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Psilocybin at the End of Life: A Doorway to Peace

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There exists an experience you can (probably) have, in a single day, that may lastingly improve your outlook on life, even if you’re in fear because the end of your life is near.  Researchers are once again using psilocybin to occasion such experiences in patients facing life-threatening illness.

Steve Ross, a psychiatrist at NYU, has written a wonderful article about it:  Psilocybin at the End of Life: A Doorway to Peace.  You may be curious to compare Ross’s contemporary snapshot with a lecture given at Harvard Divinity School by Walter Pahnke in 1968, The Psychedelic Mystical Experience and the Human Encounter with Death.

In the intervening four decades, some things have changed, presumably for the better – for example, it is no longer routine to withhold frank ‘c-word’ diagnoses and prognoses from patients.  As for making use of the potential of mystical-type experience (aka non-dual consciousness, primary religious experience) to ease a patient’s psychological distress, Rip Van Winkle’s slumber is into double overtime.

If you know of anyone who may want to participate in a study of psilocybin with cancer patients, two are now open:  the Ross team’s at NYU and a study at Johns Hopkins in Baltimore.  For the latter, need-based partial grants are available to help out-of-town volunteers with travel expenses.

 

Psilocybin and personality change

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My colleagues at Johns Hopkins have a new paper out, reporting that psilocybin, the “magic mushroom” chemical, can bring about significant and lasting changes in a key aspect of personality. This is big news for academic psychology:

A large body of evidence, including longitudinal analyses of personality change, suggests that core personality traits are predominantly stable after age 30. To our knowledge, no study has demonstrated changes in personality in healthy adults after an experimentally manipulated discrete event. Intriguingly, double-blind controlled studies have shown that the classic hallucinogen psilocybin occasions personally and spiritually significant mystical experiences that predict long-term changes in behaviors, attitudes and values. In the present report we assessed the effect of psilocybin on changes in the five broad domains of personality – Neuroticism, Extroversion, Openness, Agreeableness, and Conscientiousness. Consistent with participant claims of hallucinogen-occasioned increases in aesthetic appreciation, imagination, and creativity, we found significant increases in Openness following a high-dose psilocybin session. In participants who had mystical experiences during their psilocybin session, Openness remained significantly higher than baseline more than 1 year after the session.  [from the report’s abstract]

The five domains named above constitute the widely embraced Five Factor Model of personality.  Openness, the factor showing increases in the Hopkins studies, is described as curiosity, creativity, openness to unusual ideas, openness to emotion, openness to adventure, appreciation for art, and variety of experience.  Its poles are described as ”inventive/curious vs. consistent/cautious.”

Surely there can be too much of a good thing: so “open” as to be awash in fantasy, for example, or continually overwhelmed by emotion.  But for more than a few of us, doesn’t a judicious increase in Openness sound appealing?

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Prejudice over Evidence? Clouded thinking about psilocybin

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ABC News ran an article on the recent Johns Hopkins psilocybin findings.  It ends with this doozy of a quote from Dr. Daniel Angres, associate professor of psychiatry at Rush University Medical Center, who argued the use of psilocybin is “too risky”:

“Character can and will deteriorate with the use of substances that have abuse potential over the long run,” he said, “even though initially there may sometimes seem to be ‘positive personality adaptations.’”

Excuse me?  Where is the evidence that psilocybin has “abuse potential over the long run” – if by that the professor means compulsive use – or that psilocybin “can and will” lead to character deterioration?  Can Dr. Angres point to a single peer-reviewed study supporting his statement as applied to psilocybin, or to any of the classical hallucinogens?

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Mushroom Myth-conceptions, Part 2

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Earlier, I posted some of the key findings of the Johns Hopkins psilocybin experiments and a condensation of the concerns and criticisms the research has drawn. I promised responses to some of those concerns; this is the first in that series.

Concern/criticism:  “What’s the big deal?  I took mushrooms, and my experience was neither ‘spiritual’ nor life-changing.”

