consciousness when we alter it, either with a molecule or with meditation. Yet gazing at the bars on the graph before me, these crude hieroglyphs of psychedelic thought, I felt as if I were standing on the edge of a wide-open frontier, squinting to make out something wondrous.