This of course proves that not all hallucinogen experiences are profound, but not that none is.*

Why are some hallucinogen experiences recalled as life-transforming and others as trivial?  Likely because the trivial experiences involved a suboptimal dosage, ill-focused intentions, a suboptimal setting, or the wrong person. Or because even when all those things are right, any given experience may not be profound. But the research shows that well-screened and well-prepared people given a sufficient dose under good circumstances have a two-thirds or better chance of a profound experience, and a very small risk of real harm.
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Mushroom Myth-conceptions

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Last month’s report on a Johns Hopkins study of psilocybin and spirituality, of which I’m a co-author, has drawn numerous comments on blogs and on-line news articles.  A fraction of those comments have raised questions or criticisms which I’d like to try to address.  (On the RBC, see Mark’s posts and Andy’s critique.)

For those who think that substances such as psilocybin have something valuable to offer spiritual seekers, myself included, it may be helpful to reflect upon the concerns of people less invested in the subject (“disinterested,” even).  At the same time, the exercise could help clear up misunderstandings of the research or its implications.

Here’s a condensation of the issues I’ve heard raised.  I will be taking them up one at a time in forthcoming posts.  If you’re aware of other issues, feel free to add them as comments to this post.

1.  “I took mushrooms, and my experience was neither ‘spiritual’ nor life-changing.  So what’s the big deal?” (response)

2.  The studies used volunteers with a spiritual orientation, so of course they reported spiritual experiences, and so the studies prove nothing.

3.  Hallucinogens cause hallucinations; hallucinations cannot be a source of learning, healing, or betterment.

4.  Psilocybin may cause people to adopt untrue beliefs (e.g., about the nature of ultimate reality).

5.  The substance may harm some people or cause them to harm themselves or others.

6.  An enlightening experience doesn’t necessarily lead to an enlightened life.

For a refresher on the research findings, continue reading beneath the fold.

(And many thanks to Mark and to Keith for welcoming me to the RBC.)

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New RBC poster: Bob Jesse

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In the next day or so, I hope to see the first post by our newest collaborator, Bob Jesse. He’s one of the smartest, sanest, most decent, most focused people I’ve ever known.

Back in 1994, he left Oracle (where he had been a VP for business development; he’s an electrical engineer by training) to organize the Council on Spiritual Practices, which identifies itself as “a collaboration among spiritual guides, experts in the behavioral and biomedical sciences, and scholars of religion, dedicated to making direct experience of the sacred more available to more people.”

CSP, and Bob in particular, helped design, staff, and support the Hopkins psilocybin research that will be the focus of his first few posts.

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Mysticism in the lab

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[Inadvertently posted as "admin"; I'm leaving it this way because there's already a comment thread. MK]

Roland Griffiths and his colleagues at Hopkins have been studying what happens when you take a screened group of people with spiritual interests who have never taken any of the hallucinogenic (aka psychedelic, aka entheogenic) drugs and give them a few hours of preparation followed by a supervised experience with psilocybin, the active agent in “magic” mushrooms.

Earlier papers by the team showed that:

•About two-thirds of the volunteers had experiences that met pre-established criteria for major mystical events;
• About the same fraction later recalled the experience as “one of the five most spiritually meaningful” of a lifetime (with more than a third reporting “the most meaningful”);
• No one suffered any lasting damage, though some had a rough ride during the session; and
• Most of the participants thought the process had lasting benefits for their mood and behavior, and those opinions were supported by family members and friends.

A new study out today (again, in the journal Psychophamacology) tries to zero in on a dose large enough to give a good chance at a major experience but small enough to limit the risk of major stress. They seem to have succeeded; at the second-highest dose, two-thirds of the subjects had a profound experience and only one out of eighteen had intense side-effects. Again, the benefits of the process seem to be lasting.

The latest results have attracted a decent amount of attention: long, serious stories by Zachary Roth at Yahoo (whose story has drawn 34,000 Facebook links) and Maia Szalavitz at Time and shorter but quite high-quality pieces by Rachel Rettner at MS-NBC and Cassi Feldman at CBS.

What is strikingly about all four mainstream-media accounts is that they focus on health benefits. That reflects, I think, the mindset – also reflected in the drug laws – that drug-taking is either medical or “drug abuse,” with no third possibility. (Kevin Drum isn’t wearing the same blinders; his analysis is well worth reading, especially because he actually digs down into the data. Andrew Sullivan reports on his own experience, from a mystical rather than a medical viewpoint.)

There are really two different questions here: whether psilocybin and related materials can be used with reasonable risk and a good chance of success to produce psychological states that resemble classical mystical experiences, and whether they can be made safe and effective to treat diseases or relieve symptoms. The answers to those questions need not be the same.

The current study has nothing directly to say about therapeutic uses. It was designed to shed light on whether psilocybin can produce potentially life-changing experiences, and whether it can do so without undue risk. The answers seem to be yes and yes: again, for screened, prepared, and supervised volunteers.

Among the results of having a subjective glimpse of the Nameless might indeed be improved mental or physical health, reduced fear of dying among those with terminal illness, and positive behavior change such as giving up smoking. (The Hopkins team has a smoking study underway.) All of that would be good news, if true.

But, as C.S. Lewis remarks of claims that religion makes better citizens, there’s something very odd about asking whether the Staircase to Heaven can be used as a short-cut to the drugstore grocery store. What’s potentially at stake here is the availability to large numbers of people to experiences and insights historically limited to a tiny minority, and often deliberately protected by walls of esoteric practice.

Imagine that it were true, and known to be true, that many or even most adults could go through the sort of process the Hopkins volunteers went through and get where most of the Hopkins volunteers got. We’re not there yet, but imagine that additional research were to nail that down.

Now imagine going to a person with some spiritual interest - not a saint, but l’homme moyen spituel - and telling him, “For about the time and effort you would invest in a week in Cancun, you’d have a good chance of seeing something like the Beatific Vision. And when you were finished, you might well not be afraid to die.”

How many people would take you up on that offer? Would the laws allow it? Should they allow it?
What would be the impact, if the reported positive behavior changes also turned out to be real? We might witness, within a few years, the fulfillment of Moses’s prayer: “Would that all my people were prophets!” People unafraid to die might act differently than the currently accepted norm.

Just how much enlightenment can our current social order absorb? We may be on the road to find out.

[Updated to remove an ambiguity; when Lewis said “drugstore” (he actually said “chemist’s shop”) he was talking about the tendency to overvalue the immediately practical impacts of spiritual experience over the experience itself; as he wasn’t talking about entheogens at all, the word “drug” adds a confusion not present in the original passage.]

Research into the benefits of hallucinogens

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Among the great tragedies of the culture wars that got started in the 1960s was the loss of the potential benefits of carefully-used hallucinogens: to stretch psychic horizons, to improve creative performance, to worship (or to attempt to encounter something worth worshipping), to help the dying confront the end, and to treat mental illness. Mechanisms, techniques, benefits, and risks all remain imperfectly understood, but there is overwhelming evidence that the materials can be safely used under appropriate supervision and that they sometimes deliver impressive rewards.

One of the remaining overhangs from the 1960s is the inability of most of the mass media to discuss the issue without reference to Tim Leary. The headline-writer for the New York Times op-ed page couldn’t resist assigning “Hallucinogens Have Doctors Tuning In Again” to John Tierney’s calm and well-reported piece on some of the latest advances in the field. The piece itself carefully abstains from the use of the term “psychedelic,” with all its paisley-and-Day-Glo associations.

Robert Jesse, the research entrepreneur behind the Hopkins psilocybin work reported in Tierney’s piece, doesn’t get mentioned. That reflects Bob’s operating style; the phrase “a passion for anonymity” might have been written with him in mind.

Tierney notes that federal funding for this line of research is scarce. One strong example comes from an issue Tierney doesn’t mention: the use of MDMA to treat Post-Traumatic Stress Disorder. The preliminary results of that research are so encouraging, and the outcomes of conventional treatments for chronic PTSD so poor, that you might expect the VA hospital system to be eagerly looking into it. No doubt it would, if the therapy didn’t involve a popular recreational drug. As it is, the fear of headlines and hearings linking the VA to raves will guarantee that veterans with PTSD will continue to wait and suffer until privately-funded research has established safety and efficacy beyond doubt.

In some ways, the psycotherapeutic uses of the true hallucinogens (and of MDMA, which is a member of a related but distinct drug class) pose the easiest problem from a regulatory perspective. If two well-controlled large-scale trials show safety and efficacy for the treatment of some disorder, the Food and Drug Administration will approve a New Drug Application, which automatically* moves a drug from Controlled Substances Act Schedule I - which means a complete ban for other than research purposes - to Schedule II, available by prescription. (This is simple, of course, only in theory: there’s tens of millions of dollars’ worth of activity concealed in that sentence, and the political backlash were FDA to consider approving and down-scheduling LSD, for example, can only be imagined.)

On the worship side, the courts are now in the process of ruling that any extant religion which uses an otherwise-banned drug in its rituals may lawfully do so, as long as the practice is reasonably safe and the drug doesn’t “leak” into non-ritual use. But that process still involves church-by-church litigation, and individual seekers after the Beatific Vision have no legal protection.

As for the apparent value of low-dose hallucinogens to enhance creative performance, or their use in higher doses for personal exploration without an explicitly “religious” label, right now we don’t even have regulatory frameworks in place that would allow some agency to consider those claims. At some point, there is going to have to be a reconsideration of the drug-regulation process to deal with drugs designed to enhance normal functioning rather than to treat diseases or deficits.

If it seems to you - as it does to me - that the revival of this work is of historic importance, you might want to take a look at the website of the Council on Spiritual Practices, the group Bob Jesse set up to support work on the ritual/religious/spiritual applications of the hallucinogens. Contributions to support the work of CSP are being accepted by the San Francisco Foundation:

The San Francisco Foundation, CSP Fund
225 Bush Street, Suite 500
San Francisco, CA 94104

* Update A friend closer than I am to this process points out that downscheduling is “automatic” only in theory. FDA approval means that a drug has, by definition, accepted medical use, which in turn means that it no longer meets the criteria for Schedule I: abuse potential and no accepted medical use. The actual process of rescheduling can grind slowly.

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Not just a flash in the pan

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Fourteen months after receiving a single dose of psilocybin in a Johns Hopkins University laboratory, more than six out of ten of the participants report lasting benefit in the form of an increased sense of well-being and improved behavior. Two-thirds recall the experience as one of the five most meaningful in their entire lives.

If:

(1) A good chance of experiencing a full-blown mystical experience is available for a few hours’ preparation and a day’s supervised exposure to the active agent in mushrooms that grow wild in many parts of the country; and

(2) Having such an experience has a good chance of generating lasting benefits and

(3) supervised exposure by screened participants is physically and psychologically safe;

then the case for keeping that process illicit by forbidding possession of the mushrooms seems hard to make out. And making what is undoubtedly a religious experience unavailable by law does not seem to fit well with either the Free Exercise Clause or the international human-rights treaties.

Links to the follow-up and the original paper are available on the website of the Council on Spiritual Practices. The same research team is now recruiting volunteers for a study of whether such experiences can relieve anxiety in cancer patients.

Mushrooms and mystical experience

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There’s now good scientific support for the claim that psilocybin, the active agent in “magic” mushrooms, has a better-than-even chance of generating a full-blown mystical experience in properly selected and prepared subjects.

Now what?

Here’s the backgroud:

Last summer, there appeared in the profoundly respectable journal Psychopharmacology a most unusual paper, written by a team at Johns Hopkins Medical School led by the profoundly respectable Roland Griffiths, Professor of Neuroscience and Psychiatry, who spends most of his time studying the effects of caffeine. (They’re bigger than you thought they were. The technical term for that headache you have until you have your morning cup of coffee is “withdrawal syndrome.”)

The paper is called “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance.” (Psilocybin is one of the long-known hallucinogens, being the active agent in “magic” or “sacred” mushrooms.)

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